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STEP 1 > Arthritis/ Spondylopathies > Flashcards

Arthritis/ Spondylopathies Flashcards

1
Q

characterized by progressive fissuring, flaking, and erosion (fibrillation) of articular cartilage

A

Osteoarthritis

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2
Q

The etiology of Osteoarthritis is multifactorial, with excessive biomechanical stress and increased intraarticular ______ activity as the major contributors to cartilage destruction

A

metalloproteinase

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3
Q 
Better in the morning
Worse at end of day
Crepitus
Normal Range of Motion
No swelling/Warmth
A

Osteoarthritis

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4
Q

Calcium pyrophosphate deposition disease presents with an acute inflammatory arthritis

A

pseudogout

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5
Q

an inflammatory arthritis associated with synovial hyperplasia.

A

Rheumatoid arthritis

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6
Q

symmetric joint involvement
prolonged morning stiffness

most commonly affects the PIP and MCP,
wrist, knee, and ankle joints.

A

Rheumatoid arthritis

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7
Q

The preferred treatment to prevent recurrent gout attacks is _______, which decrease uric acid production.

Prophylactic therapy is usually initiated during between attacks because acute changes in serum ____ levels can worsen an acute attack.

A

xanthine oxidase inhibitors
(eg, allopurinol, febuxostat)

uric acid

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8
Q

Oral or intraarticular _______ can be used for acute gout in patients who cannot tolerate NSAIDs or colchicine

A

glucocorticoids

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9
Q

second-line drugs for chronic management of gout. These drugs increase renal excretion of uric acid and are therefore contraindicated in patients with a history of renal stones.

A

Uricosuric agents

probenecid

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10
Q

Inflammatory back pain (onset at age <40)
morning stiffness that is better with activity and worse with rest
+/- fusion of the sacroiliac joints.
NSAIDs may help

A

ankylosing spondylitis (AS).

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11
Q

inflammation at the bony insertions of tendons, ligaments, and joint capsules

a prominent manifestation of spondyloarthritis ( like ankylosing spondylitis)

A

Enthesitis

*can happen in achilles tendon, plantar fasciitis, dactyilitis

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12
Q

COX-2 is an inducible enzyme that is undetectable in most tissues under normal conditions. During inflammation, infiltrating cells secrete cytokines
(___, ____)
that cause COX-2 upregulation in the inflamed tissue. COX-2 then drives the synthesis of pro-inflammatory arachidonic acid metabolites.

A

interleukin-1

TNF-α

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13
Q

PTs with a PHx of PUD & GERD for acute gout attack should be treated with an agent that provides prompt pain relief without exacerbating GI problems.

Non-seletive NSAIDs can damage the gut.

Instead use:

A

Selective COX-2 inhibitors
(celecoxib)

*PUD co-morbidity CAME UP ALOT

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14
Q

presents with localized swelling at the olecranon (ex: posterior elbow)

Range of motion is preserved and pain-free

A

Olecranon bursitis

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15
Q

Preceding infections causing Reactive arthritis (5)

A 
Chlamydia trachomatis
Salmonella, 
Shigella, Yersinia, 
Campylobacter, 
C. difficile
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16
Q

The classic triad of ______ is nongonococcal urethritis, conjunctivitis, and arthritis.

HLA ___-associated arthropathy that occurs within several weeks following a genitourinary or enteric infection.

seronegative spondyloarthropathies that can cause:

A

reactive arthritis

HLA-B27

sacroiliitis (20%)

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17
Q

middle-aged woman with polyarthritis, morning stiffness, and systemic symptoms =

A

rheumatoid arthritis (RA)

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18
Q

1st line treatment for RA
a folate antimetabolite that halts purine and pyrimidine synthesis through competitive inhibition of dihydrofolate reductase.

A

Methotrexate

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19
Q

List 5 adverse effects of Methotrexate which affects tissues with rapid cellular turnover

A

Methotrexate causes toxicity to tissues with rapid cellular turnover, such as oral and gastrointestinal mucosa (ulcerations), hair follicles (alopecia), and bone marrow (pancytopenia). Methotrexate can also cause hepatotoxicity (hepatitis, fibrosis, cirrhosis) and pulmonary fibrosis.

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20
Q

Hydroxychloroquine is a well-tolerated antirheumatic drug used in mild RA and systemic lupus erythematosus. Its most significant toxicity is

A

irreversible retinopathy

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21
Q

is characterized by stiffness and fusion (ankylosis) of the axial joints. The sacroiliac and apophyseal joints of the spine are the most commonly affected, leading to restricted spinal mobility.

A

AS

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22
Q

Ankylosing spondylitis: back pain onset ____ age

better with movement, not with rest. Pain at night

A

<40

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23
Q

3 Extra-skeletal complications of Ankylosing Spondylitis

A

limited chest wall expansion, leading to hypoventilation (restricted lung disease)

ascending aortitis, which can lead to dilation of the aortic ring and aortic insufficiency.

Uveitis pain, blurred vision, photophobia, and conjunctival erythema

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24
Q

Pt with hand joint pain and stiffness. Pain wakes them at night. Chronic fatigue and poor sexual performance (Hypopituitarism). X-rays reveal bilateral erosions and joint deformities involving the second and third MCP joints and calcifications. +/– Elevated liver enzymes/hepatomegaly, Heart problems

A

Hemachromatosis

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25
Q

iron depositionin the articular cartilage and synovium, free radical damage and crystal deposition.

X-ray findings include hook-like osteophytes)and deposition of calcium pyrophosphate dihydrate in the articular cartilage (chondrocalcinosis).

A

Hemachromatosis associated arthritis

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26
Q

Polyarticular arthritis mostly of the small hand joints ulnar deviation of the digits (fingers lean towards pinky)

A

rheumatoid arthritis (RA)

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27
Q

anti-CCP antibodies

C-reactive protein & ESR correlate with disease activity

X-ray: soft tissue swelling, joint space narrowing, bony erosions

A

rheumatoid arthritis (RA)

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28
Q

may also involve the wrists, elbows, knees, and ankles.

Cervical spine involvement common in longstanding disease causing:
pain, disability,
Cord compression

Hips and lumbosacral joints usually spared

A

rheumatoid arthritis (RA)

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29
Q

symmetric, polyarticular arthritis with joint swelling and stiffness

A

rheumatoid arthritis (RA)

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30
Q

Cervical spine involvement: subluxation, cord compression

A

rheumatoid arthritis (RA)

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31
Q

Activation of T lymphocytes in response to rheumatoid antigens (2) ______-.

Activated T cells release cytokines (__ &__) that cause _____

The accelerated metabolic rate of the inflamed synovial tissue leads to local hypoxia and increased production of hypoxia-inducible factor 1 and ____ by local MQs and fibroblasts, resulting in __________.

This facilitate expansion of inflammed synovium into a rheumatoid ______, an invasive mass composed of fibroblast-like synovial cells, granulation tissue, and inflammatory cells.

Over time, the mass encroaches into the joint space and can destroy the articular cartilage and erode the bone.

Ossification of the mass can lead to ____ of the bones across the affected joint (bony ankylosis).

A

citrullinated peptides type II collagen

IL-1 & TNF-alpha

synovial hyperplasia

vascular endothelial growth factor (VGEF)

synovial angiogenesis (neovascularization)

pannus

fusion

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32
Q

Osteoarthritis vs RA age of onset

A

OA: >40
RA: 40-60 or younger

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33
Q

Osteoarthritis vs RA joints involved

A

OA: knees, hips, DIPs
RA: Wrists, MCP, PIP

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34
Q

Osteoarthritis vs RA length of morning stiffness

A

OA: none/less than 30 min
RA: greater than 30 min

35
Q

Osteoarthritis vs RA systemic symptoms

A

OA: none
RA: Fever, Fatigue, Weight loss

36
Q

Osteoarthritis vs RA exam findings

A

OA: hard bony masses/joints
RA: Soft, spongy bones

37
Q

Patients with OA of the hands may also have osteophyte formation leading to bony enlargement of the:

distal interphalangeal (DIP) joints ( \_\_\_\_\_ nodes)
and 
proximal interphalangeal (PIP) joints ( \_\_\_\_\_ nodes)
A

Heberden

Bouchard

38
Q

Pt with recurrent acute severely painful monoarthritis
and
history of a myeloproliferative disorder (ET, PCV, Myelofibrosis, CML)

Diagnosis of acute painful joint=

A

Gout attack

39
Q

Needle shaped, negative biorefringent crystals

A

Gout

40
Q

Tumor Lysis syndrome can cause

because of

A

Gout

increased uric acid production

41
Q

Chronic kidney disease
Volume depletion
Diuretics (eg, thiazide, loops)
Cyclosporine & tacrolimus (immunosuppresants)

Risk factors for

A

GOut

42
Q

firm, nontender, subcutaneous nodules that occur at pressure points such as the elbows or forearms.

A

Rheumatoid Nodules

43
Q

an antibody (typically IgM) specific for the Fc component of IgG.

A

Rheumatoid factor

44
Q

Anticentromere antibodies are found in the majority of patients with …

A

CREST syndrome

Calcinosis, Raynouds, Esophageal Dysmotility, Scleradactyly, Talengtasias

45
Q

Antiphospholipid antibodies can be found in patients with ____& ____.

cause a hypercoagulable state with paradoxical PTT prolongation.

A

SLE

antiphospholipid antibody syndrome

46
Q

The Monospot test assesses the serum’s ability to agglutinate ____.

Positive in the presence of heterophile antibodies
(Mono–EBV diagnosis)

A

sheep erythrocytes

47
Q

a disease caused by tissue deposition of monosodium urate crystals.

A

Gout

48
Q

occurs with increased frequency in patients with activating mutations involving phosphoribosyl pyrophosphate synthetase (PPRP) due to increased production and degradation of purines

A

Gout

49
Q

____ are first-line therapy for treating acute gouty arthritis.

If they are contraindicated (eg, peptic ulcer disease, renal impairment), ______ is useful in the acute management of gout

as it inhibits neutrophil chemotaxis and phagocytosis by preventing _______ formation.

A

NSAIDs –> inhibits neutrophils.

colchicine –> Inhibit microtubules

50
Q

In RA:

The proteases ( ___ & ___ ) contribute to cartilage destruction.

Cytokines indirectly activate ____, resulting in bony erosions.

Monoclonal antibodies that inhibit TNF-alpha ( __ & ___) or IL-1 receptors (___) are widely used to slow progression of the disease.

A

collagenase, metalloproteinase

osteoclasts

adalimumab, etanercept

Anakinra

51
Q

Digital clubbing
Joint pain
Periostosis (tender thickening of periosteum)
Joint effusions

A

Hypertrophic OA

52
Q

Associated with

Malignant: lung adenocarcinoma, metastases
Nonmalignant lung disease
(eg, cystic fibrosis, bronchiectasis, lung abscess)

Cyanotic heart disease (ToF, TA, TGV, TAPVR)

A

Hypertrophic OA

53
Q

Pathogenesis of HOA:

Due to AV shunting, ____ bypass lung and skip fragmentation into platelets & deposit in peripheral tissues & distal bone

casuing focal hypoxemia & release of _____

leading to fibrovascular hyperplasia & _____

A

Megakaryocytes

PDGF & VEGF

abnormal bone formation

54
Q

a syndrome characterized by painful bone and soft tissue enlargement in the distal extremities

A

hypertrophic osteoarthropathy (HOA)

55
Q

Avascular necrosis (AVN) of the femoral head can be caused by

A

glucocorticoids

56
Q

Decreased spinal range of motion & chest expansion
Stiff or stooped posture
Tenderness at spine & peripheral tendon insertions
(Achilles, plantar fasciitis)
Dactylitis (swelling of fingers & toes)
Uveitis

A

AS

57
Q

Due to:
Increased osteoclast activity & bony erosions
due to cytokines __ & __
Increased bone/syndesmophyte formation causing a bamboo spine appearance

A

AS

TNF, IL-17

58
Q

Elevated ESR & CRP

HLA-B27

A

AS

59
Q

Intervertebral disc protrusion and thickening of the ligamentum flava can lead to _____.

The pain in this disorder typically radiates to the posterior thighs and legs and

is relieved by sitting and flexion of the spine

A

spinal stenosis

60
Q

Intervertebral disc protrusion and thickening of the _____ can lead to spinal stenosis

A

ligamentum flava

61
Q

In spinal stenosis the pain in this disorder typically radiates to the ______ and
is relieved by sitting and ____ of the spine

A

posterior thighs and legs

flexion

62
Q

In Pseudo-gout synovial fluid analysis shows rhomboid-shaped crystals (looks like a rectangles toppling over to one side) formed from _____

These crystals are ____ birefringent under polarized light. The knee joint is involved in >50% of cases.

A

calcium pyrophosphate

positively

63
Q

Clochicine causes gastrointestinal mucosal function to also be impaired by microtubule disruption, leading to _____ and, less commonly, nausea, vomiting, and abdominal pain.

A

diarrhea

64
Q

Swan neck deformity (hyperextension of PIP and flexion of DIP).
Ulnar deviation of fingers (MCP joints)
Radial deviation of knuckles

A

RA (advanced)

65
Q

Calcific degeneration of the articular cartilage (______) is a characteristic feature of calcium pyrophosphate dihydrate deposition disease (pseudogout)

A

chondrocalcinosis

66
Q

Autoimmune complex deposition (type III hypersensitivity) plays a significant role in the arthritis associated with

A

systemic lupus erythematosus

67
Q

Diuretics (eg, hydrochlorothiazide, furosemide)
Salicylates (eg, low-dose aspirin)
ACE inhibitors (eg, lisinopril)
Cyclosporine

cause GOUT via

A

decreased Uric acid urinary excretion

68
Q

Dietary sources
Purine-rich foods (eg, seafood, red meat)
Fructose-containing & alcoholic beverages (beer)

↑ Cell turnover (eg, tumor lysis syndrome)

Lesch-Nyhan syndrome (deficiency of HGPRT)

↑ Phosphoribosyl pyrophosphate activity

cause GOUT via

A

Increased Uric acid productions

69
Q

In treating gout
____ is used in patients with contraindications to both NSAIDs and colchicine
(due to renal dysfunction, the elderly)

but it is CONTRAINDICATED in patients with _____

A

Glucocorticoid

Diabetes

70
Q

Uric acid-lowering therapy with
uricosuric agents (probenecid)
or
xanthine oxidase inhibitors (allopurinol, febuxostat)

is used to prevent acute attacks in patients with recurrent gouty arthritis and those with

A

macroscopic tophi

*These drugs should not be initiated during an acute gout attack as they can exacerbate acute arthritis.

71
Q

____ binds to the intracellular protein ___ and inhibits its polymerization into microtubules.

This, in turn, disrupts cytoskeletal-dependent functions such as chemotaxis and phagocytosis.

Its administered initially at the first signs of a gout flare
It may also be used for prophylaxis

A

Colchicine

tubulin

72
Q

Associated with:

keratoderma blennorrhagicum (keratinized skin lesions on palms and soles that can ooze or spread)

circinate balanitis (dick skin inflammation- tip)

Oral ulcers

conjunctivitis, anterior uveitis

urethritis, cervicitis, prostatitis

A

Reactive Arthritis

Can’t see, Can’t pee, Can’t climb a tree

73
Q

Patient with Bell’s Palsy in the past and presents with asymmetric large joint arthritis (painful knee swelling) probably has:

A

Late Lyme disease can cause chronic asymmetric large joint arthritis and encephalopathy.

  • Early Lyme disease= flu-like symptoms and erythema chronicum migrans (Target).
  • Second stage of Lyme disease may involve atrioventricular block and facial palsy
74
Q

Tumor necrosis factor-alpha (TNF-α) inhibitors impair cell-mediated immunity. All patients beginning treatment with TNF-α inhibitors for RA should be evaluated for

A

latent tuberculosis

75
Q

Tumor necrosis factor-alpha (TNF-α) inhibitors impair cell-mediated immunity. All patients beginning treatment with TNF-α inhibitors for RA should be evaluated for

A

latent tuberculosis

76
Q

The foundation of management for RA is disease-modifying antirheumatic drugs (DMARDs), which alleviate pain and inflammation and reduce long-term joint destruction and disability.

Examples of DMARDS are

A 
Methotrexate (typically first-line), 
Sulfasalazine, 
Hydroxychloroquine, 
Minocycline,  
TNF-alpha inhibitors
77
Q

DMARDs can alleviate pain and inflammation and reduce long-term _____ and disability in RA

A

joint destruction

78
Q

For RA, DMARD therapy typically takes weeks therefore, short-term treatment with ____ (2) can provide rapid, temporary relief.

A

Glucocorticoids (prednisone)

NSAIDs

79
Q

Colchicine disrupts cytoskeletal-dependent functions such as _______ (3).

It also reduces the formation of ____.

A

chemotaxis, phagocytosis, and degranulation
*leukocyte attraction

leukotriene B4

80
Q

Altered gut biome/defective mucosal barrier
Increased production of IL-17, TNF-α &______
what disease?

A

Ankylosing Spondylitis

prostaglandins

81
Q

What is the most sensitive test to diagnose AS?

A

X-rays of the spine and pelvis

Can see sacroiliitis (eg, joint erosions with subchondral sclerosis and eventual ankylosis)

and bridging syndesmophytes (heterotopic ossification affecting vertebral body margins).

82
Q

In AS common X-Ray findings include

_____ (joint erosions with subchondral sclerosis and eventual ankylosis)

____ (heterotopic ossification affecting vertebral body margins).

A

sacroiliitis

bridging syndesmophytes

83
Q

_____ is an autosomal-recessive disorder caused by a deficiency in an enzyme involved in tyrosine metabolism that can cause osteoarthropathy of the spine and large joints.

A

Alkaptonuria

84
Q

____ causes erythema infectiosum (fifth disease) in children and arthritis in adults.

It can mimic rheumatoid arthritis but is usually self-resolving

A

Parvovirus B19

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