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Skin/MSk > Exam 6 arthridities > Flashcards

Exam 6 arthridities Flashcards

1
Q

What is a type of non-inflammatory arthritis?

A

Osteoarthrits

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2
Q

What are the inflammatory arthridities?

A

Rheumatoid arthritis, Juvenile idiopathic arthritis, System lupus erythematosus, Crystal induced arthritis, sponydloarthropathies (ankylosing spondy, psoriatic, reactive)

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3
Q

What is the distribution of osteoarthritis?

A

Knees, hips, spine (cervical and lumbar), hands (DIP, PIP), feet (first metatarsophalangeal)

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4
Q

How does osteoarthritis advance?

A

progressive loss of articular cartilage

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5
Q

What is the clinical presentation of osteoarthritis?

A

>50 yo, Gradual onset, initially intermittent and self-limited, Use-related pain (knees and hips worse w/ weight bearing, hands worse w/ over use), Relieved by rest, morning stiffness less than 30 mins

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6
Q

What are risk factors for osteoarthritis?

A

Increasing age, major joint trauma, obesity (knees), repetitive activities, genetic predisposition, congenital/developmental defects, females

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7
Q

What is most common arthritis?

A

Osteoarthritis

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8
Q

What arthritis do you think when you hear “bone on bone”?

A

Osteoarthritis

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9
Q

How long is the stiffness for osteoarthritis?

A

only 30 minutes

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10
Q

What does the physical exam of osteoarthritis look like?

A

Localized pain, limited ROM, bony enlargement, soft tissue swelling

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11
Q

T/F: Osteoarthritis patients have heat in their affect joints?

A

False

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12
Q

What are x-rays of osteoarthritis?

A

new bone formation in subchondral trebeculae, osteophyte formation at joint margins, loss of cartilage

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13
Q

How do you treat osteoarthritis (non-drug treatments)?

A

Weight reduction, exercise helps a lot, physical therapy for ROM, assistive devices, joint replacement

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14
Q

What are the drugs to treat osteoarthritis?

A

Acetaminophen, NSAIDs, alagesics, some topical agents, joint injections, hyaluronic derivative injections

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15
Q

When is the onset of rheumatoid arthritis?

A

30-50 years old

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16
Q

T/F: more women have rheumatoid arthritis than men?

A

True, 3:1

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17
Q

what are the risk factors of rheumatoid arthritis?

A

smoking, periodontal disease

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18
Q

What does rheumatoid arthritis present as?

A

symmetric inflammation (insidious and erosive), chronic and progressive, positive rheumatoid factor, positive anti-CCP Ab, systemic factors

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19
Q

What are some extra-articular manifestations of rheumatoid arthritis?

A

subcutaneous nodes, pericarditis, pulmonary nodules, interstitial fibrosis, inflammatory eye disease, vasculitis

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20
Q

T/F: stiffness of rheumatoid arthritis in the AM lasts longer than osteoarthritis?

A

True, lasts at least 1 hour

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21
Q

What is the classification criteria of rheumatoid arthritis?

A

Morning stiffness for 1 hour, swelling in 3+ joints, swelling in hands, symmetric joint swelling, erosions/decalcification of hand on x-ray, rheumatoid nodules, + rheumatoid factor

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22
Q

What joints are affected by rheumatoid arthritis?

A

Wrists, MCP, PIP, MTP, ankles, knees, elbows, shoulders

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23
Q

What are the treatments of rheumatoid arthritis?

A

patient education, PT/OT, exercise/rest, medications (NSAIDs, steroids, DMARD’s (disease modifying anti-rheumatic drugs))

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24
Q

What are some DMARD options for rheumatoid arthritis pts?

A

Hydroxychloroquine, minocycline, gold, slfasalazine, TNF-blockers, B-cell blockers, T-cell costimulators, anti-interleukins

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25
Q

What are differential subtypes of juvenile idiopathic arthritis?

A

systemic onset, polyarticular onset, pauciarticular onset

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26
Q

When is the onset of juvenile idiopathic arthritis?

A

typically 1-6 years old

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27
Q

What are systemic features of juvenile idiopathic arthritis systemic onset?

A

lymphadenopathy, hepatosplenomegaly, pericardial/pleural effusions, fatigue, muscle atrophy, weight loss, leukocytosis, anemia

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28
Q

T/F: juvenile idiopathic arthritis polyarticular onset can be divided into rheumatoid factor positive/negative individuals?

A

true (mostly RF-negative)

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29
Q

What is the clinical feature of juvenile idiopathic arthritis polyarticular onset?

A

malaise, weight loss, low grade fever, lympadenopathy, anemia

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30
Q

T/F: juvenile idiopathic arthritis oligoarticular/pauciarticular onset has a positive ANA?

A

True

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31
Q

What joints does juvenile idiopathic arthritis oligoarticular/pauciarticular onset affect?

A

knees, ankles, wrists, elbows

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32
Q

What are the subgroups of juvenile idiopathic arthritis oligoarticular/pauciarticular onset?

A

Psoriatic (nail pitting, dactylitis, sacroiliitis), Enthesitis-related JIA (Negative RF and ANA, older than 6 males, Positive HLA-B27, ocular inflammation, sacroiliitis), Undifferentiated

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33
Q

What is the treatment of juvenile idiopathic arthritis oligoarticular/pauciarticular onset?

A

Pt/parent education, PT/OT, NSAIDs, Steroids (intra-articular/oral), DMARDS (methotrexate, sulfasalazine, leflunomide), Biological DMARDS (anti-TNF, anti-IL-1)

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34
Q

What is systemic lupus erythematosus?

A

autoimmune disease with ANA

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35
Q

T/F: systemic lupus erythematosus affects more females than males?

A

True

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36
Q

What are clinical features of systemic lupus erythematosus?

A

Butterfly rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, POSITIVE ANA

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37
Q

What are the genetic links of systemic lupus erythematosus?

A

most cases are sporadic, strong familial aggregation, can strong link in twins (especially monozygotic)

38
Q

What is the treatment of systemic lupus erythematosus?

A

NSAIDs, corticosteroids, antimalarials (hydroxychloroquine), methotrexate, leflunomide, cyclophosphamide, dapsone, sunscreen

39
Q

What are the clinical presentations of drug-induced SLE?

A

fever, malaise, arthritis/arthalgias, serositis, rash

40
Q

What is the therapy for drug-induced SLE?

A

stop the medication

41
Q

What medications is drug-induced SLE associated with?

A

procainamide, hydralazine, methyldopa, chlorpromazine, isoniazid, quinidine, minocycline

42
Q

What are the two forms of crystal-induced arthritis?

A

Gout (uric acid), pseudogout (calcium pyrophsophate deposition)

43
Q

What does gout cause when it deposits in the joints, skin and kidneys?

A

Joints: acute imflammatory arthritis, Skin: accumulation of crystals (tophi), Kidney: uric acid urolithiasis, nephropathy

44
Q

What are the stages of gout?

A

asymptomatic hyperuricemia, acute intermittent gout, chronic tophaceous gout

45
Q

What are the causes of gout

A

Uric acid overproduction (HGRT, PRPP synthetase overacticity, psoriasis, alcohol), Uric acid underexcretion (90%) (hypertension, obesity, lead, low dose aspirin)

46
Q

What does acute intermittent gout usually start?

A

between fourth and sixth decade of life

47
Q

T/F: women have a later onset of acute intermittent gout?

A

True (after menopause)

48
Q

What is the clinical story or a pt with acute gouty arthritis?

A

Often occurs at night, pain escalates very highly in 8-10 hours, may subside in 3-10 days, fever, chills, malaise

49
Q

What structures are involved in acute gouty arthritis?

A

Pariarticular structure (bursa, tendons), Joints

50
Q

Where does acute gouty arthritis affect individuals?

A

Lower extremeties (podagra first MTP), usually monoarticular but may be polyarticular, can involve other MTPs, midfoot, ankles, wrist, fingers

51
Q

How do you diagnose gout?

A

Serum uric acid levels (not often specific enough for an acute attack), HISTORY AND PHYSICAL for clinical manifestations. SYNOVIAL FLUID ANALYSIS IS GOLD STANDARD

52
Q

What is the cut off of leukocytes when you are looking at a joint effusion for non-inflammatory and inflammatory joints?

A

2000

53
Q

What are triggering factors of gout?

A

Alcohol ingestion, trauma, sever illness, IV hydration, Medications (thiazide diuretics, low dose aspirin, cyclosporine), Dietary excess (high purine foods like red meat), IV contrast dye

54
Q

What can advanced gout lead to?

A

Chronic arthritis leading to joint destruction that is polyarticular (both upper and lower extremities)

55
Q

What are tophi?

A

Solid uric acid deposits (white chalky material) that are a result of advanced gout

56
Q

How do you decrease the levels of uric acid in a patient to prevent the formation of tophi?

A

xanthine oxidase inhibitor

57
Q

Where are tophi usually found?

A

helix of ear, periarticular regions (fingers, wrist, olecranon bursa)

58
Q

What are the pearls of Gout arthritis?

A

can have NORMAL uric acid levels, hyperuricemia results from diuretic therapy, allopurinol is NOT appropriate initial therapy during acute attack of gout, try to keep uric acids levels below 6

59
Q

What should acute gout be treated with (pharma)?

A

NSAIDs and steroids

60
Q

Should you treat acute gout with allopurinol?

A

NO

61
Q

What is the treatment of gout?

A

Aspiration of joint/analysis of fluid, dietary counseling (alcohol and obesity), NSAIDs, colchicine, allopurinol, glucocorticoids, analgesics

62
Q

Where do you find calcium pyrophosphate dihydrate?

A

Psuedogout patients

63
Q

What can pseudogout be confused with?

A

gout, OA, RA

64
Q

If a person is 95 years old, are they most likely to have gout or pseudogout?

A

pseudogout

65
Q

Where is pseudogout most likely to affect patients?

A

knees (most common), wrists, hips, shoulders, ankles

66
Q

What will x-rays of a pseudogout joint show?

A

chondrocalcinosis (wrist, knees, symphisis pubis)

67
Q

What is the largest risk factor for pseudogout?

A

aging

68
Q

What is pseudogout associated with?

A

hyperparathyroidism, hemochromatosis, hypothyroidism, prior trauma

69
Q

T/F: Gout has more men than women, while pseudogout has more women than men?

A

False, Gout: Men>>Women, psuedogout men=women

70
Q

What joints is gout most likely to affect?

A

1st MTP, instep, ankles, knees

71
Q

Does gout and pseudogout have renal complications?

A

only gout does

72
Q

What is the differences of x-ray for gout and pseudogout?

A

Gout: soft tissue swelling/erosions, pseudogout: chondrocalcinosis, osteoarthritis

73
Q

What are the treatments (pharma) for pseudogout?

A

NSAIDs, colchicine is kinda effective, not preventative drug, intra-articular steroids

74
Q

What are spondyloarthropathies?

A

Multisystem inflammatory disorder

75
Q

What do spondyloarthropathies usually affect?

A

spine, sacroiliitis, peripheral joints, periarticular structures

76
Q

T/F: spondyloarthropathies are HLA B27 positive?

A

true

77
Q

What are non-vertebral symptoms of spondyloarthropathies?

A

Plantar fasciitis, inflammatory eye disease, mucocutaneous lesions, asymmetric peripheral arthritis, sausage digits, achilles tenosynovitis

78
Q

What are subcatagories of spondyloarthropathies?

A

ankylosing spondylitis, psoriatic arthritis, reactive arthritis (Reiter’s syndrome), arthritis associated with inflammatory bowel disease

79
Q

What disease are associated with HLA B27 positive gene?

A

ankylosing spondylitis (90%), Reactive arthritis (Reiter’s sydrome) (85%), Psoriatic arthritis (spondylitis, peripheral arthritis), Inflammatory bowel disease (50%)

80
Q

What is ankylosing spondylitis?

A

NOT mechanical back pain, inflammatory back pain

81
Q

What does ankylosing spondylitis present with?

A

Back pain with onset before 40, gradual pain that progresses, indidious, >3 mos, Morning stiffness, pain decreases with exercise

82
Q

What other arthritises/problems does ankylosing spondylitis present with?

A

Axial arthritis, sacroiliitis, peripheral arthritis (swollen knee/foot), aortitis, cardiac arrhythmias

83
Q

What joints does psoriatic arthritis affect?

A

Peripheral arthritis at DIP joints

84
Q

What can psoriatic arthritis patients present with?

A

psoriasis, arthritis at DIP joints, sausage toes, achilles tendinitis, plantar fasciitis, sacroiliitis, pits in finger nails

85
Q

When does reactive arthritis develop?

A

after an infection (bowel with compylobacter, salmonella, shigella, yersinia), or genital (chlamydia)

86
Q

Are pts who develop reactive arthritis usually HLA B27+?

A

Yes

87
Q

Is reactive arthritis also an infection of the joint?

A

No, just triggers inflammation

88
Q

What joints does reactive arthritis affect? When does it occur?

A

usually large joints of lower extremity (knees and ankles), usually within 1 month of infection

89
Q

What are extra-articular manifestations of reactive arthritis?

A

conjuctivitis, urethritis or cervicitis, genital ulcers, rash on palms of soles

90
Q

What is the treatment of spondyloarthropathies?

A

PT/ROM/good postures, Meds: NSAIDs, for peripheral arthritis: sulfasalazine, methotrexate, for axial arthritis: biologics (TNF blockers), Abx for chlamydia

91
Q

Give an overview of osteoarthritis (clinical, lab, radiographic)

A
92
Q
A

Skin/MSk (31 decks)

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