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MSK > Lecture 10: Arthritis Part 2 > Flashcards

Lecture 10: Arthritis Part 2 Flashcards

1
Q

Juvenile idiopathic arthritis (JIA), is characterized by chronic arthritis in () joints for at least () weeks

A

1 or more joints for 6+ weeks.

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2
Q

Enthesis is…

A

Where bone and tendons interface

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3
Q

The MC type of JIA is () type, which is characterized by arthritis affecting () or fewer joints. It often affects medium to large joints and is (symmetrical/asymmetrical)

A
  • Oligoarticular type
  • 4 or less joints
  • Asymmetrical
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4
Q

Usually, the only S/S seen for oligoarticular JIA is a () discrepancy and inflammation in the ()

A
  • Leg-length discrepancy
  • Inflammation of the eye (Anterior uveitis i think)
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5
Q

Once 5 or more joints are affected in JIA, its type changes to (), and it typically is symmetrical

A

Polyarticular

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6
Q

Polyarticular JIA can be RF+ or RF-. The worse one that resembles adult RA is..

A

RF positive

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7
Q

Systemic JIA is rare, but it has 2 key features, which are:

  • High () 1-2x a day
  • () on pressure areas
A
  • High fever
  • Evanescent, salmon-pink macular rash
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8
Q

Enthesitis-associated JIA mainly affects () older than (), and typically only affects (lower/upper) extremity large joints.

A

Boys older than 10 in their LE large joints.

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9
Q

Hallmark sign of enthesitis-associated JIA is…

A

Inflammation of tendinous insertion (enthesopathy), such as tibial tubercle or the heel

LBP + sacroilitis are common too.

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10
Q

The diagnostic test for JIA is…

A

No diagnostic test :)

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11
Q

The two tests that may help detect RF+ JIA are…

A
  • Anti-CCP antibody
  • Positive ANA
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12
Q

Carrying the HLAB27 antigen increases the risk of developing (subtype) JIA

A

Enthesitis-associated

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13
Q

JIA joint fluid analysis typically shows () WBCs, primarily (). The glucose is usually ()

A
  • 5-60k WBCs, mainly neutrophils.
  • Normal to slightly low glucose
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14
Q

The initial imaging study for JIA is…

A

Radiographs

May only show soft tissue swelling

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15
Q

First line therapy for JIA is…
2nd line therapy for JIA is…

A
  1. NSAIDs (Naproxen, advil, meloxicam w/ food)
  2. MTX

TNF inhibitors are after MTX

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16
Q

You should only use corticosteroids for JIA in children with ()

A

Severe involvement/systemic JIA

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17
Q

Uveitis is primarily treated with () and ()

A
  • Steroid eye drops
  • Dilating agents
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18
Q

The best rate of clinical remission among the JIAs is (), and the worst for chronic arthritis into adulthood is ()

A
  • Best: Oligoarticular
  • Worst: RF+ JIA
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19
Q

Seronegative for spondyloarthritis means they are negative for ()

A

RF

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20
Q

Generally, the biggest association for seronegative spondyloarthritis is the () gene, especially with ankylosing spondylitis.

A

HLA B27

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21
Q

Seronegative spondyloarthritis are characterized by (symm/asymm) oligoarthritis of large peripheral joints and ()pathy

A
  • Asymmetrical
  • Enthesopathy
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22
Q

The biggest risk of developing reactive arthritis is those with HLA B27 + infection with… (3 bacteria)

A
  • Salmonella
  • Shigella
  • Enteric organisms

I feel like this could be a question…

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23
Q

The fusion of bones in ankylosing spondylitis is sometimes referred to as a () spine

A

Bamboo spine

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24
Q

Ankylosing spondylitis typically occurs in (age) and affects mainly (sex)

A
  • Late teens/early 20s
  • Males
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25
Q

Back pain worse in the morning and stiffness for hours that improves with activity in a 20M + Flattening of the lumbar and exaggeration of the thoracic is suggestive of…

A

Ankylosing spondylitis

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26
Q

Ankylosing spondylitis causes the lumbar spine to () while the thoracic spine ()

A
  • Lumbar turns into a Line
  • Thoracic Curves (Chest Curves)
27
Q

Ankylosing spondylitis can be differentiated from RA because () symptoms are not present.

A

Constitutional symptoms

28
Q

Transient acute arthritis of the peripheral joints, turning them into sausages, is known as…

A

Dactylitis

29
Q

What are the lab findings associated with ankylosing spondylitis?

  • Elevated (ESR vs CRP) in 85%
  • RF and anti-CCP antibodies are ()
  • () gene in 90% of white pts
A
  • Elevated ESR
  • NEGATIVE RF and anti-CCP antibodies
  • HLA B27 gene
30
Q
  • Bilateral and symmetrical erosion/sclerosis of sacroiliac joints.
  • Shiny corner sign
  • Bamboo spine

All describe what spondyloarthritis?

A

Ankylosing spondylitis

31
Q
  • First-line tx for ankylosing spondylitis: ()
  • 2nd-line tx:
  • () should not be used
A
  • First-line: NSAIDs
  • 2nd-line: TNF inhibitors
  • DO NOT USE corticosteroids

I think this is the only one that TNF is 2nd-line instead of MTX

32
Q

The development of () within the first 2 years of ankylosing spondylitis onset is a worse prognosis

A

Hip disease

33
Q

In psoriatic arthritis, what comes first: the psoriasis or arthritis?

A

Psoriasis first usually

34
Q

Psoriatic arthritis subtypes

  1. Symmetric polyarthritis can resemble (), but fewer joint involvement.
  2. Oligoarticular form may lead to () of affected joints
  3. () joints are primarily affected + pitting of the ()
  4. Arthritis mutilans is () deforming arthritis
  5. Spondylotic form affects () and (), usually HLAB27 positive.
A
  1. Resembles RA
  2. Destruction of affect joints
  3. DIP joints + pitting of nails
  4. Severe deforming arthritis
  5. Sacroilitis and spinal involvement
35
Q

Lab findings in psoriatic arthritis:

  • Elevated (inflammatory marker)
  • RF is ()
  • Elevated (acid)
A
  • Elevated ESR
  • RF negative
  • Elevated uric acid

but no gouty attacks

36
Q
  • Sharpened pencil fingers on XR
  • Asymmetric sacroilitis and coarse syndesmophytes

Most suggestive of…

A

Psoriatic arthritis

37
Q
  • First-line tx for psoriatic arthritis ()
  • 2nd-line ()
A
  • First-line: NSAIDs! (if mild)
  • 2nd-line: Methotrexate
  • Can add to TNF inhibitors to MTX if refractory
38
Q

In the triad of:

  • Arthritis
  • Conjunctivitis/uveitis
  • Urethritis

And HLA-B27 Positive

The underlying condition could be…

A

Reactive arthritis

39
Q

A patient that develops arthritis symptoms 1-4 weeks after a GI or STD infection might have…

A

Reactive arthritis

40
Q

Reactive arthritis is (symm/asymm) and frequently involves () joints. It is also characterized by () and () at the onset of the disease.

A
  • Asymmetrical
  • Large wt-bearing joints (knee/ankle)
  • Fever and Wt loss
41
Q

Very low yield slide but if you really want to for reactive arthritis

A
42
Q
  • First line tx of reactive arthritis is ()
  • 2nd line tx is ()
A
  • First-line: NSAIDs
  • 2nd line: MTX or Sulfasalazine
  • anti-TNF for refractory

Also treat STDs

43
Q

Which IBD is more common with arthritis?

A

Crohn’s disease

44
Q

In peripheral arthritis, the severity of IBD () the activity of the joint disease.

In spondylitis arthritis, the severity of IBD () the activity of the joint disease.

A
  • Peripheral Parallels
  • Spondylitis Single (independent)

IBD spondylitis is basically ankylosing spondylitis

45
Q
  • First-line tx of Peripheral arthritis ()
  • First-line tx of spondylitis arthritis ()
A
  • Peripheral: tx the IBD
  • Spondylitis: NSAIDs

Also DMARDs and corticosteroids can help

46
Q

Septic arthritis is an acute onset of inflammatory arthritis in () joint

A

Monoarticular!

Usually the big ones

47
Q

4 biggest RFs for septic arthritis are:

  • () in the blood
  • () joints
  • () immunity
  • Loss of () integrity
A
  • Bacteremia
  • Damaged/prosthetic joints due to RA
  • Compromised immunity
  • Loss of skin integrity
48
Q

The MC affected joint in septic arthritis is…

A

Knee

49
Q

You need to get a () to diagnose septic arthritis, showing () WBCs, and primarily () cells

A
  • Synovial fluid analysis
  • More than 50k WBCs
  • 90% PMN cells
50
Q

Generally, imaging is () in the diagnosis of septic arthiritis

A

Not very useful early on.

51
Q

The recommended initial tx for septic arthritis is (abx) + (abx) and ()

A
  • Rocephin
  • Vanco (if MRSA sus)
  • Drainage of infected joint

Always admit!

52
Q

Gonococcal arthritis is more common in (men/women)

A

Women

Common during menses and pregnancy only

53
Q

Gonococcal arthritis has two distinct patterns after the initial 4 days of migraty polyarthralgias.

Pattern 1 is similar to (), affecting wrists, fingers, ankles, or toes. 60% of pts.

Pattern 2 is a purulent () affect the knees, wrist, ankle or elbow. 40% of pts.

A
  • Pattern 1: tenosynovitis
  • Pattern 2: Purulent monoarthritis
54
Q

The characteristic skin lesiosn seen in gonococcal arthritis are usually over the () and (), presenting as small, necrotic pustules

A
  • Palms
  • Soles
55
Q

You should order cultures of (4 orifices) in all gonococcal arthritis pts.

A
  • Urethra
  • Throat
  • Cervical
  • Rectal
56
Q

Synovial fluid analysis is not super diagnostic of gonococcal arthritis because gonorrhea is not a very () disease

A

Not a very virulent disease

It can be just inflammatory levels.

57
Q

ABX therapy for gonococcal arthritis is one dose of () orally and ()

A
  • Oral azithromycin
  • Rocephin

IV therapy for 7-10 days and admit

No need to drain joint typically.

58
Q

Leflunomide/Arava is used to treat RA, but is contraindicated in (2)

A

Liver failure and pregnancy

59
Q

Entanercept is nice because you can still use () or () with it.

TNF inhibitor

A

MTX or NSAIDs can still be continued.

60
Q

In order to take bisphosphonates, a patient must take it on an () stomach, drink (), and (position) themselves for 30 minutes.

A
  • Empty stomach
  • Little water with it
  • Must remain upright for 30 mins after taking it.

-dronates

61
Q

The alternative to bisphosphonates is…

A

Teriparatide/Forteo

62
Q

The Boxed warnings for Raloxifene/Evista in osteoporosis use for postmenopausal females is…

A

VTE and CVD

63
Q

Muscle relaxers are on Beer’s List of bad drugs because they can cause () and ()

A
  • Somnolence
  • Anticholinergic effects

Also they are mostly hepatically metabolized

Flexeril/cyclobenzaprine
Robaxin
Soma
Skelaxin
Zanaflex/Tizanidine

64
Q

Prolia/denosumab is mainly indicated for…

A

Osteoporosis

MSK (17 decks)

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