Arthritis Flashcards
Osteoarthrtiis
Progressive, irreversibel condition involving loss of articular cartilage, causing pain and deformity
involves weight bearing joints mainly
assocaited with age, obesity, and trauma
mechanical wear and tear
histological changes not only associated with age.
Osteoarthitis symptoms
stiffness, pain, deformity
worse at end of day
osteoarthritis exam
heberden’s nodes at DIP and bouchard’s nodes (PIP) in hand
painful, decreased ROM
Osteoarthritis X rays
loss of joint space
sclerosis
subchondral cysts
osteophytes
subchondral cysts (pothole on the raod to knee)
Osteoarthritis TX
Weight loss
PT (exercise can help strengthen the muscles)
Braces but may be uncomfortable
glucosamine/chondroitin (has some placebo effect)
NSAIDS
CYMBALTA (antidepressant may help change the perception of pain)
steroid injection
viscosupplementation (injection to site to help lubricate)
arthroscopic debridement
joint replacement (last possible move because the joints will last maybe 10 to 20 years.)
Rheumatoid arthritis
Systemic autoimmune disorder with inflammatory synovitis that destroys cartilage
F > M, 50s
symmetrical distribution of joints
Criteria of rheumatoid arthritis
morning stiffness 1 hour
arthritis of 3 + joints for 6 weeks
systemic arthritis for 6 week
rhematoid nodules
+RF factor (80%)
Radiographic changes
malaise, fatigue, tenosynovitis, CTS, vasculitis, keratoconjunctivitis sicca, pulmonary nodules, inflammatory pericarditis
Rheumatoid arthritis exam
joint contractures, effusions, deformity
ulnar deviation of the hands
PIP and MCP nodules and inflammation
Bogginess of the joints
Rheumatoid arthritis test
RF (IgM antibodies against teh Fe portion of IgG) HLDA-DR4
ESR and CRP elevated
RA x ray
bony erosion, joint space loss
C 1-2 instability
RA TX
NSAIDS
steroids
DMARDS: hydroxychloroquine, methotrexate, gold, embrel
surgery
Septic arthritis
infection in the join
most common in kdis from hematogenous spread
adults are often immuno compromised
metalloproteases cause permanent destruction in about 8012 hours
Septic arthritis SX
acute illness, fever, tachycardia
pain with ROM of join
Septic arthritis exam
look for source
slight flex to join
passive ROM is very painful
Septic arthritis Labs
elevated or normal WVC
elevated ESR, CRP
Blood culture
X rays normal in acute setting
joint aspirate = >50000 WVC/mm3
Septic arthrits common bugs
neonate: Staph A, GBS
<5: Staph A, GAS, Hflu, strep pneumo
> 5 to
Septic arthritis TX
surgical washout and antibiotics
Seronegative spondyloarthropathies: ankylosing spondylitis
1 in 2000 persons
SI joints, spine, stiff joints
HLA-b27 + and RF-
Uveitis, carditis, enthesitis
Seronegative spondyloarthropathies: Reiter disease
After urethritis, cervicitis, or dysentry
reactive arthritis 2-8 weeks after infection
enthesitis, dactilitis, sacroiliitis, conjunctivits
chronic recurrent arthritis
Seronegative spondyloarthropathies: psoriatic arthritis
5-10 of those with psorisas
nail disorders
iritis
Seronegative spondyloarthropathies: IBD
10-20 of those with IBD, more in chrons
HLA-B27 in 50-70%
sacroiliitis, spondylitis, and arthritis of the knee and ankle
Seronegative spondyloarthropathies: SX
back pain and morning stiffness
Seronegative spondyloarthropathies: exam
FABER (flexion, abduction, external rotation) tests SI joint
enthesitis
Seronegative spondyloarthropathies: Labs
HLA b-27
Xrays of spine bamboo spine. Straight and ugilyating spine
Seronegative spondyloarthropathies: TX
Nsaids
surgery
