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Family Medicine Boards 2020 > Major Arthritides > Flashcards

Major Arthritides Flashcards

1
Q

How should you approach articular disease.

A 
Look for 1 of 3 patterns
- monoarticular
- symmetric polyarticular
- asymmetric polyarticular
Look for active vs Passive ROM
Distinguish single joint from multiple joint involvement
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2
Q

What are 7 diseases to keep in your differential for Monoarticular Arthritis?

A
  • Osteoarthritis
  • Crystals (Gout)
  • Trauma
  • Infection: septic or viral
  • Neoplastic
  • Overuse
  • Vascular (Necrosis)
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3
Q

What are 9 diseases to keep in differential for Symmetric polyarhritis?

A
  • RA
  • SLE (skin findings)
  • Psoriatic arthritis
  • scleroderma
  • polymyalgia rheumatica (older pt with shoulder/hip sx)
  • lyme disease
  • Pseudogout
  • Sarcoid (get CXR)
  • Spoldyloarhtropathy (assoc with IBD)
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4
Q

How do you distinguish arthritis from non-articular, soft tissue syndromes?

A
  • Active ROM restriction implies soft tissues

- passice ROM restriction implies joint involvement

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5
Q

What is the most specific finding in RA?

  • high ESR?
  • positive ANA?
  • positive RF?
  • Rheumatoid joint erosions?
A

Rheumatoid joint erosion is the most specific

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6
Q

What are the criteria for RA diagnosis?

A

> 6 points is unequivocably positive for RA
4 areas considered in diagnosis
1. # of joints: the higher number of small joints the more powerful
2. Serology: + RF, + ACPA
3. Acute phase reactants: + CRP/ESR
4. Duration of symptoms > 6 weeks

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7
Q

After diagnosing R.A. when should DMARDs be started?

A

Right away

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8
Q

What is the first line non biological dmard?

A

Methotrexate

Add folic acid

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9
Q

When should patients be referred to rheumatologist?

A

If symptoms last more than 6 weeks

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10
Q

What is the main cause of mortality in treating R.A.?

A

Cardiovascular disease

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11
Q

What is first line treatment for ankylosis spondylitis?

A

NSAIDs

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12
Q

How would you describe the joint findings in psoriatic arthritis?

A 
Oligoarticular associated dactylitis
Predominant DIP involvement
Nail changes
“R.A. like” poly arthritis - lacks RF 
Axial involvement - spondylitis
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13
Q

How do you treat psoriatic arthritis

A
  • physical therapy - start early

- dmards for slowing down joint- choose the biologic answer if offered

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14
Q

What is reiter’s triad

A

“can’t see, can’t pee, can’t climb a tree”
nongonococcal utrethritis, conjunctivitis, arthritis
Usually follows GI bugs with hemorrhagic diarrhea

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15
Q

What is the initial management of all spondyloarthropathies?

What DMARDs do you use after this treatment?

A

1st line - NSAIDS –> SOR C

2nd line - Sulfasalazine –> SOR B

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16
Q

What are the symptoms of OA - which joints does it affect in the hand?

A
  • insidious onset
  • aching and burning
  • more common in hands and large weight bearing joints
  • in hand: DIP and PIP but not wrist and MCP
17
Q

What treatments for Osteoarthritis are recommended by the AAFP 2014 guidelines?

A
  • recommend self-management programs with strengthenin and low impact aerobic exercise
  • Rx: nsaids and tramadol
  • don’t recommend injections, glucosamine, chondroitin, acupuncture
18
Q

When talking about birefringent crystals, what is the buzzword for gout vs pseudogout?

A

Pseudogout is Positively birefringent

Gout is negatively birefringent

19
Q

A man comes in with podagra and elevated uric acid, does he have gout?

A
  • maybe
  • hyperuricemia alone is insufficient to diagnose gout
  • you need to see negatively birefringent crystals
20
Q

What uric acid level puts you at increased risk for gout?

A

> 6.8 mg/dL

21
Q

Which foods increase gout risk?

A

Foods high in protein

High fructose corn syrup

22
Q

Which BP meds increase risk for gout?

A

Essentially all anti-HTN are bad for gout with the exception of CCB and losartan (lower RR in studies)

23
Q

What are the indications for a uric acid lower agent like allopurinol?

A

SOR A
- tophi or freuqnt attacks (> 2 per year)

SOR C

  • CKD 2
  • gout with urolithiasis
  • UA overproduction and urinary overexcretion
24
Q

Management of acute gout

A

SOR A: start with NSAIDs + PPI or colchicine

SOR C: low dose corticosteroids if colchicine or NSAIDs not tolerated

25
Q

How long should prophylaxis with UA lowering agents continue in treatment of gout?

A

First need to achieve target Uric acid levels. once these are achieved, then …

  • no tophi: 3 months after achieving target UA levels
  • tophi: 6 months after achieving target UA levels
26
Q

What are some non-rheumatic diseases that cause a false positive rheumatoid factor?

A
  • hep C
  • mixed cryoglobulinemia (90%)
  • sarcoidosis (5-30%)
  • pulmonary fibrosis (20%)
  • infections
  • aging
27
Q

What disease is associated with the following biomarker?

Anti-smith

A

SLE

28
Q

What disease is associated with the following biomarker?

RF

A

rheumatoid arthritis

29
Q

What disease is associated with the following biomarker?

Anti-centromere

A

Scleroderma

30
Q

What disease is associated with the following biomarker?

Anti-U1RNP

A

Mixed connective tissue disease

31
Q

What disease is associated with the following biomarker?

Anti-Jo1

A

polymyositis

32
Q

What disease is associated with the following biomarker?

Anti-SSA and Anti-SSB

A

Sjogren

33
Q

What disease is associated with the following biomarker?

C-ANCA and P-ANCA

A

Wegener

34
Q

What disease is associated with the following biomarker?

Anti-histone

A

Rule out drug induced lupus

35
Q

What is the mechnism of Allopurinol?

When someone is on allopurinol how often should you check uric acid?

A

MOA: reduces production of UA (inhibits xanthine oxidase)

- obtain maintenance uric acid level Q3 months for 6 months, then once yearly once at goal

36
Q

What are the clinical symptoms of lyme disease at its different stages

A

1) erythema migrans (bulls eye) 7-10 days after tick bite
2) early dissemination - migratory arhtralgias, fever, systemic
3) Late dissemination/chronic disease - migratory oligoarthritis, carditis, neurological

Family Medicine Boards 2020 (46 decks)

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