MSK joint disorders

Question 1

comprises a heterogeneous group of
arthritides of unknown cause beginning in
children up to 18 years of age (most
commonly begins during the toddler or early
adolescent period) and occurring for at least
6 weeks.

Answer 1

JIA

Question 2

JIA Pain is often ____ and less severe,
but presents in the morning and early during
the day rather than the more common
presentation of growing pains at night.

Answer 2

dull and achy

Question 3

The most common type of JIA (accounting for half of all JIA cases)

Answer 3

Pauciarticular(oligoarticular) JIA

Question 4

Generally affects four or fewer joints during the first 6 months of
disease

Answer 4

Pauciarticular JIA

Question 5

Does pauciarticular JIA have symmetric or asymmetric pattern?

Answer 5

asymmetric

Question 6

What joints does Pauciarticular mostly effect

Answer 6

knees, elbows, wrists, and ankles.

Question 7

in pauciarticular boys are more affected between ages 1-5 true or false

Answer 7

girls

Question 8

Affects five or more joints, most commonly including large and small joints.

Answer 8

Polyarticular JIA

Question 9

Joint involvement is usually symmetric/asymmetric and is most like that of adult RA, with
the potential for severe, destructive arthropathy.

Answer 9

symmetric

Question 10

Polyarticular JIA affects girls or boys more

Answer 10

girls

Question 11

Rheumatoid factor–positive (RF+)

Answer 11

The presence of rheumatoid factor.

Question 12

Subcutaneous nodules, cervical spine fusion, chronic uveitis, and destructive hip disease.

Answer 12

part of rheumatoid factor positive

Question 13

Theumatoid factor–negative (RF-)

Answer 13

Children with this subtype do not test positive for rheumatoid factor.
 Joint involvement usually less severe.
 Morning stiffness and fatigue with possible low-grade fever are common.

Question 14

Involvement of any number of joints.

Answer 14

Systemic-onset JIA (Still Disease)

Question 15

Often begins with a high-spiking fever and chills that appear
intermittently for weeks and may be accompanied by a rash on the
thighs and chest that often goes away within a few hours.

Answer 15

Systemic-onset JIA (Still Disease)

Question 16

The child may also experience macrophage activation syndrome and
lymphadenopathy; inflammation of the liver, spleen, heart, and
surrounding tissues; and anemia.

Answer 16

Systemic-onset JIA (Still Disease)

Question 17

A group of disorders formerly considered variants of RA, are in fact
distinct entities with similar features affecting the spine.

Answer 17

Spondyloarthropathies (SpAs)

Question 18

A group of disorders formerly considered variants of RA, are in fact
distinct entities with similar features affecting the spine.

Answer 18

Spondyloarthropathies (SpAs)

Question 19

o Ankylosing Spondylitis (AS)
o Sjögren syndrome
o Psoriatic arthritis
o Reactive arthritis including arthritides that accompany inflammatory
bowel disease (known as enteric arthritides)
o Reiter syndrome.

Answer 19

Spondyloarthropathies (SpAs)

Question 20

Common Features of the
Spondyloarthropathies

Answer 20

 Chronic inflammation of the axial skeleton and sacroiliac joints.
 Asymmetric involvement of a small number of peripheral joints.
 Young males (late teens, early adulthood) most affected.
 Familial predisposition.
 Inflammation at sites of ligament, tendon, and fascial insertion into
bone.
 Seronegativity for rheumatoid factor, but an association with
histocompatibility antigens including HLA-B27.
 Extraarticular involvement of eyes, skin, genitourinary tract, cardiac
system.

Question 21

An inflammatory arthropathy of the axial
skeleton including the sacroiliac joints,
apophyseal joints, costovertebral joints, and
intervertebral disk articulations.

Answer 21

Ankylosing Spondylitis
(Marie-Strümpell disease)

Question 22

does AS have symmetric or asymmetric involvement?

Answer 22

asymmetric

Question 23

What age does AS usually affect?

Answer 23

Typically affects young people, beginning between the ages of 15 and
30 years (rarely after age 40 years).

Question 24

When is back pain occur?

Answer 24

This differs from back pain of mechanical origin, which is much
more likely to develop 30-65

Question 25

Chronic nongranulomatous inflammation at the area where the ligaments attach to the vertebrae (an area called the enthesis.)

Answer 25

AS

Question 26

The replacement of inflamed cartilaginous structures by bone contributes to progressive ossification with bony growth between the vertebrae, leading to a fused, rigid called?

Answer 26

bamboo spine

Question 27

What is pain pattern of AS?

Answer 27

At first, the pain is described as a dull ache that is poorly localized; over time, pain becomes more severe and constant.

Question 28

AS pain worse with or without movement?

Answer 28

Many patients report symptoms will increase with prolonged rest and are relieved with active movements.

Question 29

AS pain radiates below knee?

Answer 29

no

Question 30

inflammation of the tendons, ligaments, and capsular attachments to bone is called?

Answer 30

enthesitis

Question 31

Early loss of normal lumbar lordosis with accompanying increased kyphosis or lordoic of the thoracic spine in AS

Answer 31

kyphosis

Question 32

What are some complications of AS?

Answer 32

Osteoporosis, fracture, atlantoaxial subluxation, and spinal stenosis.  In the most severe cases the spine becomes so completely fused that the person may become locked in a rigid upright or stooped position, unable to move the neck or back in any direction.  Flexion contractures, rigid gait, and flexing at the knees to maintain an upright position are common findings.  Significant loss of functional mobility and may be unstable enough to result in neurologic changes in the spinal cord and cervical nerve roots

Question 33

what is the most common extraarticular manifestation of AS?

Answer 33

uveitis

Question 34

in AS what can result from the proliferation of bony tissue from the spinal ligaments and facet joints creating neurogenic claudication and CE syndrome?

Answer 34

spinal stenosis

Question 35

An idiopathic variant of OA.

Answer 35

Diffuse Idiopathic Skeletal Hyperostosis (DISH)

Question 36

Also called Forestier disease.

Answer 36

Diffuse Idiopathic Skeletal Hyperostosis (DISH)

Question 37

Ossification of what ligaments in DISH?

Answer 37

longitudinal ligaments

Question 38

What spine does DISH commonly affect

Answer 38

thoracic

Question 39

men or women in DISH and ages?

Answer 39

men 2:1 ages 50/70

Question 40

Difference between DISH, OA and AS? lumbar or thoracic spine? age? location?

Answer 40

In contrast to OA, DISH does not directly result in degeneration of vertebral facet joints, joint space narrowing, or spondylophytes (lipping of vertebral bodies); instead, it manifests with syndesmophytes, resulting in decreased mobility of the spine, especially the lumbar spine. The condition can aggravate the effects of OA and other degenerative conditions of the spine. DISH is differentiated from ankylosing spondylitis by age (older), location (cervical, thoracic spine > lumbar spine, no sacroiliac involvement), and morphology (loosely flowing ossification on

Question 41

bony outgrowths attached to ligaments

Answer 41

syndesmophytes

Question 42

A chronic autoimmune disease that causes arthritis-related effects in several organs.

Answer 42

Sjögren Syndrome

Question 43

Most commonly the moisture-producing glands (e.g., mouth, eyes) but also joints, lungs, kidneys, or liver.

Answer 43

Sjögren Syndrome

Question 44

The syndrome may be a primary condition occurring alone or secondary to other autoimmune diseases, such as RA or lupus.

Answer 44

Sjögren Syndrome

Question 45

The second most common autoimmune rheumatic disease

Answer 45

Sjögren Syndrome

Question 46

Developing most often in postmenopausal women.

Answer 46

Sjögren Syndrome

Question 47

what is hallmarks of Sjögren Syndrome

Answer 47

dry eyes (keratoconjunctivitis sicca) and dry mouth

Question 48

A seronegative inflammatory joint disease affecting about 20% of people who have psoriasis (more often in people with severe psoriasis.)

Answer 48

Psoriatic Arthritis

Question 49

Psoriatic arthritis occurs in what age group?

Answer 49

The disease can occur in children, with onset typically between the ages of 9 and 12 years.

Question 50

Where is psoriatic arthritis most common in? DIP OR PIP JOINTS?

Answer 50

DIP

Question 51

What hand deformity is seen in psoriatic arthritis?

Answer 51

claw

Question 52

How is sacroilitis in PA different than AS?

Answer 52

Usually unilateral, in contrast to that in AS (which is bilateral)  Occurs in 20% to 40% of clients.

Question 53

A slight predilection for girls is noted in children.

Answer 53

Psoriatic arthritis

Question 54

In psoriatric arthritis what joint is most commonly affected?

Answer 54

hip joint

Question 55

What occurs in nails for psoriatic arthritis?

Answer 55

(A) Pitting of the nail beds associated with psoriasis.  (B) Onycholysis associated with reactive arthritis, a separation of the nail plate from the nail bed beginning at the free margin and progressing inward.

Question 56

The occurrence of an acute, aseptic, inflammatory arthropathy arising after an infectious process but at a site remote from the primary infection, which differs from bacterial arthritis, a local response with joint destruction and sepsis.

Answer 56

Reactive Arthritis

Question 57

reactive arthritis is symmetric or asymmetric?

Answer 57

 Usually asymmetric affecting more than one joint, typically the large and medium joints of the lower extremities.

Question 58

In psoriatric athritis associated findings?

Answer 58

Associated findings may include uveitis, enthesitis (inflammation involving the sites of bony insertion of tendons and ligaments), sacroiliitis, urethritis, and conjunctivitis.

Question 59

What are extraarticular manifestations for psoriatric arthritis?

Answer 59

Onycholysis of the fingernails or toenails dactylitis (sausage-like swelling of the toes and fingers because of joint and tenosynovium inflammation), painless mucosal ulcers in the mouth, discharge from the vagina or penis, urologic symptoms (urgency, frequency, difficulty starting or continuing a flow of urine), or various types of skin lesions.

Question 60

What is the clinical triad for reactive arthritis?

Answer 60

arthritis, urethritis, and conjunctivitis, called reiter syndrome

Question 61

what is one of the most common examples of reactive arthritis?

Answer 61

reiter syndrome

Question 62

Usually follows venereal disease or an episode of bacillary dysentery (enteric infection) and is associated with typical extraarticular manifestations.

Answer 62

reiter syndrome

Question 63

Acute, monarticular, inflammatory arthritis manifested by exquisite joint pain occurring suddenly at night.

Answer 63

gout

Question 64

What is produced in gout?

Answer 64

uric acid

Question 65

What is deposited in the joints, soft tissues and kidneys of gout?

Answer 65

urate crystals (tophi)

Question 66

What age is gout most common in?

Answer 66

middle age men

Question 67

What diet causes gout?

Answer 67

A diet rich in purines: shellfish, trout, sardines, anchovies, meat (especially organ meats), asparagus, beans, peas, spinachand fructose-sweetened foods and beverages can increase the risk.

Question 68

After recovering from the initial episode of gout the person enters an asymptomatic phase called

Answer 68

intercritical period

Question 69

An articular abnormality related to neurologic deficits

Answer 69

Neuroarthropathy (Neuropathic Arthropathy)

Question 70

Advanced neuroarthropathy is more clearly defined

Answer 70

with enlarging and persistent effusion and minimal subluxation, fracture, or fragmentation.

Question 71

a common condition related to age- related changes in the intervertebral disk materials that can produce radiculopathy, limited spinal stability, and disabilit

Answer 71

Degenerative intervertebral disk disease

Question 72

Degenerative intervertebral disk disease results in pain where?

Answer 72

neck and low back pain

Question 73

When does degenerative intervertebral disk disease occur?

Answer 73

Can occur before age 20 years, usually in a familiar pattern or in elite athletes who have been exposed to repetitive physical loading of the spine from frequent trunk rotations, frequent kicking or jumping, or repeated spinal flexion and extension.

Question 74

Half of all Americans > 40 y/o are affected by degenerative disk disease (DDD). true or false

Answer 74

T

Question 75

in Degenerative intervertebral disk disease men present with?

Answer 75

sciatica

Question 76

what is the greatest risk factor for disk degeneration?

Answer 76

familial aggregation including genetic inheritance

Question 77

what is associated with intervertebral disk degeneration?

Answer 77

spinal stenosis, degenerative spondylolisthesis

Question 78

As the intervertebral disk loses height, what happens to the annulus and ligamentum flavum?

Answer 78

As the intervertebral disk loses height, the annulus may bulge circumferentially, and the ligamentum flavum can buckle. Both encroach on the spinal canal, subarticular (facet) recesses, and lateral intervertebral foramina.

Question 79

what is often the first symptom of intervertebral disc?

Answer 79

low back pain

Question 80

where does pain spread to for intervertebral disk?

Answer 80

butt and thighs