Arthritis - Johnston, Smith

Question 1

RF – spinal finding

Answer 1

Fused C1 and C2

Question 2

RF –> tender red/purple papules that become non-healing necrotic ulcers

Answer 2

Pyoderma gangrenosum

Question 3

CV associations w/ RF

Answer 3

Vasculitis, CAD, HF

Question 4

Caplan syndrome

What on CXR?

Answer 4

RA + pneumoconiosis + pulmonary nodules

Hyperlucency (dark, air-trapping)

Question 5

Felty syndrome

Answer 5

RA, splenomegaly, pancytopenia

Question 6

RA is the most common cause of secondary ____

Answer 6

Sjogren’s

Question 7

Diagnosing Sjogrens

Answer 7

Schirmer’s test (eye water), slit-lamp test

Question 8

RA –> what causes joint destruction?

Answer 8

Pannus formation –> bone erosion and joint fusion

Question 9

RA – genetics

Answer 9

HLA-DRB4

Question 10

A classification criteria score of ___ confirms RA

What are the criteria? (LOOK UP)

Answer 10

6/10

Question 11

Must have active inflammation for ___ to make diagnosis

Answer 11

6+ weeks

Question 12

First line DMARDs?

What is the 2nd one?

Answer 12

Methotrexate, Leflunomide

Leflunomide = pyrimidine antagonist - used in treatment of RA (instead of MTX)

Question 13

If pregnant w/ RA, treatment?

Answer 13

Anti-malarial (hydroxychloroquine), Sulfasalazine

Question 14

Biologic DMARDs – risks?

Drugs?

Answer 14

Infection (ex. TB reactivation), neoplasia, MS, autoimmune

Etanercept, infliximab, adalimumab, rituximab

Question 15

Commonalities to the SNSAs

Answer 15

• SPINE + symmetric SI JOINTS
• HLA-B27
• RF negative, ACCP negative
• Morning stiffness
• Asymmetry
• New bone formation
• Ankylosis
• Enthesitis
• Uveitis

Question 16

SNSAs - how to see erosions?

How to see inflammation?

Answer 16

CT

MRI

Question 17

General treatment for SNSAs

Answer 17

PT/exercise
NSAIDs
Biologic DMARD - for joint damage halting

Question 18

Young male, reduced lumbar flexion, dorsal kyphosis, less chest expansion

Signs on imaging?

Potential complication?

Answer 18

Ankylosing spondylitis

Squaring, shiny corners, bamboo spine, SI joint pseudo-widening and sclerosis/fusion

Cauda equina syndrome – bowel/bladder problems

Question 19

What is DISH? Signs (5)

Answer 19

Diffuse idiopathic skeletal hyperostosis

• Males > 50 w/ DM
• Multiple flowing osteophytes
• 4+ vertebrae calcification
• NO SI JOINT
• Ligament calcification

Question 20

Male, LE arthritis, asymmetrical SI joint, rash on penis, sausage finger, painless plaque lesions on palms and soles

Classic triad for this?

Causes?

What are the specific findings above called? (3)

Treatment?

Answer 20

Reactive arthritis

Urethritis, conjunctivitis, arthritis

Chlamydia or GI bug

• Circinate balanitis
• Keratoderma blennorrhagicum
• Dactylitis

Self-limited, NSAID, steroid, OR Azithromycin/Doxycycline (if Chlamydia)

Question 21

Pitting nails, pencil-in-cup deformities

Treatment?

Answer 21

Psoriatic arthritis

Sulfasalazine

Question 22

Patient w/ IBD, large joint arthritis of LE, small joint arthritis of UE, SNSA signs

Potential extra-arthritis signs? More likely in what?

Answer 22

Enteropathic arthritis

Skin = PG, EN
Uveitis
GI
Nephrolithiasis
Thrombotics
Bone issues

MORE LIKELY IN CD (rather than UC)

Question 23

SMOADs - names?

Answer 23

Symptom-modifying OA drugs = “OSTEO BIFLEX”

- MMPI, Risedronate, Doxy, Glucosaime, Chondroitin)

Question 24

When does Medicare kick in?

How do you surgically approach a hip for OA?

Answer 24

65 y/o

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