Clinical Approach to RA, Seronegative Arthropathies and Gout (Johnston) Flashcards

1
Q

What imaging should you use for RA?

Which is more sensitive detecting erosions?

A

1) X-rays of hands and feet

2) CT (more sensitive detecting erosions)

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2
Q

What mortality is highly associated with RA?

A

1) CAD

2) HF

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3
Q

The 2010 RA Classification Criteria has to have a score of what for definite RA?

A

6/10

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4
Q

What is found on labs for RA?

A

1) RF

2) Anti-CCP

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5
Q

What deformities are seen with RA in the hands?

A

1) Swan neck (hyperextension of PIP joints)

2) Boutonniere (hyperflexion of PIP joints)

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6
Q

Rheumatoid nodules seen in the elbow are always positive for?

A

RF

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7
Q

What physical findings are found in the wrist with RA?

In the knee what can be found?

A

1) Radial deviation

2) Bakers cyst

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8
Q

What is Pyroderma Gangrenosum which can be seen in RA patients?

A

Tender reddish purple papule that leads to necrotic non-healing ulcer

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9
Q

What is Rheumatoid Vasculitis?

A

Purpura, petechial, splinter hemorrhages, digital infarct

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10
Q

What autoimmune disorder with lacrimal and salivary dysfunction is seen in 35% of RA patients?

A

Sjogren’s syndrome

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11
Q

Seronegative Spondyloarthropathies has immune susceptibility to what HLA?

A

HLA-B27

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12
Q

Seronegative Spondyloarthropathies have a predilection for what areas of the body?

A

Spine and SI joint

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13
Q

Which seronegative spondyloarthropathies has the strongest association with HLA-B27?

A

Ankylosing Spondylitis

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14
Q

Ankylosing Spondylitis is the most common inflammatory disorder of?

A

Axial skeleton and SI joints

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15
Q

What are the clinical manifestations of Ankylosing Spondylitis?

A

1) Low back pain for more than 3 months
2) Morning stiffness that improves with activity
3) Symmetrical SI joint pain
4) Planter fasciitis

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16
Q

What extra-articular manifestation of the eye can occur with Ankylosing Spondylitis?

A

Anterior uveitis (Iritis)

17
Q

What is found on physical exam for Ankylosing Spondylitis?

A

Restricted forward flexion (Schober test) and restricted chest expansion

18
Q

What is found on vertebral imaging for Ankylosing Spondylitis?

A

1) Squaring (loss of anterior convexity)

2) Shiny corners (sclerosis at edge of vertebral bodies)

19
Q

What is syndesmophytes?

A

Bridging of vertebrae (boney bridges cause ankylosis)

20
Q

What imaging is more sensitive for erosions?

What imaging detects inflammation before changes seen on other modalities?

A

1) CT

2) MRI

21
Q

In the differential diagnosis of AS, osteitis condensans ilii, will show what findings on imaging?

A

1) Normal SI joints

2) X-ray shows sclerosis on iliac side of SI join

22
Q

The age of onset for AS is?

A

Below age 40

23
Q

What autoimmune disease will cause asymmetric mon-arthritis or oligo-arthritis (large joints) in lower extremities?

A

Reactive Arthritis

24
Q

Reactive Arthritis may be associated with infections from what track?

A

GI/GU (Salmonella, shigella, chlamydia, etc)

25
What HLA is present in 75% of reactive arthritis and IBD associated arthritis?
HLA B27
26
What are the clinical manifestations of reactive arthritis in young men?
1) Arthritis in ankles/knee 2) Achilles inflammation (Enthesitis) 3) Toe/finger inflammation (Dactylitis)
27
In regards to reactive arthritis, what is Keratodermia blennorrhagica in a patient with Reiter’s syndrome?
Painless eruptions of the feet
28
Pitting of the nails is associated with?
Peripheral arthritis
29
Psoriatic arthritis has what classic appearance on imaging?
Pencil in cup
30
Enteropathic Arthritis has what peripheral arthritis symptoms?
1) Parallels activity of IBD 2) Affects large joints of LE 3) Affects small joints of UE
31
Gout is due to elevated levels of? What location does it affect most? What is the characteristic lesion associated?
1) Uric acid 2) Base of big toe 3) Tophi, white chalky masses of uric acid
32
What appearance does gout have on polarizing microcopy?
Negative Birefringence, needle-like crystals
33
Uric acid is an end product of?
Purine degradation
34
Calcium Pyrophosphate Dehydrate Deposition Disease (CPPD) is also known as?
Pseudogout
35
Pseudogout leads to? It affects what population most commonly?
1) Calcium deposits in articular cartilage of large joints | 2) Older patients
36
The CPPD crystals are described as?
Short blunt rods, rhomboids/cuboids
37
What appearance does pseudogout have on polarizing microcopy?
POSITIVE birefringence