MSK/RHEUM Flashcards
what is the most common arthropathy among adults and elderly
OA
how is OA defined
progressive loss of articular cartilage with reactive changes in the bone resulting in pain and destruction of the joint
Clinical features of OA
Decreased ROM, Joint crepitus and pain gradually worsening throughout the day and changes with weather
hard and bony joints
what are the common sites of involvement for OA
DIP (Heberden’s nodes)
PIP (Bouchards nodes)
Wrist, Hip, Knee, Spine
what do radiographs show with OA
asymmetric narrowing, subchondral sclerosis, cysts and marginal osteophytes
what is the treatment for OA
Weight reduction, moderate physical activity, Tylenol, NSAID are 1st line, Intra-articular steroids, viscuosupplement injection, bracing
what is rheumatoid arthritis
is a chronic disease with synovitis affecting multiple joints and other systemic extra-articulat manifestations
who is more affected by RA
females are more often affected than males with onset between 40-60 years of age.
what is the criteria for diagnosing RA
morning stiffness for >1hr for at least 6weeks
Arthritis and soft tissue swelling of >3joints and presents for at least 6 weeks
arthritis of hand joints for at least 6 weeks
symmetric arthritis for 6 weeks
subcutaneous nodules in specific places
Rheumatoid factor at a level above the 95th percentile
radiology changes of joint erosions or calcific changes
what lab findings are positive in RA
ESR and CRP are elevated
RF and Anti-CCP antibodies
radiographic findings show soft tissue swelling and juxta articular demineralization
what is the treatment for RA
Consult rheumatologist PT/OT NSAIDs with DMARDS methotrexate initial DMARD used Reconstructive surgery for severe cases
what serological test is most sensitive for RA
anti-CCP
what drugs are DMARDS that are used in RA
methotrexate, hydroxychloroquine, azothiprine
what are the symptoms of RA
fever, fatigue, wt loss joint stiffness MCP, wrist, PIP, knee shoulder, ankle worse in morning better with movement swollen, tender, boggy, erythematous joints Boutonniere deformity Ulnar deviation at MCP
what is gout
inflammatory monoarticular arthritis caused by the crystallization of monosodium urate in joints
hyperurecemia is the hallmark of the disease
who is affected by gout
90% of patients are men over 30 and women are not affected until after menopause
what causes gout
increased production of uric acid
decreased excretion of uric acid
renal disease, NSAIDs, diuretics
what are the clinical features of gout
increased serum uric acid level
peak age of onset is between 40 to 60
sudden onset of exqusite pain where patient can not tolerate even a bed sheet on the toe
most often affects the big toe (podagra)
pain, erythema, swelling and warmth
what are tophi
where are they usually located
aggregations of urate crystals surrounded by giant cells in an inflammatory reaction
extensor surfaces of forearms, elbows, knees
how is gout diagnosed
joint aspirations under polarized light will show
needle shaped negatively shaped birefringent urate crystals
Serum uric acid is not helpful as it can be normal during an acute attack
what is the treatment for gout attack
bed rest,
NSAID (indomethacin)
Colchicine for pts who can not take NSAIDs
prednisone (7-10days)
what medication is used prophylactic therapy for gout
Allupurinol, probenecid,
what is pseudo gout
calcium pyrophosphate deposit in joints leading to inflammation
what are risk factors for pseudo gout
increases with age, and with OA of the joints
common in elderly with degenerative joint disease
hemochromatosis, hyperparathyroidism, hypothyroidism,
what are the symptoms of pseudo gout
most common joints affected are knees and wrists
classically monoarticular
how is pseudo gout diagnosed
joint aspiration will show weakly positively birefringent rod shaped and rhomboidal crystals
what is the treatment for pseudo gout
treat underlying disorder
symptomatic managament of NSAIDs, colchicine, steroid injections
what Systemic lupus erythematosus
autoimmune disorder characterized by inflammation and positive ANAs and involvement of multiple organs
what are risk factors for SLE
Genetics Sun exposure Infections Hormonal estrogen drugs (procainamide, hydralazine, INH
SLE is most common in what patient
MC in young female
AA affected greater than whites
what are the clinical features of SLE
Joint pain, Fever, Malar/butter fly rash discoid lesions pericarditis renal disease pleuritis neurologic disease
what is the criteria for the diagnosis of SLE
Need 4 of these:
Malar rash, Discoid skin lesions
Photosensitivity, Oral ulcers, Arthritis, Serositis
Renal Dz protein uria, Neuro Dz seizures, psychosis
Lab results in SLE
Positive ANA sensitive but not specific
Anti-ds DNA and Anti-Sm are diagnostic of SLE but not very sensitice
Anti-Histone Ab are present in 100% of cases of drug induced SLE
what is the treatment for SLE
avoid sun
NSAID for MSK complaints
Local or systemic steroids for acute exacerbations
hydroxychloroquine
what is polymyositis
inflammatory disease of striated muscle affecting the proximal limbs, neck and pharynx
who is more commonly affected by polymyositis
women
what are the clinical features of polymyositis
proximal muscle weakness, dysphagia, over weeks Skin rash (malar) heliotrope (blue-purple) upper eyelid discoloration polyarthralgias and muscle atrophy
what are the laboratory findings in polymyositis
elevated CPK, aldolase muscle biopsy will show myopathic inflammation Anti-Jo-1 Anti-signal recognition particle Anti-Mi2 antibodies
what is the treatment for polymyositis
high dose steroids, methotrexate, azathioprine until symptoms resolve
what is polymyalgia rheumatic
idiopathic inflammatory condition causing synovitis, bursitis and tenosynovitis
what are the clinical features of polymyalgia rheumatica
aching/stiffness of proximal joints (shoulders, hips and neck)
MC in Femal >50
Closely associated with temporal arteritis
what are the symptoms of Polymyalgia rheumatica
bilateral joint aching/stiffness >30min of the pelvic and shoulders with trouble combing hair, putting on coat and getting out of chair
profound morning Stiffness
how is polymyalgia rheumatica diagnosed
clinical
elevated ESR
whats is TX for PMR
steroids
what is fibromyalgia
chronic nonprogressive course with waxing and waining in severity
what is the key to the diagnosis of fibromyalgia
multiple trigger points that are tender to palpation, symmetrical
eighteen characteristic locations have identified
how is fibromyalgia diagnosed
point tenderness in 11 of the 18 trigger points for >3 months
Biopsy will show moth eaten appearance
what is the Tx for fibromyalgia
exercise
Pregabalin (lyrica)
TCA,Cymbalata
SSRI, Neurontin
what is reactive arthritis
is asymmetric inflammatory oligoarthritis of lower extremities that is preceded by an infectious process that is remote from the site of arthritis (1-4 weeks) prior
who commonly gets Reiters syndrome
HLA-B27 positive indiviuals
what organisms are associated with reiters
Salmonella, shigella, campylobacter, chalmydia, yersinia
what is the classic triad of reiters syndrome
arthritis, urethritis and ocular inflammation (conjuntivitis or uveitis
cant see, cant pee and can’t climb a tree
how is reactive arthritis diagnosed
synovial fluid for analysis WBC 10,000-20,000 elevated ESR Synovial fluid 1,000-8,000 cells/mm synovial fluid is bacterially negative
what is the treatment for reactive arthritis
NSAIDs first line
if no response then try sulfasalazine or azathioprine
Abx use is controversial
what is polyarteritis nodosa
small and medium artery inflammation involving the skin, kidney and peripheral nerves and gut
Who is affected by polyarteritis nodosa
Men generally between the ages of 40-60
associated with hepatitis B&C
what are the clinical features of polyarteritis nodosa
fever, anorexia, weight loss, abdominal pain, peripheral neuropathy
Skin lesions palpable purpura and livedo reticularis
HTN, edema, oligouria and uremia
how is polyareritis nodosa diagnosed
vessel biopsy or angiography
Lab finding with polyarteritis nodosa
elevated ESR, CRP, proteinuria positive Hep B surface antigen
what is the treatment for polyarteritis nodosa
high doeses of steroids
cytotoxic drugs and immunotherapy also may be used
treat HTN
what is scleroderma
unknow cause and is characterized by deposition of collagen in the skin and less commonly in the kidney, heart and lungs
who is affected by scleroderma
women
ages 30 to 50
what are the clinical features of scleroderma
skin involvement affects 95% of the patients, changes most often start with the fingers swelling and the hands then the face
Raynauds is seen in 75% of the patietns
CREST
Calcinosis, Raynauds, Esophageal dysfunction, sclerodactyly, telangiectasias
what lab finding are there with scleroderma
ANA is present in 90% of patients with diffuse scleroderma
Anticentromere antibody
what is Tx for scleroderma
there is no cure
treatment is organ specific of PPI, ACE, CCB
what is sjogrens syndrome
is an autoimmune disorder that destroys salivary and lacrimal glands
could also be a secondary complication of RA, SLE, Scleroderma or Polymyositis
who is affected by sjorgrens
middle aged females
what are the clinical features of sjogrens
mucous membranes are most affected, dry mouth, dry eyes, parotid gland enlargement
what lab findings are there with sjogrens
RF present in 70% of cases, ANA in 60% of cases and Anti-RO
what test evaluates secretions by the lacrimal gland
schirmers tear test
wetting of less than 5mm of filter paper in the lower eyelid for
what is the treatment of sjogrens
artificial tears, and saliva, increased fluid intake, ocular and vaginal lubricants
pilocarpine
what is juvenile idopathic arthritis
autoimmune mono or polyarticular arthritis
what types of JRA are there
Pauci-articular 4 or fewer medium or large joints
systemic acute arthritis
polyarticular resembles adult RA with systemic joint involvement
how is JRA diagnosed
RF+ in 15%
it is usually a clinical diagnosis
elevated ESR and CRP
what is the treatment for JRA
NSAIDs
methotrexate, leflunomide
