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Arthropathies Flashcards

1
Q

_____ have increased frequency of Heberden’s and Bouchard’s nodes

A

Women

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2
Q

_____ hypothesis: HLA-B27 has a propensity to misfold in the ER, leading to a stress response

A

Unfolded Protein Hypothesis

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3
Q

______ crystals are rhomboid-shaped and ______ bifringent

A

Calcium pyrophosphate dehyrate (CPPD); positively

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4
Q

______ have more severe osteoarthritis.

A

Women

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5
Q

______ hypothesis: homodimers of HLA-B27 heavy chains can trigger activation of Natural Killer (NK) cells through killer cell immunoglobulin-like receptors (KIRs)

A

Free Heavy Chain

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6
Q

______ hypothesis: induction of autoreactivity to self antigens between epitopes of infecting organism/antigen and a portion of the HLA-B27 molecule (or other self peptides)

A

Molecular Mimicry

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7
Q

______ hypothesis: make RF and anti-CCP antibodies that may lead to production of immune complexes, enhancing local inflammation

A

B cell

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8
Q

_______ crystals are enedle shaped and ________ bifringent

A

monosodium urate; negatively

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9
Q

_______ emigrate from circulation under influence of cytokines, IL-8, and TGFb into the synovium

A

Neutrophils

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10
Q

_______ hypothesis: may recognize citrullinated peptides, or proteoglycan or collagen altered by enzymatic degradation with presentation of neoepitopes

A

T cell

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11
Q

_______ hypothesis: microbial peptides that bind to HLA-B27 and then are presented uniquely to CTLs to result in disease

A

Arthritogenic peptides

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12
Q

_______: arthritis, urethritis, inflammatory eye disease, and mucocutaneous lesions

A

Reiter’s Syndrome

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13
Q

______: decrease uric acid production in over-producers

A

Xanthine oxidase inhibitors

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14
Q

______: directly opposed to articular cartilage and marginal bone, responsible for most of the joint tissue destruction

A

Pannus

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15
Q

______: enhances renal excretion of uric acid in under-excreters

A

Uricosuric

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16
Q

_____: aggregated deposits of monosodium urate crystals occurring in joints, bones, and soft tissue

A

Tophi

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17
Q

_____: diminished migration, metabolic, and phagocytic activity of PMNs, may block NLRP3 inflammasome activation in monocytes

A

colchine

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18
Q

____: renal interstitial, glomerular, and/or tubular deposition of MSU crystals

A

Gouty nephropathy

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19
Q

Ankylosing Spondylitis Specific Therapy Strategies

A

Back exercises/Good posture; smoking avoidance (to prevent loss of chest wall function)

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20
Q

Bouchard’s nodes are bone swellings of the ____ joints

A

PIP

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21
Q

Cause of urethritis in reactive arthritis

A

Chlamydia

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22
Q

Causes of diarrhea in reactive arthritis (4)

A

Campylobacter, shigella, salmonella, yersinia

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23
Q

Factors affecting Monosodium Urate solubility (5)

A

Temperature, Dehydration; Trauma, Proteolytic abnormalities, pH

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24
Q

Gout can result from decreased excretion of uric acid due to activation of _____.

A

URAT1

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25
Q

Gout can result from increased production of uric acid, due to _____ activity of ______ or deficiency of ______.

A

increased, phosphoribosyl-pyrophosphate synthetase (PRPP); hypoxanthine-guianine phosphoribosyltransferase (HGPRT)

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26
Q

Heberden’s nodes are bone swellings of the ____ joints

A

DIP

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27
Q

Igs (typically Ig__) that recognize epitopes in _______.

A

M; the Fc region of IgG

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28
Q

In ankylosing spondylitis, ______ may contribute to development of calcification at entheses and in joint

A

TGF-beta, WNT proteins, Bone Morphogenic Proteins (BMPs)

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29
Q

In ankylosing spondylitis, the environmental trigger is unknown but thought to be common to all patients, such as________

A

normal bowel flora

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30
Q

In osteoarthritis, water content _____, proteoglycan content ______, and chondrocyte numer ______.

A

increases; increases; initially increases then decreases

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31
Q

In Rheumatoid arthritis, the cellular infiltrate into the synovium primarily consists of ______.

A

mononuclear cells (lymphocytes and monocytes) and fibroblasts

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32
Q

Inflammatory response depends on ______, promoted by IL-8, _______ chemoattractant protein-1, and cytokines (IL-1 and TNF)

A

PMNs; neutrophil

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33
Q

Lifestyle/Nutritional changes in treating gout (3)

A

Weight loss; reduction of high purine foods (meat, shellfish) in diet; limitation of fructose and alcohol consumption

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34
Q

MSU crystals engage ________, activating _________ with IL-1β production

A

caspase-1; NLRP3 inflammasome

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35
Q

Other gene mutations associated with Ankylosing Spondylitis (5)

A

ERAP1, IL23R, IL-IR2, ANTXR2, Genes associated with TNF pathway

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36
Q

Recognition of MSU crystals by_____ leads to inflammatory response

A

TLR2/TLR4

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37
Q

The common HLA allele in Ankylosing Spondylitis is _____.

A

HLA-B27

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38
Q

The common HLA allele in reactive arthritis, psoriatic spondylitis, and colitic spondylitis is _____.

A

HLA-B27

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39
Q

The common HLA allele in Rheumatoid Arthritis is _____.

A

HLA-DR4 with QKRAA

40
Q

Which arthropathy? abrupt onset of painful, warm, red, swollen joint often during night or early morning

41
Q

Which arthropathy? Activation of URAT1

42
Q

Which arthropathy? Anti-CCP (Anti-cyclic citrullinated protein) antibody in 70%

A

Rheumatoid Arthritis

43
Q

Which arthropathy? Associated with previous trauma

A

Osteoarthritis

44
Q

Which arthropathy? asymmetric, oligoarticular lower extremity arthritis; knees and ankles most common

A

Reactive Arthritis

45
Q

Which arthropathy? C1/C2 commonly involved

A

Rheumatoid Arthritis

46
Q

Which arthropathy? Can result from increased activity of phosphoribosyl-pyrophosphate synthetase (PRPP) or deficiency of hypoxanthine-guianine phosphoribosyltransferase (HGPRT)

47
Q

Which arthropathy? Carpometacarpal joint involvement

A

Osteoarthritis

48
Q

Which arthropathy? Constitutional and end organ symptoms, nodules on extensor surfaces and tendon sheaths,

A

Rheumatoid Arthritis

49
Q

Which arthropathy? cystic changes of subchondral bone, osteophyte formation

A

Osteoarthritis

50
Q

Which arthropathy? decreased joint space superiorly with relative medical preservation in the hip

A

Osteoarthritis

51
Q

Which arthropathy? DIP joints often spared

A

Rheumatoid Arthritis

52
Q

Which arthropathy? Disease of cartilage

A

Osteoarthritis

53
Q

Which arthropathy? Disease of entheses

A

Reactive Arthritis

54
Q

Which arthropathy? Disease of synchondroses

A

Ankylosing Spondylitis

55
Q

Which arthropathy? Disease of synovium

A

Rheumatoid Arthritis

56
Q

Which arthropathy? Elevated ESR; ANA(-), RF(-)

A

Ankylosing Spondylitis and Reactive Arthritis

57
Q

Which arthropathy? elevated serum uric acid with no gouty arthritis, tophi (monosodium urate deposites in joints, bones, or soft tissue), or uric acid nephrolithiasis (>7mg/dL)

A

Asymptomatic Hyperuricemia

58
Q

Which arthropathy? enthesopathy: Achilles tendinitis and/or plantar fasciitis (20%)

A

Reactive Arthritis

59
Q

Which arthropathy? ESR/CRP elevated

A

Rheumatoid Arthritis

60
Q

Which arthropathy? Gull wing changes in IP joints

A

Osteoarthritis

61
Q

Which arthropathy? hallux valgus

A

Osteoarthritis

62
Q

Which arthropathy? Heberden’s (DIP) and Bouchard’s nodes (PIP)

A

Osteoarthritis

63
Q

Which arthropathy? HLA-DR4

A

Rheumatoid Arthritis

64
Q

Which arthropathy? increased males 45 years old

A

Osteoarthritis

65
Q

Which arthropathy? Infectious diarrhea or urethritis preceding onset of arthritis by 2-4 weeks

A

Reactive Arthritis

66
Q

Which arthropathy? inflammatory peripheral arthritis (10-20% of patients with IBD) that follows activity of IBD; axial arthritis resembling AS (5% of patients with IBD) that does not follow activity of IBD

A

Colitic arthropathies

67
Q

Which arthropathy? juxta-articular osteopenia, symmetric loss of joint space

A

Rheumatoid Arthritis

68
Q

Which arthropathy? loss of cartilage space

A

Osteoarthritis

69
Q

Which arthropathy? Male:Female- 5-10:1; onset from childhood to age 40-50; Caucasians predisposed

A

Reactive Arthritis

70
Q

Which arthropathy? May involve cricoarytenoid cartilage, ossicles of inner ear, or the TMJ

A

Rheumatoid Arthritis

71
Q

Which arthropathy? medial compartmental disease of knee

A

Osteoarthritis

72
Q

Which arthropathy? Metacarpophalangeal joint involvement

A

Rheumatoid Arthritis

73
Q

Which arthropathy? morning stiffness, soft tissue swelling around joints, pain, improves with activity

A

Rheumatoid Arthritis

74
Q

Which arthropathy? MTP joint of great toe most often involved, followed by insteps, ankles, heels, knees, wrists, fingers, and elbows

75
Q

Which arthropathy? pain with use, Improvement with rest

A

Osteoarthritis

76
Q

Which arthropathy? peripheral arthritis preferentially affects upper extremities DIP, PIP, and MCP joints asymmetrically; axial arthritis resembles that of reactive arthritis

A

Psoriatic Arthritis

77
Q

Which arthropathy? Peripheral joints, symmetric pattern, particularly hands and feet

A

Rheumatoid Arthritis

78
Q

Which arthropathy? rarely significant symptoms before age 40

A

Osteoarthritis

79
Q

Which arthropathy? Spontaneously result in 3-10 days

80
Q

Which arthropathy? squaring of first carpometacarpal joint

A

Osteoarthritis

81
Q

Which arthropathy? stiffness (usually less than 30 minutes), localized to joints

A

Osteoarthritis

82
Q

Which arthropathy? Type I Fluid (200-2000 WBCs, 25% PMNs)

A

Osteoarthritis

83
Q

Which arthropy? asymptomatic intervals between acute attacks

A

Intercritical Gout

84
Q

Which arthropy? Back deformities and reduced chest expansion late in disease course

A

Ankylosing Spondylitis

85
Q

Which arthropy? calcium pyrophosphate dehydrate (CPPD) crystals and chondrocalcinosis (calcification of cartilage)

A

Pseudogout

86
Q

Which arthropy? Consequence of abnormal pyrophosphate metabolism

A

Pseudogout

87
Q

Which arthropy? crystals are released by shedding of pre-formed crystals in the cartilage matrix

A

Pseudogout

88
Q

Which arthropy? crystals do not form by spontaneous precipitation

A

Pseudogout

89
Q

Which arthropy? development of subcutaneous, synovial, or subchondral bone deposits of monosodium urate crystals; commonly on digits of hands and feet, olecranon bursa, extensor surface of forearm, Achilles tendon, and ear antihelix (less frequently)

A

Chronic tophaceous gout

90
Q

Which arthropy? Global loss of spine range of motion

A

Ankylosing Spondylitis

91
Q

Which arthropy? inflammatory back pain: insidious onset lasting >3 months, prolonged morning stiffness >30-60 minutes, improvement of pain with exercise

A

Ankylosing Spondylitis

92
Q

Which arthropy? male:Female- 7:3; onset 16-40 years old; Caucasians predisposed

A

Ankylosing Spondylitis

93
Q

Which arthropy? mutations of ank gene (ANKH), which facilitates _______ deposition

A

Pseudogout; Calcium Pyrophosphate Dehydrate (CPPD)

94
Q

Which arthropy? Peripheral arthritis of shoulders and hips (25%)

A

Ankylosing Spondylitis

95
Q

Which arthropy? SI joint tenderness

A

Ankylosing Spondylitis

96
Q

Which arthropy? sudden onsets of severe pain, swelling, warmth, and redness in the knee; wrist and ankle less frequently

A

Pseudogout

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