Joint Disease Flashcards
Osteoarthritis RA Septic Arthritis Reactive Arthritis
Modifiable Risk Factors for Osteoarthritis? (3)
- Obesity
- Trauma
- Labor-intensive Occupations
Most common presentations of Osteoarthritis?
- Stiffness
- Joint Pain
Symptoms that differentiate Osteoarthritis from Rheumatoid Arthritis?
Osteoarthritis: - Worsens w/ activity or weight bearing - DIP & PIP w/ MCP sparing Rheumatoid: - Improves with Activity - Spares DIP - Morning Stiffness
Presentations of Osteoarthritis on X-ray?
- Joint space narrowing
- Osteophtyes
- Subchondral sclerosing
- Subchondral cysts
Preferred Pharmacological Treatment of Osteoarthritis?
- Topical NSAIDS –> Oral NSAIDS
Autoimmune disease that causes muscles and joint pain. Associated w/ Temporal Arteritis
Polymyalgia rheumatica
Presentation of Polymyalgia Rheumatica?
- Pain in neck, Shoulders, hip
- Symmetrical morning Muscle Pain/Stiffness
Physical Exam observations of Polymyalgia Rheumatica?
- Edema in extremities
- Fatigue
- Tenderness to Palpitation
- Normal Muscle Strength
Lab Abnormalities?
- Increased ESR w/ decreased hematocrit
Treatment for Polymyalgia Rheumatica?
Low dose corticosteriods
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
Presentation of Septic Arthritis?
- Fever
- Pain in affected joint
- Pain in range of motion
Serum findings of Septic Arthritis?
- WBC > 10,000
- ESR > 30
- CRP > 5
Diagnosis of Septic Arthritis?
Joint Aspirate w/ 50,000+ WBC
also low glucose and high neutrophils
Treatment of Septic Arthritis?
Joint drainage + Appropriate Antibiotic
- S. Aureus: Pencillinase- Resistant (nafcillin, oxacillin)
- N. gonorrhoeae: Ceftriaxone,
- Gram neg: Cephalosporin, Fluoroquinolone
Rheumatoid Arthritis presents with what deformities?
- Ulnar Deviation
- Boutonniere Deformities
- MCP hypertrophy
- Z thumb
- Swan neck Deformities
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