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Rheumatology > Arthritis > Flashcards

Arthritis Flashcards

1
Q

Heberden’s nodes

A

DIP enlargement 2/2 osteophytes

a/w osteoarthritis

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2
Q

Bouchard’s nodes

A

PIP enlargement

a/w osteoarthritis

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3
Q

X-ray findings for OA

A

Osteophytes
Joint space narrowing
Subchondral bone cysts
Subchondral sclerosis

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4
Q

Pseudogout lab and associations

A

Lab: rhomboid shaped crystals that are + birefringence under polarized light
a/w hemocrhomatosis and hyperparathyroidism

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5
Q

Tx for gout: acute, ppx, contraindications, what to discontinue

A

Acute: NSAIDs (indomethacin) are first line; colchicine (neutrophil chemotaxis inhibitor) is second line and not as effective
Ppx: for overproducers give allopurinol (xanthine oxidase inhibitor); for undersecretors give probenecid
c/i to probenecid = tophi, renal stones, CKD
discontinue ASA during acute flare as ASA can decrease uric acid excretion by the kidneys
allopurinol decreases risk of acute urate nephropathy

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6
Q

Reactive arthritis: what is it and when do you get it

A

Arthritis, conjunctivitis, uveitis, urethritis

follows an infection by Campylobacter, Shigella, Salmonella, Chlamydia, or Ureaplasma

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7
Q

Psoriatic arthritis: description and X-ray findings

A

Arthritis a/w psoriasis
Can include DIP joints
Sausage shaped digits = dactylitis
X-ray: pencil in cup deformity

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8
Q

Enteropathic spondylitis

A

Ankylosing spondylitis like dz, characterized by sacroiliitis that is asymmetric and a/w IBD

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9
Q

Ankylosing spondylitis: description, what it affects and how to diagnose

A

Arthritis of young men, a/w HLA-B27, affects sacrum and pelvic bone; worsens w/ inactivity (in morning)
Dx w/ X-ray showing fused sacroiliac joints, bamboo spine, squaring of lumbar vertebrae, development of vertical syndesmophytes
a/w decreased chest expansion
a/w anterior uveitis and heart block

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10
Q

Treatment of seronegative spondylarthropathies

A

NSAIDs like indomethacin for pain; exercise will help
TNF inhibitors: infliximab
Sulfasalazine

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11
Q

Myositis presentation and how to diagnose

A

Progressive, proximal, bilateral muscle weakness
Advanced dz can cause difficulty breathing and swallowing
Anti-Jo-1 abs +, muscle biopsy shows necrosis, increased CK

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12
Q

Dermatomyositis cutaneous findings

A 
Shawl sign (rash over shoulders, upper chest, back)
Heliotrope rash (violaceous periorbital rash)
Gottron's papules (papular rash w/ scales over dorsum of hands on bony prominences)
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13
Q

Rheumatoid arthritis HLA risks

A

HLA-DR4

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14
Q

Rheumatoid arthritis

-sx, PE

A

Insidious onset of morning stiffness > 1 hour w/ painful, warm swelling of multiple symmetric joints > 6 weeks. DIP spared

PE: ulnar deviation w/ MCP joint hypertrophy; ligament and tendon deformations (swan-neck and boutonniere deformity), vasculitis, atlantoaxial subluxation, keratoconjunctivitis sicca
Rheumatoid nodules

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15
Q

Rheumatoid arthritis labs

A

Increased rheumatoid factor (IgM against IgG)
Anti-CCP abs
Increased ESR
ACD (important: not present in OA)
Synovial fluid: turbid, decreased viscosity, increased WBC

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16
Q

Rheumatoid arthritis treatment

A

DMARDS

  • MTX (best initial DMARD)
  • Hydroxychloroquine (retinal toxicity)
  • Sulfasalazine
  • TNF inhibitors: infliximab
  • Rituximab (anti-CD20)
  • leflunomide
17
Q

Felty’s syndrome

A

RA + splenomegaly + neutropenia

18
Q

Baker’s cyst

A

tender mass in the popliteal fossa
result of excessive fluid production by inflamed synovium
a/w RA, OA, cartilage tear etc.

19
Q

CREST syndrome

A

Limited form of scleroderma (systemic sclerosis)
Calcinosis (local dystrophic deposition of Ca in skin)
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias

20
Q

Systemic sclerosis (diffuse)

A

Pulmonary fibrosis, cor pulmonale, acute renal failure, malignant HTN

21
Q

Systemic sclerosis labs

A

RF and ANA +
Anticentromere antibodies (specific for CREST)
Anti-Scl-70 = antitopoisomerase I antibodies are a/w diffuse dz
Eosinophilia is common

22
Q

Tx of Raynaud’s phenomenon

A

Calcium channel blockers

23
Q

SLE tx

A

NSAIDs for mild joint pain
Corticosteroids = acute exacerbations

Progressive or refractory cases:
-corticosteroids, hydroxychloroquine, cyclophosphamide, azathioprine

Hydroxychloroquine: good for isolated skin and joint involvement
Cyclophosphamide: good for severe lupus nephritis

24
Q

SLE associated endocarditis

A

Libmann-Sacks endocarditis
-noninfectious vegetations seen on mitral valve
a/w SLE and antiphospholipid syndrome

25
Q

associations and treatment for temporal arteritis

A

Associations: polymyalgia rheumatica
-most feared manifestation is blindness 2/2 occlusion of central retinal artery

Biopsy: subacute granulomatous inflammation; biopsy shows necrosis of the media, thrombosis, and lymphocyte/plasma cell/giant cell infiltration

Tx: high-dose prednisone

26
Q

Sjogren’s triad, associations, pathophysiology, treatment

A

drye eyes (keratoconjunctivitis), dry mouth, arthritis

a/w Non-Hodhkins lymphoma
-lymphocytic involvement of salivary and lacrimal glands

Tx: pilocarpine or cevimeline

  • artificial tears
  • NSAIDs/steroids for arthritis
27
Q

Rheumatoid arthritis

-sx, PE

A

Insidious onset of morning stiffness > 1 hour w/ painful, warm swelling of multiple symmetric joints > 6 weeks. DIP spared

PE: ulnar deviation w/ MCP joint hypertrophy; ligament and tendon deformations (swan-neck and boutonniere deformity), vasculitis, atlantoaxial subluxation, keratoconjunctivitis sicca
Rheumatoid nodules

28
Q

SLE: 11 symptoms

A 
Cutaneous findings:
-malar rash
-heliotropic rash
-photophobia
-apthous ulcers
Serositis (pleuritis, pericarditis)
AKI
Heme: leukopenia, anemia, thrombocytopenia
Arthritis: non deforming
CNS: sz, lupus cerebritis
ANA+
Labs: + immune preps, +anti-dsDNA, +anti-Smith, +antihistone (drug-induced), +anti-Ro (neonatal SLE); can cause false positive RPR/VDRL
29
Q

Fibromyalgia:

-labs, pathology, classic findings

A 
Normal ESR
Normal muscle biopsy
Classic: point tenderness, negative workup, anxiety, stress
a/w depression, anxiety, sleep disorders, IBS, cognitive disorders
>11/18 tender points on body
-less than 11 = myofascial pain syndrome
Tx: anti-depressants (TCA is first line)
-avoid narcotics
30
Q

Polymyalgia rheumatica

-associations, treatment

A

a/w temporal arteritis

Tx: low-dose corticosteroids

Rheumatology (5 decks)

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