Mehlman reactive; UW post trauma arthritis/synovial fluid normal 12-13 (2)

Question 1

M. Reactive. CP?

Answer 1

Classically presents as triad of
1) urethritis or abdominal infection
2) polyarthritis
3) “eye-itis” (i.e., conjunctivitis, episcleritis, or anterior uveitis).

Question 2

M. Reactive. CP.
Classically presents as triad of
….
2) polyarthritis
3) “eye-itis” (i.e., conjunctivitis, episcleritis, or anterior uveitis).

Answer 2

1) urethritis or abdominal infection

Question 3

M. Reactive. CP.
Classically presents as triad of
1) urethritis or abdominal infection
…..
3) “eye-itis” (i.e., conjunctivitis, episcleritis, or anterior uveitis).

Answer 3

2) polyarthritis

Question 4

M. Reactive. CP.
Classically presents as triad of
1) urethritis or abdominal infection
2) polyarthritis
….

Answer 4

3) “eye-itis” (i.e., conjunctivitis, episcleritis, or anterior uveitis).

Question 5

M. cause of reactive?

Answer 5

CHLAMYDIA

gonoccus DOES NOT cause reactive on usmle

Question 6

M. what viral can cause reactive?

Answer 6

Rubella
Hep B and C

also Yersinia

Question 7

M. reactive part of what genetic alteration?

Answer 7

Part of HLA-B27 constellation (PAIR).

Question 8

M. post-traumatic arthritis. CP?

sito nera lapuose, tik cia.

Answer 8

Pain in joint that can present soon, or many years after, injury, where other DDx are ruled out.

Question 9

M. post-traumatic arthritis. case on 2CK.

case where it sounds like patellar tendonitis (i.e. 2 years of knee pain, first worsened with basketball, but then progresses to more constant pain), but then they go on to say that patient had fracture to proximal tibia 30 year ago and has varus deformity of the knee.

ANSWER - traumatic arthritis, not patella tendonitis.

Answer 9

the implication is that the etiology for patient’s arthritis is ultimately linked to the varus deformity from the prior injury

Question 10

UW. Synovial fluid analysis.
Appearance in normal?

Answer 10

Clear

Question 11

UW. Synovial fluid analysis.
WBC in normal?

Answer 11

<200

Question 12

UW. Synovial fluid analysis.
PMNs in normal?

Answer 12

<25 proc.

Question 13

UW. Synovial fluid analysis.
Appearance in non-inflammatory (eg OA)?

Answer 13

clear

Question 14

UW. Synovial fluid analysis.
WBC in non-inflammatory (eg OA)?

Answer 14

200 - 2000

Question 15

UW. Synovial fluid analysis.
PMNs in non-inflammatory (eg OA)?

Answer 15

25 proc.

Question 16

UW. Synovial fluid analysis.
Appearance in inflammatory (crystals, RA)?

Answer 16

translucent or opaque

Question 17

UW. Synovial fluid analysis.
WBCs in inflammatory (crystals, RA)?

Answer 17

2000 - 100 000

Question 18

UW. Synovial fluid analysis.
PMNs in inflammatory (crystals, RA)?

Answer 18

Often >50 proc.

Question 19

UW. Synovial fluid analysis.
Appearance septic joint?

Answer 19

Opaque

Question 20

UW. Synovial fluid analysis.
WBCs septic joint?

Answer 20

50 k - 150k

Question 21

UW. Synovial fluid analysis.
PMNs septic joint?

Answer 21

> 80 - 90 proc.

Question 22

UW reactive arthritis table. Preceding infection?

Answer 22

Genitourinary: Chlamydia trachomatis

GI: salmonella, Shigella, Yersinia, Campylobacter, Clostridioides difficile.

Question 23

UW reactive arthritis table. Genitourinary m/o?

Answer 23

Genitourinary: Chlamydia trachomatis

Question 24

UW reactive arthritis table. GI m/os?

Answer 24

GI: salmonella, Shigella, Yersinia, Campylobacter, Clostridioides difficile.

Question 25

UW reactive arthritis table. MSK CP?3

Answer 25

Asymetric oligoarthritis
Enthesitis
Dactylitis

Question 26

UW reactive arthritis table. extraarticular symptoms. ocular?

Answer 26

conjuctivitis, anterior uveitis

Question 27

UW reactive arthritis table.
extraarticular symptoms. genital?

Answer 27

urethritis, cervicitis, prostatitis

Question 28

UW reactive arthritis table.
extraarticular symptoms. dermal?

Answer 28

keratoderma blennorrhagicum, circinate balanitis

Question 29

UW reactive arthritis table.
extraarticular symptoms. GI?

Answer 29

oral ulcers

Question 30

UW reactive arthritis table.
Dx? 3

Answer 30

CLinical

Elevated inflammatory markers: ESR, CRP

Synovial fluid: incr. WBC (2-4k), negative gram stain and culture

Question 31

UW reactive arthritis Q. arthritis tx?

Answer 31

Usually self-limited (eg, resolving within 6 months), and treatment is largely supportive. Arthralgia usually improves NSAIDs.

Question 32

UW reactive arthritis Q. balanitis tx?

Answer 32

If treatment for circinate balanitis is desired, low-potency topical corticosteroids (eg, 1% hydrocortisone) are often adequate.

Question 33

UW reactive arthritis Q. what underlying condition?

Answer 33

the risk of reactive arthritis is increased in patients with HLA-B27

Question 34

UW reactive arthritis Q. when manifests?

Answer 34

1-4 weeks following certain GU/GI infection

Question 35

UW reactive arthritis table. Management. 2 drugs

Answer 35

First line: NSAIDs

sometimes antibiotics (chlamydia, non-self limiting GI infection)

Question 36

UW reactive arthritis table. Management. If nsaids fail or contraindicated?

Answer 36

Intraarticular GK
Systemic GK
Disease-modifying antirheumatic drugs

Question 37

UW reactive arthritis Q. first line Tx?

Answer 37

NSAIDS

Question 38

UW reactive arthritis Q. why abs are not first line?

Answer 38

Activated lymphoid cells (from infection) migrates to joints and extraarticular sites = cause inflammation. So this infl. is not because of bacteria –> no need of abs.

abs may be indicated depending on the underlying infection

Question 39

UW reactive arthritis Q. Clinical + arthrocenthesis –> suspected ReA. what additional studies needed to establish Dx?

Answer 39

no additional studies

primarily = clinical
also arthrocentesis allows to rule out other causes

buvo option HLA-B27 - in these patients is inc. risk for ReA, but is not necessary