Arthritis & Arthropathies Flashcards
Progressive and irreversible condition involving loss of articular cartilage that leads to pain and sometimes deformity.
- Degeneration of Cartilage and Hypertrophy of Bone at Articular Margin
Most Common form of Joint Disease
Osteoarthritis
Symptoms of Osteoarthritis
Stiffness (rarely more than 15 minutes)
Pain with motion
Crepitus
Flexion contracture
Varus + Valgus
Heberden + Bouchard Nodes
Osteoarthritis X-Ray Findings
Loss of Joint Space
Sclerosis
Subchondral Cysts
Osteophytes
Osteoarthritis Treatment
Exercise
Weight Reduction
NSAIDs
Duloxetine
Elevated levels of uric acid due to overproduction or under-excretion of the uric acid.
Excess monosodium urate crystals deposit in the tissue.
Gout
Masses from uric acid crystal deposition with associated foreign body reaction.
- noted several years after the onset of gout
Tophi
Symptoms of Gout
Sudden Onset
- Frequently Nocturnal
Fever
Metatarsophalageal Joint of Great Toe is Most Commonly affected
(Podagra)
Disease caused by the precipitation of calcium pyrophosphate dehydrate crystals in connective tissues.
Knee is most affected.
Pseudo-gout
What is the distinguishing characteristic between Pseduogout and Osteoarthritis?
No Bony Erosions in Pseduogout
Negatively birefringent needle-shaped urate crystals
Gout
Positive birefringent rhomboid-shaped crystals
Pseduogout
Acute Gout Attack Treatment
NSAIDs
- Indomethacin
Colchicine
- if symptoms less than 36 hours
Interleukin 1 Inhibitors
- if hospitalized
Gout Management - Between Attacks
Diet
- Avoid Alcohol
- Avoid Purines (Liver, Seafood, Yeast)
Avoid Thiazide and Loop Diuretics
Colchicine Prophylaxis
Allopurinol → decrease uric acid
Probenecid → increases uric acid excretion via urination
Therapeutic and diagnostic treatment for pseduo-gout
Joint Aspiration
What medication is given during acute attacks of pseudo-gout?
NSAIDs
What medication is given within the first 24 hours of pseudo-gout for prophylaxis?
Colchicine
Systemic autoimmune disorder characterized by acute and chronic inflammation in the synovium, causing proliferative and erosive joint changes.
Rheumatoid Arthritis
Signs and Symptoms of Rheumatoid Arthritis
Symmetric pain
- Hands, Wrists, Knees and Feet and Ankles
Morning Stiffness for more than 30 minutes
Carpal Tunnel Syndrome is Common
Can Affect the Neck
- usually spares the rest of spine and SI joints.
Major Exam finding of Rheumatoid Arthritis
Boggy Feeling in Swollen Joints
- synovial hypertrophy
What is the most sensitive and specific blood test for Rheumatoid Arthritis?
anti-CCP
(anti-cyclic citrullinated peptides)
What drug therapies are used to treat Rheumatoid Arthritis?
Steroids
DMARDS
- Methotrexate
- Sulfasalazine
- JAK inhibitors
Seronegative Spondyloarthropathies
(PEAR - U)
Psoriatic Arthritis
Enteropathic Arthritis
Ankylosing Spondylitis
Reactive Arthritis
Undifferentiated Spondylarthropathy
General Manifestations of Sero-negative Spondyloarthropathies
Male Predominance
Spine
SI Joints
Enthesopathy
Ocular Inflammation
Axial Skeleton Commonly Involved
HLA-B27 GENETIC MARKER
- 90% of pts. with Ankylosing Spondylitis
Preceded by Psoriasis
- arthritis
- dactlylitis (sausage fingers)
- nail disorders
Psoriatic Arthritis
X-Ray finding of Psoriatic Arthritis
Arthritis Mutilans
PENCIL IN A CUP DEFORMITY
Arthritis associated with:
- Chron’s Disease
- Ulcerative Colitis
Enteropathic Arthritis
What are the two distinct forms of Enteropathic Arthritis?
Peripheral Arthritis
- oiligoarthritis of large joints (4 or fewer joints)
- Joint disease parallels the bowel disease
Spondylitis
- indistinguishable from ankylosing spondylitis
How do you treat Enteropathic Arthritis?
Controlling intestinal inflammation will eliminate peripheral arthritis
Sero-negative spondyloarthropathy that primarily affects the axial skeleton and causes sacroiliitis and kyphosis.
90% have HLA-B27 Gene
Ankylosing Spondylitis
Symptoms of Ankylosing Spondylitis
Morning Stiffness relieved by activity and leaning forward
Limited spinal motion
- progresses towards the head
FABER maneuver stresses SI Joint
X-Ray findings of Ankylosing Spondylitis
Bamboo Spine
Shiny Corner Sign
Acute Spondyloarthropathy precipitated by GI or GU Infection (especially STI)
Reactive Arthritis
3 Major Symptoms of Reactive Arthritis
Can’t See, Can’t Pee, Can’t Climb a Tree
- Arthritis
- Urethritis
- Conjunctivitis
+ mucocutaneous lesions
Psoriatic Arthritis Treatment
TNF inhibitor
Methotrexate
Enteropathic Arthritis Treatment
Control IBD
- may add NSAID
Ankylosing Spondylitis Treatment
NSAIDs
TNF
Reactive Arthritis Treatment
Methotrexate
Sulfasalazine
NSAIDs
- may need to treat for Chlamydia
