Clinical Approach to RA, Seronegative Arthropathies and Gout (Johnston) Flashcards
What imaging should you use for RA?
Which is more sensitive detecting erosions?
1) X-rays of hands and feet
2) CT (more sensitive detecting erosions)
What mortality is highly associated with RA?
1) CAD
2) HF
The 2010 RA Classification Criteria has to have a score of what for definite RA?
6/10
What is found on labs for RA?
1) RF
2) Anti-CCP
What should you not do with RA patient?
Flexion of neck because C1-C2 can sublux
Rheumatoid nodules seen in the elbow are always positive for?
RF
What physical findings are found in the wrist with RA?
In the knee what can be found?
1) Radial deviation
2) Bakers cyst
What is Pyroderma Gangrenosum which can be seen in RA patients?
Tender reddish purple papule that leads to necrotic non-healing ulcer
What is Rheumatoid Vasculitis?
Purpura
Petechial splinter hemorrhages
Digital infarct
What autoimmune disorder with lacrimal and salivary dysfunction is seen in 35% of RA patients?
What antibody test will be seen?
What else is seen?
Sjogren’s syndrome
Anti Ro and La
Keratoconjunctivitis
Seronegative Spondyloarthropathies has immune susceptibility to what HLA?
HLA-B27
Seronegative Spondyloarthropathies have a predilection for what areas of the body?
Spine and SI joint
Which seronegative spondyloarthropathies has the strongest association with HLA-B27?
Ankylosing Spondylitis
Ankylosing Spondylitis is the most common inflammatory disorder of?
Axial skeleton and SI joints
What are the clinical manifestations of Ankylosing Spondylitis?
1) Low back pain for more than 3 months
2) Morning stiffness that improves with activity
3) Symmetrical SI joint pain
4) Planter fasciitis
What extra-articular manifestation of the eye can occur with Ankylosing Spondylitis?
Anterior uveitis (Iritis)
What is found on physical exam for Ankylosing Spondylitis?
Restricted forward flexion (Schober test)
Restricted chest expansion
What is found on vertebral imaging for Ankylosing Spondylitis?
1) Squaring (loss of anterior convexity)
2) Shiny corners (sclerosis at edge of vertebral bodies)
What is syndesmophytes?
Bridging of vertebrae (boney bridges cause ankylosis)
What imaging is more sensitive for erosions?
What imaging detects inflammation before changes seen on other modalities?
1) CT
2) MRI
In the differential diagnosis of AS, osteitis condensans ilii, will show what findings on imaging?
What happens in Diffuse idiopathic skeletal hyperosteosis (DISH)?
1) Normal SI joints
2) X-ray shows sclerosis on iliac side of SI joint
3) Normal SI Joint
4) Calcification along 4 contiguous vertebrae bodies
The age of onset for AS is?
Below age 40
Reactive Arthritis is an autoimmune disease that affects what?
Asymmetric mono-arthritis or oligo-arthritis (large joints) in LE
Reactive Arthritis may be associated with infections from what track?
GI/GU (Salmonella, shigella, chlamydia, etc)
What HLA is present in 75% of reactive arthritis and IBD associated arthritis?
HLA B27
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)
4) Asymmetrical SI Joint
5) Aortic Regurgitation/Insufficiency
In regards to reactive arthritis, what is Keratodermia blennorrhagica in a patient with Reiter’s syndrome?
Painless eruptions of the feet
Pitting of the nails is associated with?
Psoriatic arthritis
Psoriatic arthritis has what classic appearance on imaging?
Pencil in cup
Enteropathic Arthritis has what peripheral arthritis symptoms?
1) Parallels activity of IBD
2) Affects large joints of LE
3) Affects small joints of UE
What is the characteristic lesion associated with Gout?
What appearance does gout have on polarizing microcopy?
1) Tophi, white chalky masses of uric acid
2) Negative Birefringence, Needle like crystals
What are the cutaneous manifestations of Enteropathic Arthritis?
Erythema Nodosum
Pyoderma Gangrenosum
Uveitis
Uric acid is an end product of?
Purine degradation
Calcium Pyrophosphate Dehydrate Deposition Disease (CPPD) is also known as?
Pseudogout
Pseudogout leads to?
It affects what population most commonly?
1) Calcium deposits in articular cartilage of large joints
2) Older patients
The CPPD crystals are described as?
Short blunt rods, rhomboids/cuboids
What appearance does pseudogout have on polarizing microcopy?
POSITIVE birefringence
What is seen in Felty’s syndrome?
RA
Splenomegaly
RF+Anti CCP
