Arthritis Flashcards
Treatment for RA
- Rest during flares, ROM during remission
- NSAIDs
- Corticosteroids (prednisone)
- Anti-malarial drugs (hydroxychloroqine)
- Gold salts, methotrexate
Juvenile rheumatoid arthritis
- RA factor is usually negative
- ANA is usually positive
- Not a life-long disorder (fades with age)
- Onset before 16
- usually involves ankles, knees, elbows or neck
- Fever and skin rash common
- Can be associated with Still’s disease (splenomegaly, generalized adenopathy)
- Treat the same as RA
Eburnation
The process by which cartilage wears down in osteoarthritis exposing subchondral bone, which becomes worn and polished
Over time, the ends of bones are also affected with bone growing along the sides producing lumps
Seronegative spondyloarthropathies (HLA-B27)
A = Ankylosing spondylitis R = Reactive arthritis (Reiter's) P = Psoriatic arthritis E = Enteric colitis
Reactive arthritis tetrad
- Conjunctivitis (can’t see)
- Non-bacterial urethritis (can’t pee)
- Arthritis (can’t climb a tree)
- Mucocutaneous lesions
What percent of poriasis patients have psoriatic arthritis?
7%
Another name for gout of the first MPJ
Podagra
Gout - most commonly affected joints in the foot
- First MPJ
- Lisfrac
- Heel
Gout joint aspiration
Negatively birefringent yellow needle shaped crystals when parallel to axis of lens, blue when perpendicular
Uric acid levels in blood
Hyperuricemia = >7.5 mg/dl
NOT conclusively diagnostic for gout
Overproducer of uric acid
- Metabolic gout
- High uric acid levels in urine (>600 mg/24 hrs)
- Genetic enzyme defect or tumor
- Treat with allopurinal (xanthine oxidase inhibitor) 300 mg QD
Underexcreter of uric acid
- Renal gout (more common)
- Low uric acid levels in urine (<600 mg/24 hrs)
- Cause: kidney disease or secondary kidney problem (lead poisoning, excessive acids - lactic acid, ASA)
- Treatment: probenecid which competes with uric acid for reabsorption from kidneys
Pseudogout
- Associated with acute or chronic inflammatory arthritis
- Caused by calcium pyrophosphate dihydrate (CPPD) crystals in the joint
- Symptoms similar to gout but longer course
- Knee most often involved
- Risk factors: age, trauma, metabolic disease
- Associated with high grade fever
- Diagnose by joint aspiration (rhomboid crystals) or radiographs (calcifications of articular cartilage or meniscus
- Treat with immobilization, NSAIDs, analgesics
Dermatomyositis
Chronic progressive inflammatory disease of skeletal muscle (polymyositis) or skin (dermatomyositis) with symmetric weakness and Gottron’s papules (flat-topped violaceous papules over the dorsal aspect of the knuckles
