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MSK > Lecture 9: Arthritis Part 1 > Flashcards

Lecture 9: Arthritis Part 1 Flashcards

1
Q

MC form of joint disease

A

Arthritis

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2
Q

90% of all patients will have radiographic evidence of arthritis in weight bearing joints by age….

A

40

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3
Q

Who is OA of the hands and knees MC in?

A

Females

But men complain more

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4
Q

Why do osteophytes develop in articular margins?

A

It is where they try to repair it

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5
Q

Is OA relieved by rest?

A

Yes

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6
Q

What does OA typically reduce?

A

Range of motion

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7
Q

What are bony enlargements of the DIP and PIP called?

A
  • DIP: Herberden nodes
  • PIP: Bouchard nodes

Peanut Butter, Dip in Herbs

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8
Q

Does OA cause elevations in ESR?

A

No

Also does not show inflammatory synovial fluid

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9
Q

Diagnostic modality of choice for OA?

A

XR

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10
Q

What is typically seen on XR for OA?

A
  • Narrowing of joint space
  • Osteophyte formation
  • Lipping of marginal bone
  • Thickened, subchondral bone
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11
Q

First line therapy for mild OA

A

3-4g of acetaminophen daily

Caution in liver dz and heavy alcohol

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12
Q

What is the issue with NSAIDs vs acetaminophen for OA?

A

NSAIDs have more SEs

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13
Q

Which NSAID has low systemic absorption but is good for pain?

A

Voltaren gel

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14
Q

Which PO NSAIDs are safe to use with coumadin?

A

Celebrex?

Selective COX-2 inhibitor

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15
Q

When might we administer PPI with NSAIDs?

A

For High risk OA patients

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16
Q

What can we inject into joints for OA?

A
  1. Intra-articular steroids
  2. Hyaluronic acid (last resort, symptomatic relief)
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17
Q

Where is natural hyaluronic acid from?

A
  • Rooster Combs
  • Cow
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18
Q

When is surgery indicated for OA?

A
  • Pain at rest
  • Restricted walking

Total replacements

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19
Q

How does gout typically present?

A

MONOarticular buildup of gout

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20
Q

Who is primary gout MC in?

A

Men older than 30y

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21
Q

What is considered hyperuricemia?

A

> 6.8

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22
Q

MC joint affected in gout

A

MTP of big toe

Looks like a bunion

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23
Q

What is the characteristic lesion of gouty arthritis?

A

Tophus

Monosodium urate crystal deposit + Foreign body rxn

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24
Q

What is podagra?

A

A tophus of the MTP joint of the big toe

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25
Q

Where does gouty arthritis rarely affect?

A
  • Hips
  • Shoulders
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26
Q

How does a gout attack present?

A
  • Sudden
  • Noctunral
  • Asymmetric
  • Swelling
  • fever sometimes
27
Q

What diagnostic study confirms gouty arthritis?

A

Joint fluid analysis showing sodium urate crystals (needle-like and negatively birefringent with light microscopy)

28
Q

What is a “rat bite” on XR?

A

Punched out erosions with overhanging rim or cortical bone (seen in gouty arthritis)

29
Q

When do you treat hyperuricemia?

A

Only if symptomatic, otherwise diet modifications!

30
Q

What is the main diet modification for gout?

A

Avoiding purine-rich foods

Also drink water, avoid alcohol

31
Q

What is first-line tx for management of pain in gouty arthritis?

A
  • Naproxen BID
  • Indomethacin Q8h
32
Q

MC SEs of colchicine?

A

GI effects

Usually a loading dose then maintenance

33
Q

When are corticosteroids primarily used for acute gout?

A
  • People who can’t take NSAIDs
  • For dramatic attacks
34
Q

Which corticosteroid is used primarily for joint injection during acute gout?

A

Triamcinolone

If mono-articular

35
Q

Between Triamcinolone and Methylpredinosolone, which is more likely to lead to bursitis?

A

Triamcinolone per kevin

36
Q

When is colchicine best used for gout?

A

Prophylaxis

37
Q

What common drug classes can lead to hyperuricemia?

A
  • Thiazides
  • Loop diuretics
  • Niacin
38
Q

When is urate lowering therapy indicated and what is the goal?

A
  • Frequent arthritis (> 2 attacks annually)
  • Tophaceous deposits
  • CKD stage 2 or worse
  • Goal: < 6
39
Q

First-line therapy for urate lowering therapy?

A

Xanthine oxidase inhibitors: Allopurinol & Uloric

40
Q

What is the main HSR that occurs with allopurinol?

A

Rash progressing to TEN associated w/o vasculitis & hepatitis

41
Q

What is the main concern with Uloric?

A

CV outcomes

42
Q

What does probenecid do?

A

Increase uric acid excretion by kidney

Indicated when xanthine oxidase inhibitor fails or not good enough

Cannot use if CrCl < 50

43
Q

For chronic tophaceous arthritis, how do we get the body to resorb the urate crystals?

A

Keep serum uric acid < 6

44
Q

What distinguishes pseudogout from gout?

A

Pseudo has Positive birefringent rhomboid-shaped crystals on synovial fluid analysis.

45
Q

How does rheumatoid arthritis (RA) differ from gouty?

A

RA is synovitis of MULTIPLE joints, and is symmetrical

46
Q

Who is RA MC in?

A

Women, also tends to occur early at 40-50

Male is typically 60+

47
Q

What are the pathologic findings in the joint associated with RA?

A

Formation of a pannus

48
Q

How long and when is stiffness prominent in RA?

A
  • Most prominent in the AM
  • Lasts GREATER THAN 30 mins, up to hours
49
Q

Image of late RA

A
50
Q

Where do RA nodules typically occur over?

A

Bony prominences

51
Q

What does presence of RA nodules correlate with?

A

Serum rheumatoid factor

52
Q

Besides joint stuff, what else does RA present with?

A
  • Dryness of eyes, mouth, mucous membranes
  • ILD
  • Pericarditis or pleural dz
  • Felty syndrome (splenomegaly + neutropenia)
  • Small vessel vasculitis
53
Q

What is the most specific blood test for RA?

A

Anti-CCP antibodies

54
Q

What confirms the inflammatory nature of RA?

A

Joint fluid analysis

R/o superimosed septic arthritis

55
Q

What kind of imaging is specific for RA?

A

Radiograph changes (stocking-glove distribution)

After 6 months

56
Q

In later RA, what occurs to joint spaces?

A

Uniform narrowing of joint spaces

57
Q

Primary tx for RA

A

DMARDs

Once diagnosed with RA

58
Q

What is the role of corticosteroids in RA?

A

Bridging to DMARDs

59
Q

What is the max # of injections of triamcinolone we want to give for RA?

A

4 a year

60
Q

What is the initial DMARD of choice for RA?

A

Methotrexate

Takes 4-6 weeks

61
Q

What do you need to monitor/educate about with methotrexate use?

A
  • Teratogenic
  • Gastric irritation/stomatitis
  • Avoid alcohol
  • Folic acid 1mg daily
62
Q

What is the 2nd line therapy for RA?

A

Sulfasalazine

63
Q

Main SEs of sulfasalazine

A
  • Neutropenia
  • Thrombocytopenia
  • Hemolysis in G6PD

CI in someone with an ASA allergy

Need CBC Q2-4wks for 3 months, then every 3 months

64
Q

When are TNF inhibitors used for RA?

A

Inadequate response to MTX

Usual combo is TNF + MTX for RA

MSK (27 decks)

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