Inflammatory Joint Disorders Flashcards
What are the 4 Key characteristics of Inflammatory joint disorders?
- -Symmetric erosions
- -Soft tissue swelling
- -Uniform loss of joint space
- -Juxta-articular osteoporosis (bare area)
What are the 2 types of inflammatory diseases?
Seropositive (Rheumatoid types)
Seronegative (Rheumatoid variants)
What are the 4 types of Seropositive inflammatory diseases?
- -RA
- -SLE
- -Scleroderma
- -Jaccoud’s
What are the 4 types of Seronegative inflammatory diseases?
- -AS
- -Reactive
- -Psoriatic arthritis
- -Enteropathic arthritis
What are 2 characteristics of Rheumatoid arthritis?
- -Pannus forming
- -Bilateral symmetric
Rheumatoid arthritis targets what 3 sites?
- -Hands
- -Feet
- -Cervical spine
What symptoms differentiate RA in the hand from other arthritides?
Pain, tenderness, swelling, stiffness ESPECIALLY IN AM
What 2 joints are most commonly affected by RA in the hand?
PIPs and MCPs
Boutonnière deformity affects what joints and how?
- -DIP extension
- -PIP flexion
Swan neck deformity affects what joints and how?
- -DIP flexion
- -PIP extension
Haygarth’s nodes affect what joints and how?
Soft tissue swelling adjacent to MCP
What is the first sign of RA in the wrist?
Soft tissue swelling at the distal ulna
If untreated, RA in the wrist will lead to erosions at what locations?
- -Distal ulna
- -Radial styloid
How does RA affect the knees?
Symmetric loss of joint space (both medial and lateral)
How does RA affect the hips?
Bilateral symmetric decrease in joint space
If a patient has RA in the cervical spine, what must you evaluate?
Upper C-spine stability (ADI space)
How is Juvenile RA different from adult RA?
Juvenile = Seronegative
Adult = Seropositive
Juvenile RA produces what growth deformity?
Ballooned epiphyses
What are the target sites of Juvenile RA?
- -Knees
- -Ankles
- -Hands
- -Hips
- -Cervical spine
How does SLE differ from RA or OA?
Reversible deformities:
- -Ulnar drift
- -Swan-neck/boutonnière
- -hitchhiker thumb
How is Jaccoud’s arthropathy different from RA or OA?
Non-erosive, reversible joint deformity
What hand and feet deformities are associated w/ the Jaccoud’s arthropathy?
–Ulnar deviations and flexion of the MCPs
–Fibular deviation of the MTPs
What seropositive arthropathy begins w/ GI symptoms, Raynaud’s phenomena and RA-like arthritis?
Scleroderma
What population is most at risk for Scleroderma?
Women, onset is 30-50
What seropositive arthropathy doesn’t have spinal involvement?
Scleroderma
What are the 2 distinctive findings that would lead some be diagnosed w/ scleroderma?
Mouse-like facies and hidebound skin
What is Crest Syndrome?
- -Calcinosis
- -Raynaud’s phenomenon
- -Esophageal dysmotility
- -Sclerodactyly
- -Telangiectasia
CREST Syndrome is associated w/ what arthropathy?
Scleroderma
What seropositive arthropathy has retraction of the fingertips w/ resorption of the distal tufts?
Scleroderma
What is Acro osteolysis?
Resorption of the distal bony phalanges
What is the lab finding for seronegative arthropathies?
POSITIVE HLA-B27
What are the 4 Seronegative RA variants?
- -Psoriatic arthritis
- -Enteropathic arthritis
- -AS
- -Reactive
What is the most common seronegative RA variant?
AS
AS is a chronic inflammatory condition most commonly affecting what populations?
Males
Ankylosing Spondylitis is 100% involved in what joint?
SI joint
How is Ankylosing Spondylitis differentiated from the other arthropathies affecting the SI joints?
Bilateral symmetric
Ankylosing Spondylitis erosions present as what sign?
Rosary bead sign
Ankylosing Spondylitis involving the upper SI will present with what sign?
Star sign
How does AS affect the vertebral body?
- -destroy corner of vertebral body
- -squaring of vertebrae anteriorly
- -ossification of outer annular fibers
What seronegative RA variant presents as “bamboo spine?”
AS
What seronegative RA variant presents as “Shiny corner sign?”
AS
What is the difference between marginal and non-marginal?
Marginal = originates at vertebral margin
Non-marginal = originates mid-body
What is a syndesmophyte?
Bony growth originating inside a ligament
Radiographically what is the difference between marginal and non-marginal?
Marginal = thin
Non-marginal = thick
What are 3 signs of AS at the apophyseal joints?
Erosion, sclerosis, loss of space
If AS produces a “Trolly track sign,” what 4 ligaments will ossify?
- -Capsule,
- -Ligamentum Flavum
- -Inter/supraspinous lig
If AS produces a “Dagger sign,” what 2 ligaments will ossify?
Inter/supraspinous ligaments
What 3 joints are affected w/ psoriatic arthritis?
- -Peripheral joints
- -SI
- -Spine
If you find arthritis affecting peripheral joints, SI, spine, and the patient has nail pitting what is the pathology?
Psoriatic Arthritis
What joints in the hand are affected by psoriatic arthritis?
DIPs and PIPs
What is it called if psoriatic arthritis 3 joints in the hand?
Ray pattern
What type of pattern does psoriatic arthritis present as in the hands?
Asymmetric, joint widening, and erosion
What do the marginal erosions of the psoriatic arthritis resemble?
Mouse ears
What form of arthritis presents with:
- -Conjuctivitis
- -Urethritis
- -Heel spur or retrocalcaneal bursitis
Reactive arthritis
How does one distinguish the reactive arthritis from psoriatic arthritis?
Reactive primarily involves feet, psoriatic arthritis primarily involves hands
What is the foot rash associated w/ reactive arthritis?
Keratoma blennorrhagica
What are the 4 common sites involving CPPD?
- -Knee (menisci)
- -Wrist
- -MCPs
- -Symphysis pubis
What is the most frequent joint for clinical and radiographic changes of CPPD?
Knee (menisci)
If CPPD is in the wrist, it will present as a calcification of triangular cartilage in what joint?
Ulnar meniscial triquetral joint
Hemochromatosis presents as a triad of what 3 things?
- -cirrhosis
- -diabetes
- -bronze colored skin
What radiographic sign will hemochromatosis present with in the hand?
MCP hook osteophytes
What pathology presents w/ an “overhanging edge/margin” sign, at periarticular erosions?
Gout
What 3 lab tests are used to determine seropositive/RA types?
Increased ESR, + ANA test, –HLA-B27
What 3 lab tests are used to determine seronegative/RA variants?
Increased ESR, – ANA test, + HLA-B27
