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T4 CONA > Lec 5: Arthritides > Flashcards

Lec 5: Arthritides Flashcards

1
Q

Most common rheumatic disease

A

osteoarthritis

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2
Q

Osteoarthritis pathogenesis

A

Abnormal biomechanics leading to:
sclerosis, cysts, osteophytes, inflammation
**Asymmetric distribution

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3
Q

OA Clinical presentation

A
  1. Gradual onset of pain
  2. Deep achy pain
  3. Pain after activity, relieved by rest
  4. Morning stiffness that resolves after 30min
  5. Damp weather?
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4
Q

Damp weather and OA

A

No link made yet, barometric pressure?

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5
Q

OA-Spondylosis

A

Degeneration of facets, discs, vertebral bodies

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6
Q

Degenerative Disc Disease

A

Back pain due to IVD degeneration

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7
Q

Spinal OA management

A 
CMT
PT
Weight loss if indicated
Exercise
Traction help with stenosis
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8
Q

Seronegative Arthritides

A

Group of musculoskeletal syndromes similar to common clinical symptoms and mechanisms
*Absent rheumatoid factor

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9
Q

Common clinical features of Seronegative arthritides

A
  1. Male predominant
  2. **Spontaneous exacerbations and remission
  3. other issues: IBD, urethritis, eye disease
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10
Q

Ankylosing Spondylitis presentation

A
  • *3mos

* *relief with mild to moderate activity

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11
Q

AS

A 
**progressive spinal stiffening and fusion
usually affects SIJ
inflammatory arthritis
Loss of lordosis, increase kyphosis
Peripheral joint involvement
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12
Q

AS evaluation

A

Normal neuro/ortho exams
decrease Lumbar ROM
**Primary radiographic diagnosis

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13
Q

Amoss Sign

A

Instruct pt to get up from side lying position

Pos finding= pt places hands far from body and/or thoracic or thoracolumbar pain

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14
Q

AS Radiograph

A
  • *Bilateral asymmetric widening, erosion of SIJ
  • *trolley track/bamboo spine seen
  • *Changes may not be visible for 4-6yrs
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15
Q

AS management

A

**Unpredictable remission/relapse
CMT to maintain mobility
Monitor for cardiac, pulmonary involvement

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16
Q

Reiters Syndrome/Reactive Arthritis presentation

A

Young male

**Urethritis, conjunctivitis, skin lesions

17
Q

Reactive Arthritis

A

Diagnostic Triad-

  • *Polyarthritis-knees, ankles, SIJ
  • *Urethritis
  • *Conjunctivitis
  • *Lesion
18
Q

Reactive Arthritis evaluation

A

Hx of infection present (STD)
HLA-B27 marker
**Mechanical testing of SIJ=pain
change in film unilaterally (space narrowing, erosion)

19
Q

Reactive arthritis management

A

AB used to treat infection
CMT cautioned-could aggravate
Nonarticular symptoms resolve in days to weeks

20
Q

Psoriatic Arthritis

A

Precedes arthritis
**Can develop n absence of detectable psoriasis
MC in whites 35-55yo

21
Q

Psoriatic Arthritis with spondylitis

A

Occurs in 5% patients
Male predominance
**Sacroilitis if present is asymmetric
**vertebrae affected asymmetric

22
Q

Red flags are

A

Tumor, infection, spinal fx, nuero compromise (cauda equine)

**History is everything-be specific and ask lots of questions..weight loss, fever, numbness, weakness, etc

23
Q

abdominal aortic aneurysm (AAA) cause

A

Atherosclerosis MCC

24
Q

Location of AAA

A

MC L2-L4

**Most asymptomatic until rupture/bleed

25
Q

AAA facts

A

**life threatening
**MC in white males 65-75yo
M>F

26
Q

AAA presentation

A

Mild to severe Abdominal pain or LBP

Possibly leg pain due to claudication

27
Q

AAA radiograph

A

**>3.8cm=diagnostic
**10-20% survival rate for ruptures
>6cm needs surgical consult

28
Q

Cauda Equina Syndrome presentation

A 
LBP
sciatica
**bladder/bowel dysfunction
**Bowel dysfunction= most sensitive/specific indicator of Cauda equine
**could be fatal
29
Q

Metastatic Disease

A

Most common site=Spine
Not relieved with bed rest
**May become symptomatic after trauma due to vertebral weakness
**Immediate referral to oncologist

30
Q

Systemic Cancer

A

**Presents as initial spinal metastasis in 10% of pop

60-70% of systemic cancer patients will have spinal metastasis

31
Q

Primary sources for metastatic disease

A

Lung-31%
Breast-24%
GI-9%

32
Q

Multiple Myeloma

A

MC primary malignant tumor of bone
70% patients experience bone pain
**Lumbar spine most common site of pain

33
Q

Multiple Myeloma presentation

A

hypercalcemia
renal disease
**Bence jones proteins found
**Osteopenia found on film

34
Q

Infectious Spondylitis

A

**History of recent respiratory tract , urinary, skin infection

35
Q

2 types of infectious spondylitis

A
  1. Pyogenic- staph (90%), strep, gram neg organsims (could involve more than one vertebra)
  2. Nonpyogenic- TB, fungi, brucella (centered around L1)
    * *REFER OUT
36
Q

Mechanical BP

A

Relief by rest
1 or more pain free positions
sleep possible
able to reproduce cc

37
Q

Non mechanical BP

A

No relief of symptoms
no pain free positions
may be worse at night
unable to reproduce pain

T4 CONA (5 decks)

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