Causal Conditions Flashcards
Type 1 collagen
Type 2 “”
Type 3””
Type4 “”
1-bone
2-cartilage
3-b.v
4-basement membrane
Septic Arthritis
Bacteria entering joint: direct inoculation, hematogenous spread, infection from a nearby place
Monoarticular, erythematous, edematous, painful
Staph aureus, strep, mycobac. Tuberculosis, lyme disease
Tx: vanco = gram positive, ceftriaxone = gram negativ
Gout
Hyperuricemia: breaking down purines into uric acid & build up uric acid
Risk factors: male, high alcohol diet, high fatty diet
1 metatarsal: nocturnal pain, fire in the toe
Labs: long slender needles light microscopy, negative birefringent
Tx: indomethacin
Chronically = have tophi & kidney problems (stones=nephropathy)
Disseminated Gonococcoemia
Neisseria gonorrhea infection that goes undetected = disseminates
Triad: tenosynovitis, polyarthritis, dermatitis
- tenosynovitis: wrist, finger, ankles, toes
- dermatitis: pustules painless
- polyarthritis: follows, uncommon bilateral, small & large joints
Feel unwell
Complications: endocarditis, meningitis, perimyocarditis, osteomyelitis, abscesses, vasculitis
X2 blood cultures
Tx: ceftriaxone + doxycycline (chlamydia)
Rheumatic fever
Occurs post strep throat ~ infection of group A strep
2-4 weeks after, activation innate immune system = antibodies to strep attack proteins on valves, myocardium, brain, joints, skin = leads symptoms
Fever, polyarthralgias, pancarditis, chorea movements, erythema marginatum (non itchy red rash arms/trunk)
Children ~ neuropsychiatric: chorea, OCD, hyperactivity, tics
Post strep arthritis
Tx: pen G+ anti-inflammatories + antipyretics
Ankylosing Spondylitis
Inflammatory disorder where spine becomes stiff = SI joints, intervertebral discs, facet joints
Negative RF
Sx: insidious back pain, <40 yo, worse at night/rest, better with exercise
Asymmetric joint pain, buttock pain, heel pain, UC/Crohn’s/psoarisis
Assoc HLAB27 gene
Psoriatic arthritis
Inflammation of joints in pt who has psoriasis ~ could be symmetrical could be asymmetrical
Sometimes presents similarly to RA ~ psoriatic arthritis = -ve rheumatoid factor
Xray ~ pencil-in-cup deformity in phalanges
Associated HLA B27 gene
Rheumatoid arthritis
Chronic inflammatory condition
RF positive, anti CCP positive, ESR/CRP elevated
Classically: >5 symmetrical joints involved ~ MCP, PIP, MTP ~ shouldes, wrists, ankles, knees, Boutonniere deformities, swan neck deformities, ulnar deviation, stiff after inactivity (in the morning)
Extra-articular manifestations:
- nodules in skin
- lungs: pleural effusions, fibrosis
- brain: pyrogens ~ fevers
- liver ~ decreased iron absorption
- skeletal m. Breakdown
Tx: DMARDS ~ methotrexate, hydroxychloroquine
Biologics
Fibromyalgia
Issues pain processing Central sensitization Environmental Genetics Depression/anxiety
Labs ~unremarkable
Diffuse tenderness in multiple sites >5
Brain fog, sleeping difficulties, fatigue
Tx: education, exercise programs (Tai-Chi), CBT, TCA ~ amitriptyline, SNRIs ~ duloxetine, anticonvulsants ~ pregabalin/gabapentin
Polymyalgia Rheumatica
Peri-articular & inter-articular areas involved ~ inflammation of these areas (muscles not involved)
Symmetrical, over night/sudden stiffness/painin shoulders, neck, pelvic girdle ~ worse in the morning, >50 yo
elevated ESR/CRP, negative anti ccp & RF
PRECEDE, ASSOCIATED, FOLLOWED WITH GIANT CELL ARTERITIS
Tx: prednisone
