Arthritis Flashcards
Heberden’s nodes
DIP enlargement 2/2 osteophytes
a/w osteoarthritis
Bouchard’s nodes
PIP enlargement
a/w osteoarthritis
X-ray findings for OA
Osteophytes
Joint space narrowing
Subchondral bone cysts
Subchondral sclerosis
Pseudogout lab and associations
Lab: rhomboid shaped crystals that are + birefringence under polarized light
a/w hemocrhomatosis and hyperparathyroidism
Tx for gout: acute, ppx, contraindications, what to discontinue
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
Reactive arthritis: what is it and when do you get it
Arthritis, conjunctivitis, uveitis, urethritis
follows an infection by Campylobacter, Shigella, Salmonella, Chlamydia, or Ureaplasma
Psoriatic arthritis: description and X-ray findings
Arthritis a/w psoriasis
Can include DIP joints
Sausage shaped digits = dactylitis
X-ray: pencil in cup deformity
Enteropathic spondylitis
Ankylosing spondylitis like dz, characterized by sacroiliitis that is asymmetric and a/w IBD
Ankylosing spondylitis: description, what it affects and how to diagnose
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
Treatment of seronegative spondylarthropathies
NSAIDs like indomethacin for pain; exercise will help
TNF inhibitors: infliximab
Sulfasalazine
Myositis presentation and how to diagnose
Progressive, proximal, bilateral muscle weakness
Advanced dz can cause difficulty breathing and swallowing
Anti-Jo-1 abs +, muscle biopsy shows necrosis, increased CK
Dermatomyositis cutaneous findings
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)
Rheumatoid arthritis HLA risks
HLA-DR4
Rheumatoid arthritis
-sx, PE
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
Rheumatoid arthritis labs
Increased rheumatoid factor (IgM against IgG)
Anti-CCP abs
Increased ESR
ACD (important: not present in OA)
Synovial fluid: turbid, decreased viscosity, increased WBC
Rheumatoid arthritis treatment
DMARDS
- MTX (best initial DMARD)
- Hydroxychloroquine (retinal toxicity)
- Sulfasalazine
- TNF inhibitors: infliximab
- Rituximab (anti-CD20)
- leflunomide
Felty’s syndrome
RA + splenomegaly + neutropenia
Baker’s cyst
tender mass in the popliteal fossa
result of excessive fluid production by inflamed synovium
a/w RA, OA, cartilage tear etc.
CREST syndrome
Limited form of scleroderma (systemic sclerosis)
Calcinosis (local dystrophic deposition of Ca in skin)
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias
Systemic sclerosis (diffuse)
Pulmonary fibrosis, cor pulmonale, acute renal failure, malignant HTN
Systemic sclerosis labs
RF and ANA +
Anticentromere antibodies (specific for CREST)
Anti-Scl-70 = antitopoisomerase I antibodies are a/w diffuse dz
Eosinophilia is common
Tx of Raynaud’s phenomenon
Calcium channel blockers
SLE tx
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
SLE associated endocarditis
Libmann-Sacks endocarditis
-noninfectious vegetations seen on mitral valve
a/w SLE and antiphospholipid syndrome
associations and treatment for temporal arteritis
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
Sjogren’s triad, associations, pathophysiology, treatment
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
Rheumatoid arthritis
-sx, PE
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
SLE: 11 symptoms
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
Fibromyalgia:
-labs, pathology, classic findings
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
Polymyalgia rheumatica
-associations, treatment
a/w temporal arteritis
Tx: low-dose corticosteroids
