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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 used 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
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 can present as the following subsets

  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 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

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 inflamamtory 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…

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 (27 decks)

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