Arthritis - Johnston, Smith Flashcards
RF – spinal finding
Fused C1 and C2
RF –> tender red/purple papules that become non-healing necrotic ulcers
Pyoderma gangrenosum
CV associations w/ RF
Vasculitis, CAD, HF
Caplan syndrome
What on CXR?
RA + pneumoconiosis + pulmonary nodules
Hyperlucency (dark, air-trapping)
Felty syndrome
RA, splenomegaly, pancytopenia
RA is the most common cause of secondary ____
Sjogren’s
Diagnosing Sjogrens
Schirmer’s test (eye water), slit-lamp test
RA –> what causes joint destruction?
Pannus formation –> bone erosion and joint fusion
RA – genetics
HLA-DRB4
A classification criteria score of ___ confirms RA
What are the criteria? (LOOK UP)
6/10
Must have active inflammation for ___ to make diagnosis
6+ weeks
First line DMARDs?
What is the 2nd one?
Methotrexate, Leflunomide
Leflunomide = pyrimidine antagonist - used in treatment of RA (instead of MTX)
If pregnant w/ RA, treatment?
Anti-malarial (hydroxychloroquine), Sulfasalazine
Biologic DMARDs – risks?
Drugs?
Infection (ex. TB reactivation), neoplasia, MS, autoimmune
Etanercept, infliximab, adalimumab, rituximab
Commonalities to the SNSAs
- SPINE + symmetric SI JOINTS
- HLA-B27
- RF negative, ACCP negative
- Morning stiffness
- Asymmetry
- New bone formation
- Ankylosis
- Enthesitis
- Uveitis
SNSAs - how to see erosions?
How to see inflammation?
CT
MRI
General treatment for SNSAs
PT/exercise
NSAIDs
Biologic DMARD - for joint damage halting
Young male, reduced lumbar flexion, dorsal kyphosis, less chest expansion
Signs on imaging?
Potential complication?
Ankylosing spondylitis
Squaring, shiny corners, bamboo spine, SI joint pseudo-widening and sclerosis/fusion
Cauda equina syndrome – bowel/bladder problems
What is DISH? Signs (5)
Diffuse idiopathic skeletal hyperostosis
- Males > 50 w/ DM
- Multiple flowing osteophytes
- 4+ vertebrae calcification
- NO SI JOINT
- Ligament calcification
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?
Reactive arthritis
Urethritis, conjunctivitis, arthritis
Chlamydia or GI bug
- Circinate balanitis
- Keratoderma blennorrhagicum
- Dactylitis
Self-limited, NSAID, steroid, OR Azithromycin/Doxycycline (if Chlamydia)
Pitting nails, pencil-in-cup deformities
Treatment?
Psoriatic arthritis
Sulfasalazine
Patient w/ IBD, large joint arthritis of LE, small joint arthritis of UE, SNSA signs
Potential extra-arthritis signs? More likely in what?
Enteropathic arthritis
Skin = PG, EN Uveitis GI Nephrolithiasis Thrombotics Bone issues
MORE LIKELY IN CD (rather than UC)
SMOADs - names?
Symptom-modifying OA drugs = “OSTEO BIFLEX”
- MMPI, Risedronate, Doxy, Glucosaime, Chondroitin)
When does Medicare kick in?
How do you surgically approach a hip for OA?
65 y/o
Anterior
