Arthritis and Rheumatic Diseases Flashcards
osteoarthritis is inflammatory or degenerative
degenerative
risk factors for OA
>50 yo joint injury obesity contact sport stress/job hereditary
pathophys of OA
worn articular cartilage + bone
thickening of synovium
osteophytes at articular edges
mild inflammation of joint capsule and ligaments
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
OA symptoms
DIP joints and PIP joints
weight bearing: hip, knees, spine
OA pattern
PIP joints and MCP joints
symmetric pattern of small joints
RA pattern
30-50 yo F>M chronic with acute flare-ups morning stiffness lasts 45-60 minutes systemic features inflammatory features
RA symptoms
fever + chills + one joint
septic arthritis
weight loss
mets to bone
RA
SLE
HA + loss of vision + scalp tenderness + jaw claudication
temporal arteritis (giant cell)
skin and/or nail changes
psoriasis scleroderma SLE Reiter syndrome Lyme disease (erythema migrans)
multiorgan system signs + symptoms
SLE
collagen vascular disorder
cutaneous/subq nodules
gout
RA
conjunctivits
uveitis
dry eyes
RA
sjogren syndrome
Reiter syndrome
chest pain + cough + SOB
RA
SLE
diarrhea + ab pain
slceroderma
RA
reactive arthritis
arthritis of IBD
dsyuria + urethra discharge
reactive arthritis
crepitus: cracking heard or felt with movement of joint
OA
effusion (soft swelling) of large joint with redness/warmth (inflammation) bone spurs (hard swelling)
OA
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)
OA
diagnostic test for reactive arthritis
HLA-B27
diagnostic test for anklylosing spondylitis
HLA-B27
diagnostic test for RA
rheumatoid factor
ANA
diagnostic test for SLE, sjogren syndrome, scleroderma
ANA
do you need xray to make diagnosis of OA
no
treatment of OA
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
synovial fluid:
PMN >95
positive culture or gram stain
WBC 50,000-100,000
septic arthritis
synovial fluid:
pyrophosphate crystals
pseudogout
synovial fluid:
urate crystals
gout
synovial fluid:
WBC 2,000-100,000
PMN >50
often xanthochromic
RA
synovial fluid:
WBC 2,000-15,000
PMN 50
acute rheumatic fever
osteopenia
subchondral bone cysts
joint surface erosions
RA
bone cysts
punch out erosions on joint surface
gout
bilateral sacroiliitis
squaring of lumbar vertebrae
sclerosis of corners of vertebrae
joint fusion: bamboo spine
ankylosing spondylitis
joint space loss osteophyte formation cartilage calcification cyst formation subchondral sclerosis
OA
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
RA
risk factors for RA
HLA-DR genetic susceptibility
smoking
ulnar deviation hammer fingers boutonniere swan neck tendon rupture in extremities flexion of toes valgus (inward) of foot fixed ankle joint
RA
RA associated with dry eyes, mouth
sjogren syndrome - 20% cases have this too
initially: joint pain, swelling early morning stiffness myalgia fatigue low-grade fever weight loss
RA
ACR criteria for RA
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
ACR criteria for gout
monoarthritis red over joint first MTP involved or tarsal joint tophus identified hyperuricemia urate crystals in joint fluid subcortical cysts on xray
RA markers
RF: positive wks-mo after onset of RA, 25% with RA are seronegative
variable: ANA, ESR, CRP
RF + conditions
bacterial endocarditis
TB
sarcoidosis
malignancies
man > 40 yo with inflammatory arthritis
gout
risk factors for gout
> 40 yo
man
african american
genetic predisposition
MSU crystal deposition in and surrounding tissues of joints → local inflammation, necrosis, fibrosis, subchondral bone destruction
gout
defective metabolism of uric acid or
acquired hyperuricemia: multiple myeloma, polycythemia vera, chronic renal disease, psoriasis, alcoholism, thiazide or loop diuretic, cyclosporine, niacin
gout
\+/- 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
gout
urate deposits in soft and cartilaginous tissues of MTP joint, elbow, tendons of hands, ears
causes nodular swelling, may discharge white material
gout
hyperuricemia not specific to gout
renal diseae blood disorders lymphoma diabetes HTN
measurement of serum elevated urate 2 weeks or more after episode of acute arthritis can be diagnostic of
gout
definitive diagnosis of gout requires
MSU crystals in synovial fluid, needle-like
tophus: negatively birefringent in polarized light, yellow
gout can be caused by foods
purine (block renal excretion of urate): seafood, red meat, alcohol: beer or liquor (not wine)
soft drinks
didn’t go over
treatment of RA, gout
soft tissue syndromes: fibromyalgia, somatic dysfunction, polymalgia rheumatica
red, hot joint + fever with extra-articular site of bacterial infection, think
septic arthritis
diagnosis of septic arthritis requires
arthrocentesis
risk factors for septic arthritis
diseased or prosthetic joint >80 yo DM hemodialysis immunocompromised IVDU
causes of septic arthritis
s. aureus, s. pneumo
prosthetic joint: s. epidermidis
young, sexually active: N. gonorrhea
adult with polyarthritis +/- rash symmetric joints - similar to RA distribution morning stiffness negative or low-titer RF resolve spontaneously in 4-6 wks
parvovirus B19
lyme disease
early: bulls eye rash (erythema migrans)→ migratory polyarthritis, arthralgias
mo-yrs later: chronic monoarticular arthritis (knee most common)
diagnosis of lyme disease
enzyme-linked assay
confirm: western blot
treatment of lyme disease
doxycycline if early disease - prevents progression and is curative
young men
HLA B27 positive or HIV +
arthritis following GI infection (shigella, salmonella, campylobacter) or GU (chlamydia)
reactive arthritis (reiter)
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
reactive arthritis
synovial fluid
high inflammatory changes
negative culture results
reactive arthritis
