Manifestations of MK Diseases

Question 1

Articular

Answer 1

Synovium
Synovial fluid
Articular cartilage
Intraarticular ligaments
Joint capsule
Juxtaarticular bone

-Deep or diffuse pain, limited ROM, swelling, locking, crepitation, instability, deformity

Question 2

Nonarticular

Answer 2

Supportive extraarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve, and overlying skin

• Point or focal tenderness adjacent to articular structures and have physical findings remote from the joint

Question 3

Inflammatory

Answer 3

Erythema
Warmth
Pain
Swelling 
Systemic symptoms
Laboratory evidence of inflammation
Morning stiffness

Question 4

Non-inflammatory

Answer 4

May be related to: 
Trauma 
Overuse 
Degeneration
Ineffective repair
Neoplasms 
Pain amplification

Question 5

Acute vs. Chronic

Answer 5

Acute–less than 6 wks.

Chronic–greater than 6 wks.

Question 6

HPI

Answer 6

Disease chronology
Acute vs. chronic
Sudden onset vs. gradual
Migratory vs. stationary
Extra articular manifestations/ associated symptoms
Inflammatory vs. non inflammatory
Triggers
Medications

Question 7

Pain Distribution

Answer 7

Small joints
Large joints
Diffuse
Symmetry
Axial involvement

Question 8

Antinuclear Antibody (ANA)

Answer 8

+ in 5-10% of general population
Rate increases with age
High sensitivity – negative ANA essentially rules out SLE

Tests for lupus, scleroderma, RA (some), polymyositis, Sjogren’s syndrome, mixed CT diseases
`false positives & negatives (RA)

Question 9

HLA-B27

Answer 9

Tests for ankylosing spondylitis & Reiters syndrome

+ in 8% of white persons
+ in 5-10% of healthy people
Leads to high rate of overdiagnosis

Question 10

Rheumatoid Factor

Answer 10

Lacks both sensitivity and specificity
+ in 5-10% of general population
- Elevated in 70-80% of pts w/ RA
*defer testing for 4-6 weeks

Question 11

WBC Count

Answer 11

• WBC elevation
• WBC indices indicated a left shift

Identifies infection –> increased output of WBCs & premature WBCs

Question 12

Inflammatory Markers

Answer 12

Sedimentation rate (ESR)
–usually slow to rise & slow to normalize
C-Reactive protein (CRP)
–more accurate in acute phase
–rises within 6 hrs, peaks at 48 hrs

Identifies inflammation by measuring RBCs –> More RBCs = more inflammation

Question 13

Uric Acid

Answer 13

Elevated in gout

-24 hr. urinary uric acid excretion

Question 14

Rheumatoid Disease

Answer 14

-RF elevated
\+/- ANA elevation
High ESR
High CRP
Anemia
Antibodies to cyclic citrullinated peptides (CCP)

Question 15

Enzyme Immunoassay (EIA)

Answer 15

IgM = pt actively having illness

IgE = infection now gone

Can test for syphilis–but fails in 30% of cases & can take 1-4 weeks for serologic changes

Question 16

CK & CPK

Answer 16

Creatine kinase/creatine phosphokinase

• muscle enzyme that leaks from muscle when damaged
• positive in pts w/ muscular dystrophy, polymyositis, & trauma

Question 17

Lyme’s Disease

Answer 17

Clinical dx, but serologic tests confirm
-ELISA–detects Borrelia burgdoferi
-Confirmed w/ western blot)
`negative in early illness

Question 18

Post-Viral Arthropathies

Answer 18

Parvovirus B19
Ebstein-Barr
Hepatitis viruses
Retrovirus viruses
Rubella
Herpes simplex & varicella viruses
Cytomegalovirus (CMV)
Adenovirus
Coxsackieviruses

Question 19

Spondylarthropathies

Answer 19

Anklylosing spondylitis

• HLA-B27 antigen present in 90%
• Inflammation of spine & SI joints

Reiters syndrome

• HLA-B27 antigen present in 85%
• ESR over 100 mm/hr
• Inflammation of the urethra, eyes, & joints

Question 20

Bone Tumor

Answer 20

Tests narrow ddx & provide base for chemo

• CBC w/ diff
• Serum electrolytes
• BUN/Cr (kidney)
• Calcium
• Phosphorus/Alkaline phosphatase

If over 40 years:
-UA, urine, & serum protein electrophoresis

If over 40 years & male:
-Prostate specific antigen