Essentials of Dx - Final Flashcards
Usually insidious onset with morning stiffness and pain in affected joints.
Symmetric polyarthritis w/ predilection for small joints of hands and feet; deformities common with progressive dz
Radiographic findings; juxta-articular osteoporosis, joint erosions, and joint space narrowing
Rheumatoid factor and anti-CCP are present in 70-80%
Extra-articular manifestations: subcutaneous nodules, pleural effusion; pericarditits, lymphadenopathy, splenomegaly with leukopenia and vasculitis
Adult rheumatoid arthritis
occurs mainly in young women
Rash over areas exposed to sunlight
Jt symptoms in 90% of pts
Multiple system involvement
Anemia, leukopenia, thrombocytopenia
Glomerulonephritis, CNS dz, and complications of antiphospholipid antibodies are major sources of dz morbidity
Serologic findings: ANA (100%), anti-native DNA, antibodies (2/3), and low serum complement levels (particularly during dz flares)
SLE
Limited dz (80%): thickening of skin confined to the face, neck, and distal extremities
Diffuse dz (20%): widespread thickening of skin, including truncal involvement, with areas of increased pigmentation and depigmentation
Raynaud phenomenon and ANA are present in virtually all pts
Systematic features of gastroesophageal reflux, hypo mobility of GI tract, pulmonary fibrosis, pulmonary HTN, and renal involvement
Scleroderma
Bilateral proximal muscle weakness
Characteristic cutaneous manifestation in dermatomyositis (Gottron papules, heliotrope rash)
Diagnostic tests: elevated CK, muscle biopsy, EMG, MRI
Increased risk of malignancy, particularly in dermatomyositis
Idiopathic inflammatory myopathies (polymyositis and dermatomyositis)
Women are 90% of pts; the avg age is 50 yrs
Dryness of eyes and dry mouth (sicca components) are the most common features; they occur alone or in assoc. with RA or other CT dzs
RF and other autoantibodies common
Increased incidence of lymphoma
Sjogrens syndrome
Age over 50 yrs
GCA is characterized by visual abnormalities, and a markedly elevated ESR
The hallmark of PMR is pain and stiffness in shoulders and hips lasting for several weeks without other explanation
Polymyalgia rheumatic (PMR) and Giant cell arteritis (GCA)
Chronic low backache in young adults, generally worse in morning
Progressive limitation of back motion and of chest expansion
Transient (50%) or persistent (25%) peripheral arthritis
Anterior uveitis in 20-25%
Diagnostic radiographic changes in SI jts
HLA B27 is most helpful when there is an indeterminate probability of dz
Ankylosing spondylitis (Marie-Strumpell dz)
Psoriasis precedes onset of arthritis in 80% of cases
Arthritis usually asymmetric, with “sausage” appearance of fingers and toes but a polyarthritis that resembles RA also occurs
SI jt involvement common; ankylosis of SI jts may occur
Radiographic findings: osteolysis, pencil-in-cup deformity; relative lack of osteoporosis, bony ankylosis; asymmetric SI and atypical syndesmophytes
psoriatic arthritis
50-80% of pts are HLA B27 positive
oligoarthritis, conjunctivitis, urethritis, and mouth ulcers most common features
Usually follow dysentery or an STI
Reactive arthritis (Reiter’s syndrome)
Acute onset, typically nocturnal and usually monoarticular, often involving the first MTP joint
Polyarticular involvement more common in pts with long-standing dz
ID of urate crystals in joint fluid or tophi is diagnostic
Dramatic therapeutic response to NSAIDs
With chronicity, urate deposits in subcutaneous tissue, bone, cartilage, joints and other tissues
Gouty arthritis
Acute onset of inflammatory monoarticular arthritis, most often in large weight-bearing joints and wrists
Previous jt damage or injection drug abuse common risk factors
Infection with causative organisms commonly found elsewhere in body
Jt effusions are usually large, with WBC counts commonly > 50 K/mcl
Non-gonococcal septic arthritis
Prodromal migratory polyarthralgias Tenosynovitis most common sign Purulent monoarthritis in 50% Characteristic skin lesions Most common in young women during menses or pregnancy Symptoms of urethritis frequently absent Dramatic response to antibiotics
Gonococcal septic arthritis
Erythema migrans
Headache or stiff neck
Arthralgias, arthritis, and myalgias; arthritis is often chronic and recurrent
Wide geographic distribution, with most US cases in NE, mid Atlantic, upper Midwest, and Pacific coastal regions
Lyme Disease
Uncommon in the US; more common in developing countries
Peak incidence ages 5-15 yrs
Diagnosis based on Jones criteria and confirmation of streptococcal infection
May involve mitral and other valves acutely, rarely leading to heart failure
Acute rheumatic fever (ARF)
Weakness, fatigue, cold intolerance, constipation, weight change, depression, menorrhagia, hoarseness
Dry skin, bradycardia, delayed return of DTRs
Anemia, hyponatremia, hyperlipidemia
FT4 level is usually low
TSH elevated in primary
Hypothyroidism
