CIS RA johnston Flashcards by Daniel Aaron

diagnosis RA, active signs of inflammation for at least ____ weeks

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what deviation in RA

radial deviation of wrist
ulnar deviation of fingers

think Radial (w)Rist RA

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36 hr old with history of dry mouth, decreased tearing and sandy gritty feeling under eyelids. complains of bright light sensitivity and has history of RA what is DD

extra articular RA due to secondary sjogrens
-seen in 35% of RA pts, 90% women

R/O SLE
R/O AIDS assocaited keratoconjunctivitis
R/O vitamins A deficiency

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caplan syndrome

coal workers pneumocon with backround of RA, so multiple nodules on lung

nodular densities after exoposure to coal or silica

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pencil in cup appearance

psoriatic arthritis

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enteropathic arthritis

arthritis associatred swith crohns or UC
axial involvement
peripheral arthritis
large joints LE
small joints UE

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tests for sjogren

Ro/SSa and La/SSB
schirmers test
slit lamp exam

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seronegative spondyloarthropathies

predilection for spine and SI joints

new bone formation at sites of inflammation

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tests for ankylosing and imaging

HLAB27
CRP, sed rate
xray pelvis (si joint)
xray lubar vert
CT of both if xrays non diagnostic

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late complications of AS

restrictive lung disease
compression fractures
cauda equina syndrome

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odontoid and RA

atlantoaxial subluxation due to erosoin of odontoid proces

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DD RA

sle 
viral arthritis
endocarditis
sarcoid
sjogren

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tests to order with coal workers pneumoconniosis

CT of cehst
bronchoscopy with cytology and biopsy
sputum cytology, gram stain, culture
TB skin test
PFTs

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reactive arthritis

autoimune disease, asymmetric mono arth or oligo arth in LE

may be associated with infection like blood diarr bugs or chlamydia

young men get it

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C1 and C2 in RA

may sublux

don’t force into flexion or hyperextension (when intubating)

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labs with AS

increasesd ESR and CRP
hla b27 potisitve
anemia of chornic disesae

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treatment of sjogren

lubrication with artificial tears
encourage water

anti inflammatory and immunosuppressive

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PE AS

restricted forward flexion (shober test) restricted chest expansion
loss spinal mobility

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why is RA important

significant mortality
CAD, HF due to endothelial damage from chronic inflamation

frequently disables pts

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hyperlucent lungs

look dark, cannot get air out

think obstructive pulmonary disesase

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imaging for RA

x rays of hands and feet

CT for erosions

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vertebrae in AS

squaring
shiny corners, sclerosis at edge of vertebral bodies
bamboo spine or syndesmophytes

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wrist RA compression

median nerve, carpal tunnel syndrome

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iritis seen in what

SLE and AS

not in RA

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clinical manifestations AS

``` low back pain over 3 months morning stiffness, improved with exercise fatigue, weight loss symmetric SI joint pain tendonitis, planter fasciitis ```

extra articular manifestations of AS

``` iritis photophobia aortic insuff pulmonary fibrosis IBD psoriasis ```

enthesitis

inflammed tendon insertion into bone | immune susceptibiity to allele B27

methotrexate labs to monitor and toxicity

CBC, LFTs, creat tox = hepatic, myelosupp, pulmonary dont give during pregnancy

spondylolisthesis

anterior displacement of vertebral body

clinical manifestations of reactive arth

``` asymm oligo arth LE enthesitis- achilles or plantar fasciitis dactylitis SI pain reiters syndrome circunate balanitis keratoderma blennorrhagicum on palms/soles ---- painless eruptions eyes- conjunctivitis ```

FELTY syndrome

SANTA FELTY through the roof ``` splenomegaly arthritis (Rhemuaetoid) neutropenia thrombocytopenia anemia ```

spondylosolysis

defect of portion of bone btwn inferior and superior articular process of vertebrae

extra articular manifestations enteropathic arth

``` skin- pyoderma gangrenosum, erythema nodosum uveitis GI nephrolithiasis thromboemolism bones ```

treatment of psoriatic arth

nsaids DMARDs tnf inhibitors

monitor what with sulfasalzine | pregnancy?

WBC, | safe in preg

articular manifestations of RA increase risk of what

diarthrodial synovial joints small joints first, large ones later C1-C2 increase risk osteoporosis

treatment for ReA

usually self limited nsaid and steroids dmards if chronic antibiotics for urethritis

ankylosing spond and reactive arthritis more prevelant in __

men

what is the gel time

the time it takes for joints to loosen up throughout the day longer the time, the worse the prognosis

classification of RA, what are you looking at and what score means RA

``` is synovitis there look at number of joints serology acute phase reactants duration of symptoms ``` if 6/10 then def RA

mortality associated with RA

heart disease > malignancy > infcetion > renal disease> GI

AS and SI joint

erosions

hydroxychloroquine for RA

fu with ophthalmologist bc can casue retinal damage | safe in pregancy

labs for react arth

same as AS

peak of RA

30-60 yrs old

anti TNF agents in RA

catch the TNF in the AIRE adalimumab infliximab rituximab etanercept

rheumatoid vasculitis

purpura, petechial, splinter hemorrhages, digital infacrt

HLA for RA

HLA DRB4 or DRB1

pathogenesis of AS

immune mediated t cells TNF a level high enteric bacteria

spondylitis

inflammation of vertebrae

leflunomide for RA

dont use when pregnant!!!! | GI/hepatic/teratogenic

pyroderma gangrenosum in RA

tender reddish purple papule, leads to necrotic non healing ulcer poor prognosis

treatment of enteropathic arthritis

nsaids steroids methotrex tnf alpha inhibtor

treatment of RA

general with PT and OT NSAIDs Corticosteroids (long term use AEs) DMARDS: immunosupp = increase risk infection

treatment for AS

exercise PT NSAIDs TNF inhib

treatment of RA

NSAID for pain DMARD: methotrexate low dose steroid for few weeks

most common inflamation problem with the axial spine

ankylosing spondylitis

psoriatic arthritis

``` 40-60 SI and axial involvment pitting nails soft tissue swelling small and large joints ```

keratoconjuctivitis sicca (dry eyes)

2ndary to sjogrens syndrome or SLE

systemic features RA

fatigue, fever, anemia elevated ESR, CRP malaise, myalgia, depression

enthesis

site of ligamentous attachment to bone

knee and RA

bakers cyst in popliteal fossa

DD of AS

DISH calcification osteitis condensans Ilii- normal SI jt but xray shows sclerosis on iliac side of SI joint

imaging for AS

CT for erosions | MRI detects inflammation before changes seen on x rays or CT