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PM&R Secrets 3rd Ed > Ch 68 Rheumatic Diseases > Flashcards

Ch 68 Rheumatic Diseases Flashcards

1
Q

Noninflammatory vs inflammatory Arthritis

A

Noninflammatory:

1) Chronic - Progressive - Degenerative - Asymmetrical - Morning stiffness <30min
2) Pain - Tender - Swelling - Crepitus
3) High viscosity low WBC/PMN normal ESR
4) Joint space narrow - Cartilage loss - Subchondral sclerosis - Bony spurs

Inflammatory:

1) Acute - Progressive - Symmetrical Morning stiffness >30
2) Pain - Tender - Swelling - Inflammation - Erythema - Fever
3) Low viscosity high WBC/PMN/ESR
4) Extra-articular - Swelling - Perioitis - Bony erosion & cartilage los

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2
Q

NSAIDs subgroups

A

COX1 : ASA - Ketrolac - Naproxin? > GI
COX2: Diclofnac - Celebrix - Mobic - Arcoxia > CV
Non Selective: Ibuprofen

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3
Q

ASA Mechanism of action

A

Antipyretic : inhibit PG synthesis in anterior hypothalamus

Analgesic : Inhibit PG synthesis

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4
Q

Mechanism of action of NSAIDs & S/E

A

MOC:
PG synthesis inhibition
Inhibit leukocyte migration
Inhibit COX

S/E
GI Bleeding - Decrease renal blood flow - Pancreatitis - Hepatotoxic

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5
Q

S/E methotrexate

A
  1. Hepatotoxic : Transaminitis
  2. GI Toxicity
  3. Pulmonary toxicity
  4. Teratogenic
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6
Q

Traditional DMARDs

Biologic DMARS

A

Traditional DMARDs
Immunity: Methotrexate - CellCept - Azathioprine
Others: Hydroxychloroquin - Cyclosporin

Biologic DMARDs
TNF-a: Infliximab + Humera
CD20 AB / B Cells: Rituximab

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7
Q

TNF-a S/E

A

Injection site pain / Erythema
Headache
Flu / Infection
Auto Antibody

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8
Q

Superficial heat and Arthritis

Contraindication

A

3min to elevate 3 degrees in 1cm depth.

  1. Decrease pain (pain receptors)
  2. Relive muscle spasm
  3. Improve tendon extensibility
  4. Increase joint ROM
Contraindication:
Impaired cognitive function / sensation 
Skin infection - Acute inflammation
Impaired circulation 
Malignancy
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9
Q

Beneficial effect of exercise program

A
  1. Strengthen muscle
  2. Aerobic capacity
  3. Muscle endurance
  4. Bone density
  5. Functionalists & well being
  6. Better joint function and ROM
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10
Q

Indication and contraindication of passive and active ROM in R.A patient

A 
Indication:
Subacute or chronic joint disease
Severe weakness
Prevent contracture 
* many reps may increase inflammation *

Contraindication:
Inflamed tendon or joint
Will lead to rupture or increase inflammation or joint subluxation

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11
Q

Causes of fatigue in R.A patients

A
  1. Chronic inflammation
  2. Anemia of chronic disease
  3. Abnormal posture ang gait
  4. Weak atrophied muscles
  5. Joint mal alignment
  6. Poor sleep cycle
  7. Cardiovascular and pulmonary diseases

Think about patient’s condition, disease affecting his muscles/joints + chronic pain + medication + co-morbidity

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12
Q

Benefits of orthodontics in R.A

A
  1. Prevent joint deformity, contructure
  2. Improve joint alignment
  3. Decrease pain an inflammation

Or any another disease (1+2 combined answer)

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13
Q

Rheumatoid arthritis extra-articular manifestations

A

Systemic: fatigue, malaise, fever

CNS: myelopathy, entrapment 
Eyes: scleritis
Cardio: pericarditis, valve dysfunction
Pulmonary: ILD
Heme: Felty syndrom, anemia
Derma: Rhu nodules, vasculitis

From head to toes

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14
Q

R.A. Criteria

A
  1. Morning stiffness >1 hr
  2. Arthritis in 3 joints
  3. Hand involvement
  4. Bilateral involvement
  5. Rhu Nodules
  6. Serology RF
  7. Radiographic changes

4/7 for diagnosis
1-4 for at least 6 weeks

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15
Q

Rhu Factor

A

Immunoglobulin present in 85% of R.A.
Other diseases: psoriatic arthritis - Reiter syndrome - eldarly - normal healthy

Good prognostic value

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16
Q

Radiology for R.A. Joint

A
  1. soft tissue swelling
  2. jarrow joint space
  3. bony erosion
17
Q

R.A. presents with neck pain

1st to r/o

A

Atlanto-axial subluxation

18
Q

When to stop exercise for Rhu patients?

A
  1. Increase weakness
  2. Increase soreness
  3. Flaring of inflammation
    4.
19
Q

Define spondyloarthropathies

Which joint should we check prior Dx of spondyloarthropathies?

A

seronegative inflammatory arthritis

Examples: ankylosing spondylitis, psoriatic arthritis, dieter syndrome/reactive arthritis, IBD

Check for hip joint: bony erosion - progressive sclerosis - narrowing of joint space - ankylosing

20
Q

Reiter Syndrome?

A

Reactive arthritis, due to bacterial antigens

Hx of 1 month

  1. Urethritis
  2. Conjunctivitis
  3. Arthritis
21
Q

A) Pathophysiology of OA

B) Which Joints? (pattern)

A

A) Overuse or overload lead to cartilage degeneration and result in cartilage wear and tear, decrease joint space, osteophyte formation.

B) sparing elbow and shoulder (unless occupational)
Cervical - lower lumbar - hip - knee.

22
Q

Exercise for O.A.

A
  1. Isomertic
  2. Aerobic
  3. Pool
23
Q

Foot deformity in OA

A
  1. Hallux Valgus > bunions

2. Hallux rigidus

24
Q

Diagnostic criteria for SLE

A 
SOAP BRAIN MD
Serositis
Oral ulcers
Arthritis
Bleeding disorder
Renal involvement
ANA + Immunology dsDNA anti-SM
Neurological manifestation
Malar + Discoid Rash
25
Q

MSK involvement in SLE

A
  1. Arthralgia (weakness - pain)
  2. Ligamanet laxity (tendon rupture - knee instability)
  3. Fatigue
  4. Necrosis of knee and hips (2nd steroid)
26
Q

Diagnostic criteria for Polymyositis

A

“Inflammation”

  1. Weakness > 2. EMG
  2. High CPK
  3. Biopsy
  4. Skin (dermatomyositis)
27
Q

Exercise for polymyositis

A
  1. Isometric
  2. Aerobic
  3. Sretch

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