- Increased ESR w/ decreased hematocrit

Joint Disease Flashcards by Nadia Jacob

Modifiable Risk Factors for Osteoarthritis? (3)

Obesity
Trauma
Labor-intensive Occupations

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Most common presentations of Osteoarthritis?

Stiffness

- Joint Pain

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Symptoms that differentiate Osteoarthritis from Rheumatoid Arthritis?

Osteoarthritis:
- Worsens w/ activity or weight bearing
- DIP &amp; PIP w/ MCP sparing
Rheumatoid:
- Improves with Activity
- Spares DIP
- Morning Stiffness

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Presentations of Osteoarthritis on X-ray?

Joint space narrowing
Osteophtyes
Subchondral sclerosing
Subchondral cysts

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Preferred Pharmacological Treatment of Osteoarthritis?

Topical NSAIDS –> Oral NSAIDS

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Autoimmune disease that causes muscles and joint pain. Associated w/ Temporal Arteritis

Polymyalgia rheumatica

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Presentation of Polymyalgia Rheumatica?

Pain in neck, Shoulders, hip

- Symmetrical morning Muscle Pain/Stiffness

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Physical Exam observations of Polymyalgia Rheumatica?

Edema in extremities
Fatigue
Tenderness to Palpitation
Normal Muscle Strength

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Lab Abnormalities?

Increased ESR w/ decreased hematocrit

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Treatment for Polymyalgia Rheumatica?

Low dose corticosteriods

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Most common pathogen in Septic Arthritis?
In young adults?
In sickle cell patients?
In IV drug users and diabetics?

Staph. Aureus (most common overall)
N. gonorrhoeae
Salmonella
P. aeruginosa

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Presentation of Septic Arthritis?

Fever
Pain in affected joint
Pain in range of motion

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Serum findings of Septic Arthritis?

WBC > 10,000
ESR > 30
CRP > 5

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Diagnosis of Septic Arthritis?

Joint Aspirate w/ 50,000+ WBC

also low glucose and high neutrophils

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Treatment of Septic Arthritis?

Joint drainage + Appropriate Antibiotic

S. Aureus: Pencillinase- Resistant (nafcillin, oxacillin)
N. gonorrhoeae: Ceftriaxone,
Gram neg: Cephalosporin, Fluoroquinolone

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Rheumatoid Arthritis presents with what deformities?

Ulnar Deviation
Boutonniere Deformities
MCP hypertrophy
Z thumb
Swan neck Deformities

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Cause of Pannus and joint damage in Rheumatoid Arthritis?

Pannus is caused by cell-mediated immune response. IL-1 and TNF-a in the pannus lead to joint damage

Systemic manifestations of necrotic, non-healing leg ulcers, neutropenia, splenomegaly, indicate what syndrome that is associated with long-term RA?

Felty Syndrome

Joint aspiration of RA would show?

Decreased Complement

- Increased leukocyte count

Other Lab Findings in RA?

Anti-Cyclic Citrullinated Peptide
Increased ESR, CRP
Rheumatoid Factor (only 75%)
Positive ANA (only 40%)

Choice imaging of RA and finding?

X-Ray

Findings:
- Joint Erosion
- Joint Subluxation
- Joint Space Narrowing

First Choice Treatment for RA?

Methotrexate (DMARD)
Other DMARDs: Disease modifying anti-rheumatic drugs
- Sulfasalazine
- Hydroxycholoroquine

Treatment for resistant RA?

Add Biologic DMARD (etanercept, infliximab, adalimumab

- Add another DMARD

What should the patient be screened for before strting DMARDs?

Hep B & C

- Latent TB

Causes of underproduction of uric acid in Gout?

- Renal Disease | - Diurectics

Causes of overproduction of uric acid in Gout?

- Cancer - Hemoglobinopathies - Obesity

Diagnosic criteria of Gout?

Joint aspiration shows needle shaped, negatively birefringent crystals

Complications of chronic gout?

Tophi-> Deformation

First line treatment for Gout?

NSAIDS (naproxen, indomethacin)

Which NSAID is avoided in Gout and why?

Aspirin due to reduction in uric acid excretion at low doses

Alternative Treatments for Gout?

- Colchicine (microtuble inhibitor) | - Glucocorticoids

Classes of agents used to treat chronic gout?

- Uricosuric agents (e.g. probenecid, sulfinpyrazone) - Xanthine oxidase inhibitors (e.g. allopurinol, febuxostat) - Recombinant uricases (e.g. pegloticase, rasburicase

Contraindication for Probenicid?

Nephrolithiasis

Possible side effect of Allopurinol?

Stevens-Johnson Syndorme

Diagnostic criteria for Pseudogout?

Rhomboid shaped, positively bifringent crystals in aspirate. *Podagra rules out Pseudogout*

Findings on X-Ray in Pseudogout?

Chondrocalcinosis (calcification in joints)

Complication of Pseudogout?

Risk of Osteoarthritis in Affected joints

Treatment of Pseudogout?

- NSAIDS | - Colchicine

Which joints do Psoriatic Arthritis affects?

- Smaller joints of the upper extremities. | * Distal Interphalangeal joints*

Lab Findings in Psoriatic Arthritis?

- Increased Uric acid - Negative ANA and Rheumatoid factor - Increased ESR

Treatment of Psoriatic Arthritis?

NSAIDS

Complications of Psoriatic Arthritis?

- Hypertension | - Conjunctivitis

Joint Disease Flashcards

Osteoarthritis RA Septic Arthritis Reactive Arthritis