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FA - Musculoskeletal > MS - Path (Arthritis, Sjogren syndrome, & Gout) > Flashcards

MS - Path (Arthritis, Sjogren syndrome, & Gout) Flashcards

Pg. 424-426 in First Aid 2014 Sections include: -Osteoarthritis and rheumatoid arthritis -Sjogren syndrome -Gout -Pseudogout -Infectious arthritis -Seronegative spondyloarthropathies

1
Q

What is the difference between Osteoarthritis and Rheumatoid arthritis in terms of etiology?

A

OSTEOARTHRITIS: Mechanical - joint wear and tear destroys articular cartilage; RHEUMATOID ARTHRITIS: Autoimmune - inflammatory destruction of synovial joints. Mediated by cytokines and type III and type IV hypersensitivity reactions.

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2
Q

What mediates Rheumatoid arthritis?

A

Mediated by cytokines and type III and type IV hypersensitivity reactions.

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3
Q

What are 6 joint findings in Osteoarthritis? What is not involved here that is involved in Rheumatoid arthritis?

A

Osteoarthritis joint findings: (1) Subchondral cysts (2) Sclerosis (3) Osteophytes (bone spurs) (4) Eburnation (polished, ivory-like appearance of bone) (5) Heberden nodes (DIP) (6) Bouchard nodes (PIP). No MCP involvement

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4
Q

What are 5 joint findings in Rheumatoid arthritis? What is not involved here that is involved in Osteoarthritis?

A

Rheumatoid arthritis: (1) Pannus formation in joints (MCP, PIP) (2) Subcutaneous rheumatoid nodules (fibrinoid necrosis) (3) Ulnar deviation of fingers (4) Subluxation (5) Baker cyst (in popliteal fossa). No DIP involvement.

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5
Q

What are 4 predisposing factors for Osteoarthritis?

A

(1) Age (2) Obesity (3) Joint deformity (4) Trauma

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6
Q

What gender is predisposed to Rheumatoid arthritis?

A

Females > males

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7
Q

What 2 antibodies are associated with Rheumatoid arthritis? Which is more specific? What percentage of cases have the less specific antibody?

A

80% have rheumatoid factor (anti-IgG antibody); anti-cyclic citrullinated peptide antibody is more specific

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8
Q

With what immunological marker is Rheumatoid arthritis strongly associated?

A

Strong association with HLA-DR4.

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9
Q

Describe the classic presentation of Osteoarthritis. Include a pain description, key musculoskeletal finding, and systemic symptoms.

A

Pain in weight-bearing joints after use (e.g., at the end of the day), improving with rest. Knee cartilage loss begins medially (“bowlegged”). Noninflammatory. No systemic symptoms.

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10
Q

Describe the classic presentation of Rheumatoid arthritis. Include a pain description, key musculoskeletal finding, and systemic symptoms.

A

Morning stiffness lasting > 30 minutes and improving with use, symmetric joint involvement, systemic symptoms (fever, fatigue, pleuritis, pericarditis).

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11
Q

What are 2 treatments for Osteoarthritis?

A

(1) NSAIDs (2) Intra-articular glucocorticoids

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12
Q

What are 3 treatments for Rheumatoid arthritis?

A

(1) NSAIDs (2) Glucocorticoids (3) Disease-modifying agents (methotrexate, sulfasalazine, TNF-alpha inhibitors)

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13
Q

Give 3 specific examples of Disease-modifying agents used in Rheumatoid arthritis.

A

Disease-modifying agents (methotrexate, sulfasalazine, TNF-alpha inhibitors)

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14
Q

Draw a joint and label the key structures and findings of Osteoarthritis.

A

Pg. 424 in First Aid 2014 for visual on left

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15
Q

Draw a joint and label the key structures and findings of Rheumatoid arthritis.

A

Pg. 424 in First Aid 2014 for visual on right

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16
Q

Name 2 key findings seen on X-ray in Osteoarthritis.

A

X-rays of the knee show joint space narrowing and sclerosis

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17
Q

What kind of deformities are found in Rheumatoid arthritis? What joints are associated with Rheumatoid arthritis, and what kind of deviation occurs?

A

Note boutonniere deformities of PIP joints with ulnar deviation

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18
Q

What kind of disorder is Sjogren syndrome, and what characterizes it? What 2 structures are especially involved in this syndrome?

A

Autoimmune disorder characterized by destruction of exocrine glands (especially lacrimal and salivary)

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19
Q

What gender and age of patients are predominately affected by Sjogren syndrome?

A

Predominately affects females 40-60 years old.

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20
Q

What are 4 findings associated with Sjogren syndrome?

A

Findings: (1) Xerophthalmia (decreased tear production and subsequent corneal damage) (2) Xerostomia (decreased saliva production) (3) Presence of antinuclear antibodies: SS-A (anti-Ro) and/or SS-B (anti-La) (4) Bilateral parotid enlargement

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21
Q

What are the 2 antibodies associated with Sjogren syndrome?

A

Presence of antinuclear antibodies: SS-A (anti-Ro) and/or SS-B (anti-La)

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22
Q

Is Sjogren syndrome a primary or secondary syndrome, and in what context(s)?

A

Can be a primary disorder or a secondary syndrome associated with other autoimmune disorders (e.g., rheumatoid arthritis)

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23
Q

What are 2 complications associated with Sjogren syndrome?

A

Complications - (1) dental carries; (2) mucosa-associated lymphoid tissue (MALT) lymphoma (may present as unilateral parotid enlargement)

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24
Q

Of what syndrome is MALT lymphoma a complication? How may this present?

A

Sjogren syndrome; mucosa-associated lymphoid tissue (MALT) lymphoma (may present as unilateral parotid enlargement)

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25
Q

What is gout, and what causes it?

A

Acute inflammatory monoarthritis caused by precipitation of monosodium urate crystals in joints

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26
Q

With what blood abnormality is gout associated? What are the 2 causes of this abnormality?

A

Associated with hyperuricemia, which can be caused by: (1) Underexcretion of uric acid (90% of patients) - largely idiopathic; can be exacerbated by certain medications (e.g., thiazide diuretics) (2) Overproduction of uric acid (10% of patients) - Lesch-Nyan syndrome, PRPP excess, increased cell turnover (e.g., tumor lysis syndrome), von Gierke disease

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27
Q

In what percentage of patients is underexcretion of uric acid the cause of gout? Why might this happen?

A

Underexcretion of uric acid (90% of patients) - largely idiopathic; can be exacerbated by certain medications (e.g., thiazide diuretics)

28
Q

In what percentage of patients is overproduction of uric acid the cause of gout? What are 4 reasons for this cause?

A

Overproduction of uric acid (10% of patients) - Lesch-Nyan syndrome, PRPP excess, increased cell turnover (e.g., tumor lysis syndrome), von Gierke disease

29
Q

What kind crystals cause gout? What are 2 key characteristics of these crystals? In what gender are they more common?

A

Gout = Acute inflammatory monoarthritis caused by precipitation of monosodium urate crystals in joints; Crystals are needle shaped and (-) birefringent (yeLLow under paraLLel light, blue under perpendicular light); More common in males

30
Q

Describe the joint in Gout.

A

Asymmetric joint distribution. Joint is swollen, red, and painful.

31
Q

What is the classic manifestation of Gout?

A

Classic presentation is painful MTP joint of the big toe (podagra).

32
Q

What kind of formation occurs in Gout, and where are 3 locations in which it is often found?

A

Tophus formation (often on external ear, olecranon bursa, or Achilles tendon).

33
Q

In what contexts does an acute attack of Gout tend to occur, and why?

A

Acute attack tends to occur after a large meal or alcoholic consumption (alcohol metabolites compete for same excretion sites in kidney as uric acid, causing decreased uric acid secretion and subsequent buildup in blood)

34
Q

What are 3 treatments for acute Gout?

A

Acute: NSAIDs (e.g., indomethacin), glucocorticoids, colchicine

35
Q

What is the treatment for chronic Gout (preventive)? Give 2 specific examples.

A

Chronic (preventive): xanthine oxidase inhibitors (e.g., allopurinol, febuxostat).

36
Q

What is an example of a NSAID used as treatment of acute Gout?

A

Acute: NSAIDs (e.g., indomethacin)

37
Q

What characterizes gout on histology?

A

Tophi in joints - Aggregates of urate crystals surrounded by inflammation

38
Q

What characterizes gout on gross appearance?

A

Left big toe (podagra) is swollen and red

39
Q

How does Pseudogout present, and what causes it?

A

Presents with pain and effusion in a joint, caused by deposition of calcium pyrophosphate crystals within the joint space (chondrocalcinosis on x-ray).

40
Q

How does Pseudogout appear on x-ray, and why?

A

Presents with pain and effusion in a joint, caused by deposition of calcium pyrophosphate crystals within the joint space (chondrocalcinosis on x-ray).

41
Q

What defines Pseudogout on histology?

A

Forms basophilic, rhomboid crystals that are weakly positively birefringent.

42
Q

What kind of joints does Pseudogout usually affect? What is a classic example?

A

Usually affects large joints (classically the knee).

43
Q

What age and gender does Pseudogout affect?

A

> 50 years old; both sexes affected equally

44
Q

What are 3 diseases that may be associated with Pseudogout?

A

Diseases that may be associated with Pseudogout include hemochromatosis, hyperparathryoidism, & hypoparathyroidism.

45
Q

What are 3 treatments for Pseudogout? Which is used for sudden, severe attacks?

A

Treatment includes NSAIDs for sudden, severe attacks; steroids; and colchicine.

46
Q

Contrast the crystals found in Gout versus Pseudogout.

A

Gout - crystals are yeLLow when paraLLel to light; Pseudogout - crystals are blue when parallel to the light

47
Q

What are 3 common causes of infectious arthritis?

A

S. aureus, Streptococcus, and Neisseria gonorrhoeae are common causes.

48
Q

What kind of disease is Gonococcal arthritis, and how does it present?

A

Gonococcal arthritis is an STD that presents as a migratory arthritis with an asymmetric pattern.

49
Q

What are 3 characteristics of the affected joint in infectious arthritis?

A

Affected joint is swollen, red, and painful.

50
Q

What are 3 symptoms associated with Gonococcal arthritis?

A

Think: STD (Gonococcal arthritis) = Synovitis (e.g., knee), Tenosynovitis (e.g., hand), and Dermatitis (e.g., pustules)

51
Q

What defines Seronegative spondyloarthropathies?

A

Arthritis without rheumatoid factor (no anti-IgG antibody).

52
Q

With what gene do Seronegative spondyloarthropathies have a strong association, and for what does this gene code?

A

Strong association with HLA-B27 (gene that codes for HLA-MHC class I)

53
Q

In which gender do seronegative spondyloarthropathies occur more often?

A

Occurs more often in males

54
Q

What are 4 examples of seronegative spondyloarthropathies?

A

(1) Psoriatic arthritis (2) Ankylosing spondylitis (3) Inflammatory bowel disease (4) Reactive arthritis (Reiter syndrome); Think: “PAIR”

55
Q

What is the definition of Psoriatic arthritis?

A

Joint pain and stiffness associated with psoriasis

56
Q

What are 3 findings that characterize psoriatic arthritis?

A

(1) Asymmetric and patchy involvement (2) Datylitis (“sausage fingers”) (3) “Pencil-in-cup” deformity on x-ray

57
Q

In what portion of patients with psoriasis is psoriatic arthritis seen?

A

Seen in fewer than 1/3 of patients with psoriasis

58
Q

What is ankylosing spondylitis?

A

Chronic inflammatory disease of spine and sacroiliac joints

59
Q

What are 3 symptoms/conditions that result from ankylosing spondylitis?

A

Chronic inflammatory disease of spine and sacroiliac joints –> ankylosis (stiff spine due to fusion of joints), uveitis, and aortic regurgitation

60
Q

What is seen on x-ray in patients with ankylosing spondylitis?

A

Bamboo spine (vertebral fusion)

61
Q

What are 2 examples of inflammatory bowel disease? What 2 conditions often accompany them?

A

Crohn disease and ulcerative colitis are often accompanied by ankylosing spondylitis or peripheral arthritis

62
Q

What is another name for Reactive arthritis?

A

Reactive arthritis (Reiter syndrome)

63
Q

What is the classic triad of Reactive arthritis (Reiter syndrome)?

A

Classic triad: Conjunctivitis and anterior uveitis, Urethritis, Arthritis; Think: “can’t see, can’t pee, can’t bend my knee”

64
Q

What 2 major types of infections are associated with Reactive arthritis (Reiter syndrome)?

A

Post-GI (Shigella, Slamonella, Yersinia, Campylobacter) or Chlamydia infections

65
Q

What are 4 examples of post-GI bacterial infections associated with Reactive arthritis (Reiter syndrome)?

A

Post-GI (Shigella, Slamonella, Yersinia, Campylobacter)

FA - Musculoskeletal (19 decks)

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