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Family Medicine > Arthritis and Rheumatic Diseases > Flashcards

Arthritis and Rheumatic Diseases Flashcards

1
Q

osteoarthritis is inflammatory or degenerative

A

degenerative

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2
Q

risk factors for OA

A 
>50 yo
joint injury
obesity
contact sport stress/job
hereditary
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3
Q

pathophys of OA

A

worn articular cartilage + bone
thickening of synovium
osteophytes at articular edges
mild inflammation of joint capsule and ligaments

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4
Q

mild, dull aching pain in joint
pain worse with activity + damp/cold weather, improves with rest
stiffness with inactivity, improves after 15 min of exercise
morning stiffness

A

OA symptoms

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5
Q

DIP joints and PIP joints

weight bearing: hip, knees, spine

A

OA pattern

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6
Q

PIP joints and MCP joints

symmetric pattern of small joints

A

RA pattern

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7
Q 
30-50 yo
F>M
chronic with acute flare-ups
morning stiffness lasts 45-60 minutes
systemic features
inflammatory features
A

RA symptoms

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8
Q

fever + chills + one joint

A

septic arthritis

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9
Q

weight loss

A

mets to bone
RA
SLE

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10
Q

HA + loss of vision + scalp tenderness + jaw claudication

A

temporal arteritis (giant cell)

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11
Q

skin and/or nail changes

A 
psoriasis
scleroderma
SLE
Reiter syndrome
Lyme disease (erythema migrans)
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12
Q

multiorgan system signs + symptoms

A

SLE

collagen vascular disorder

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13
Q

cutaneous/subq nodules

A

gout

RA

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14
Q

conjunctivits
uveitis
dry eyes

A

RA
sjogren syndrome
Reiter syndrome

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15
Q

chest pain + cough + SOB

A

RA

SLE

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16
Q

diarrhea + ab pain

A

slceroderma
RA
reactive arthritis
arthritis of IBD

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17
Q

dsyuria + urethra discharge

A

reactive arthritis

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18
Q

crepitus: cracking heard or felt with movement of joint

A

OA

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19
Q 
effusion (soft swelling) of large joint with redness/warmth (inflammation)
bone spurs (hard swelling)
A

OA

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20
Q

disc degeneration
ostephytes (bone spurs) of facet joints can compress spinal nerve roots (weakness and sensory loss)
can lead to spinal stenosis (symptoms may mimic claudication)

A

OA

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21
Q

diagnostic test for reactive arthritis

A

HLA-B27

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22
Q

diagnostic test for anklylosing spondylitis

A

HLA-B27

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23
Q

diagnostic test for RA

A

rheumatoid factor

ANA

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24
Q

diagnostic test for SLE, sjogren syndrome, scleroderma

A

ANA

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25
Q

do you need xray to make diagnosis of OA

A

no

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26
Q

treatment of OA

A

twice-daily exercise, low impact aerobic exercise
exercise muscle group that support affect joints: quads for knees, ab muscles for lumbar spine
if obese: weight loss before surgery
pain: NSAID, topical capsaicin cream, intraarticular hyaluronate, IA steroid injection if effusion and inflammation of joint

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27
Q

synovial fluid:
PMN >95
positive culture or gram stain
WBC 50,000-100,000

A

septic arthritis

28
Q

synovial fluid:

pyrophosphate crystals

A

pseudogout

29
Q

synovial fluid:

urate crystals

A

gout

30
Q

synovial fluid:
WBC 2,000-100,000
PMN >50
often xanthochromic

A

RA

31
Q

synovial fluid:
WBC 2,000-15,000
PMN 50

A

acute rheumatic fever

32
Q

osteopenia
subchondral bone cysts
joint surface erosions

A

RA

33
Q

bone cysts

punch out erosions on joint surface

A

gout

34
Q

bilateral sacroiliitis
squaring of lumbar vertebrae
sclerosis of corners of vertebrae
joint fusion: bamboo spine

A

ankylosing spondylitis

35
Q 
joint space loss
osteophyte formation
cartilage calcification
cyst formation
subchondral sclerosis
A

OA

36
Q

chronic inflammatory symmetric polyarthritis: *peripheral joints

  • synovial membrane of joints - synovium forms pannus of granulomatous tissue that erodes cartilage, ligament, tendons, bone- most commonly affected
  • these granulomas can form subq nodules (rheumatoid nodules) and cause vasculitis → peripheral neuropathy in legs/arms, cardiac arrhythmias, pericarditis, pleurisy, bowel, scleritis in eye
  • nerve entrapement can cause peripheral neuropathy
  • splenomegaly
A

RA

37
Q

risk factors for RA

A

HLA-DR genetic susceptibility

smoking

38
Q 
ulnar deviation
hammer fingers
boutonniere
swan neck
tendon rupture in extremities
flexion of toes
valgus (inward) of foot
fixed ankle joint
A

RA

39
Q

RA associated with dry eyes, mouth

A

sjogren syndrome - 20% cases have this too

40
Q 
initially:
joint pain, swelling
early morning stiffness
myalgia
fatigue
low-grade fever
weight loss
A

RA

41
Q

ACR criteria for RA

A

arthritis > 6 wks
+ RF
morning stiffness > 1 hr
one joint affected in wrist/MCP/PIP distribution
at least 3 joints in SYMMETRIC joint involvement: PIP, MCP, MTP
subq nodules or over bony points
hand/wrist xray shows erosions/decalcifications

42
Q

ACR criteria for gout

A 
monoarthritis
red over joint
first MTP involved or tarsal joint
tophus identified
hyperuricemia
urate crystals in joint fluid
subcortical cysts on xray
43
Q

RA markers

A

RF: positive wks-mo after onset of RA, 25% with RA are seronegative
variable: ANA, ESR, CRP

44
Q

RF + conditions

A

bacterial endocarditis
TB
sarcoidosis
malignancies

45
Q

man > 40 yo with inflammatory arthritis

A

gout

46
Q

risk factors for gout

A

> 40 yo
man
african american
genetic predisposition

47
Q

MSU crystal deposition in and surrounding tissues of joints → local inflammation, necrosis, fibrosis, subchondral bone destruction

A

gout

48
Q

defective metabolism of uric acid or
acquired hyperuricemia: multiple myeloma, polycythemia vera, chronic renal disease, psoriasis, alcoholism, thiazide or loop diuretic, cyclosporine, niacin

A

gout

49
Q 
\+/- prodrome: arthralgia, fever, chills
acute attack, desquamation of skin over joint in few days
1-3 joints of fingers and/or toes
joint is swollen, red, tender, hot
#1: great toe
#2: knee, ankle
A

gout

50
Q

urate deposits in soft and cartilaginous tissues of MTP joint, elbow, tendons of hands, ears
causes nodular swelling, may discharge white material

A

gout

51
Q

hyperuricemia not specific to gout

A 
renal diseae
blood disorders
lymphoma
diabetes
HTN
52
Q

measurement of serum elevated urate 2 weeks or more after episode of acute arthritis can be diagnostic of

A

gout

53
Q

definitive diagnosis of gout requires

A

MSU crystals in synovial fluid, needle-like

tophus: negatively birefringent in polarized light, yellow

54
Q

gout can be caused by foods

A

purine (block renal excretion of urate): seafood, red meat, alcohol: beer or liquor (not wine)
soft drinks

55
Q

didn’t go over

A

treatment of RA, gout

soft tissue syndromes: fibromyalgia, somatic dysfunction, polymalgia rheumatica

56
Q

red, hot joint + fever with extra-articular site of bacterial infection, think

A

septic arthritis

57
Q

diagnosis of septic arthritis requires

A

arthrocentesis

58
Q

risk factors for septic arthritis

A 
diseased or prosthetic joint
>80 yo
DM
hemodialysis
immunocompromised
IVDU
59
Q

causes of septic arthritis

A

s. aureus, s. pneumo
prosthetic joint: s. epidermidis
young, sexually active: N. gonorrhea

60
Q 
adult with polyarthritis +/- rash
symmetric joints - similar to RA distribution
morning stiffness
negative or low-titer RF
resolve spontaneously in 4-6 wks
A

parvovirus B19

61
Q

lyme disease

A

early: bulls eye rash (erythema migrans)→ migratory polyarthritis, arthralgias
mo-yrs later: chronic monoarticular arthritis (knee most common)

62
Q

diagnosis of lyme disease

A

enzyme-linked assay

confirm: western blot

63
Q

treatment of lyme disease

A

doxycycline if early disease - prevents progression and is curative

64
Q

young men
HLA B27 positive or HIV +
arthritis following GI infection (shigella, salmonella, campylobacter) or GU (chlamydia)

A

reactive arthritis (reiter)

65
Q

urethritis
conjunctivitis
arthritis (inflammation from immune complexes, asymmetric, oligo-articular of knee, ankle, small joint of LE)
papulosquamous rash - can coalesce to look like psoriasis
can’t see, can’t pee, can’t climb a tree

A

reactive arthritis

66
Q

synovial fluid
high inflammatory changes
negative culture results

A

reactive arthritis

Family Medicine (21 decks)

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