MSK joint disorders Flashcards
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.
JIA
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.
dull and achy
The most common type of JIA (accounting for half of all JIA cases)
Pauciarticular(oligoarticular) JIA
Generally affects four or fewer joints during the first 6 months of
disease
Pauciarticular JIA
Does pauciarticular JIA have symmetric or asymmetric pattern?
asymmetric
What joints does Pauciarticular mostly effect
knees, elbows, wrists, and ankles.
in pauciarticular boys are more affected between ages 1-5 true or false
girls
Affects five or more joints, most commonly including large and small joints.
Polyarticular JIA
Joint involvement is usually symmetric/asymmetric and is most like that of adult RA, with
the potential for severe, destructive arthropathy.
symmetric
Polyarticular JIA affects girls or boys more
girls
Rheumatoid factor–positive (RF+)
The presence of rheumatoid factor.
Subcutaneous nodules, cervical spine fusion, chronic uveitis, and destructive hip disease.
part of rheumatoid factor positive
Theumatoid factor–negative (RF-)
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.
Involvement of any number of joints.
Systemic-onset JIA (Still Disease)
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.
Systemic-onset JIA (Still Disease)
The child may also experience macrophage activation syndrome and
lymphadenopathy; inflammation of the liver, spleen, heart, and
surrounding tissues; and anemia.
Systemic-onset JIA (Still Disease)
A group of disorders formerly considered variants of RA, are in fact
distinct entities with similar features affecting the spine.
Spondyloarthropathies (SpAs)
A group of disorders formerly considered variants of RA, are in fact
distinct entities with similar features affecting the spine.
Spondyloarthropathies (SpAs)
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.
Spondyloarthropathies (SpAs)
Common Features of the
Spondyloarthropathies
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.
An inflammatory arthropathy of the axial
skeleton including the sacroiliac joints,
apophyseal joints, costovertebral joints, and
intervertebral disk articulations.
Ankylosing Spondylitis
(Marie-Strümpell disease)
does AS have symmetric or asymmetric involvement?
asymmetric
What age does AS usually affect?
Typically affects young people, beginning between the ages of 15 and
30 years (rarely after age 40 years).
When is back pain occur?
This differs from back pain of mechanical origin, which is much
more likely to develop 30-65
Chronic nongranulomatous inflammation at the area where the
ligaments attach to the vertebrae (an area called the enthesis.)
AS
The replacement of inflamed cartilaginous structures by bone
contributes to progressive ossification with bony growth between the
vertebrae, leading to a fused, rigid called?
bamboo spine
What is pain pattern of AS?
At first, the pain is described as a dull ache that is poorly localized; over time,
pain becomes more severe and constant.
AS pain worse with or without movement?
Many patients report symptoms will increase with prolonged rest and are
relieved with active movements.
AS pain radiates below knee?
no
inflammation of the tendons, ligaments, and capsular attachments to bone is called?
enthesitis
Early loss of normal lumbar lordosis with accompanying increased
kyphosis or lordoic of the thoracic spine in AS
kyphosis
What are some complications of AS?
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
what is the most common extraarticular manifestation of AS?
uveitis
in AS what can result from the proliferation of bony tissue from the spinal ligaments and facet joints creating neurogenic claudication and CE syndrome?
spinal stenosis
An idiopathic variant of OA.
Diffuse Idiopathic Skeletal
Hyperostosis (DISH)
Also called Forestier disease.
Diffuse Idiopathic Skeletal
Hyperostosis (DISH)
Ossification of what ligaments in DISH?
longitudinal ligaments
What spine does DISH commonly affect
thoracic
men or women in DISH and ages?
men 2:1 ages 50/70
Difference between DISH, OA and AS?
lumbar or thoracic spine?
age?
location?
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
bony outgrowths attached to ligaments
syndesmophytes
A chronic autoimmune disease that causes arthritis-related effects in
several organs.
Sjögren Syndrome
Most commonly the moisture-producing glands (e.g., mouth, eyes) but
also joints, lungs, kidneys, or liver.
Sjögren Syndrome
The syndrome may be a primary condition occurring alone or
secondary to other autoimmune diseases, such as RA or lupus.
Sjögren Syndrome
The second most common autoimmune rheumatic disease
Sjögren Syndrome
Developing most often in postmenopausal women.
Sjögren Syndrome
what is hallmarks of Sjögren Syndrome
dry eyes (keratoconjunctivitis sicca) and dry mouth
A seronegative inflammatory joint disease affecting about 20% of
people who have psoriasis (more often in people with severe psoriasis.)
Psoriatic Arthritis
Psoriatic arthritis occurs in what age group?
The disease can occur in children, with onset typically between the
ages of 9 and 12 years.
Where is psoriatic arthritis most common in? DIP OR PIP JOINTS?
DIP
What hand deformity is seen in psoriatic arthritis?
claw
How is sacroilitis in PA different than AS?
Usually unilateral, in contrast to that in AS (which is bilateral)
Occurs in 20% to 40% of clients.
A slight predilection for girls is noted in children.
Psoriatic arthritis
In psoriatric arthritis what joint is most commonly affected?
hip joint
What occurs in nails for psoriatic arthritis?
(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.
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.
Reactive Arthritis
reactive arthritis is symmetric or asymmetric?
Usually asymmetric affecting more than one joint, typically the large
and medium joints of the lower extremities.
In psoriatric athritis associated findings?
Associated findings may include uveitis, enthesitis (inflammation
involving the sites of bony insertion of tendons and ligaments),
sacroiliitis, urethritis, and conjunctivitis.
What are extraarticular manifestations for psoriatric arthritis?
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.
What is the clinical triad for reactive arthritis?
arthritis, urethritis, and conjunctivitis, called reiter syndrome
what is one of the most common examples of reactive arthritis?
reiter syndrome
Usually follows venereal disease or an episode of bacillary dysentery
(enteric infection) and is associated with typical extraarticular
manifestations.
reiter syndrome
Acute, monarticular, inflammatory arthritis
manifested by exquisite joint pain occurring
suddenly at night.
gout
What is produced in gout?
uric acid
What is deposited in the joints, soft tissues and kidneys of gout?
urate crystals (tophi)
What age is gout most common in?
middle age men
What diet causes gout?
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.
After recovering from the initial episode of gout the person
enters an asymptomatic phase called
intercritical
period
An articular abnormality related to neurologic deficits
Neuroarthropathy
(Neuropathic Arthropathy)
Advanced neuroarthropathy is more clearly defined
with enlarging
and persistent effusion and minimal subluxation, fracture, or fragmentation.
a common
condition related to age-
related changes in the
intervertebral disk materials
that can produce
radiculopathy, limited spinal
stability, and disabilit
Degenerative intervertebral
disk disease
Degenerative intervertebral
disk disease results in pain where?
neck and low back pain
When does degenerative intervertebral disk disease occur?
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.
Half of all Americans > 40 y/o are affected by degenerative disk
disease (DDD). true or false
T
in Degenerative intervertebral
disk disease
men present with?
sciatica
what is the greatest risk factor for disk degeneration?
familial aggregation including genetic inheritance
what is associated with intervertebral disk degeneration?
spinal stenosis, degenerative spondylolisthesis
As the intervertebral disk loses height, what happens to the annulus and ligamentum flavum?
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.
what is often the first symptom of intervertebral disc?
low back pain
where does pain spread to for intervertebral disk?
butt and thighs
