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Clinical Med - Musculoskeletal > OA / RA / Gout > Flashcards

OA / RA / Gout Flashcards

1
Q

Osteoarthritis commonly effects which joints of the finger?

A

DIP

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2
Q

Are men or women more commonly effected by osteoarthritis?

A

Women

Peak incidence rate at 65 y.o.

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3
Q

What co-morbidities increase the risk for developing osteoarthritis?

A

DM
Hypothyroidism
Gout
Paget’s Disease

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4
Q

T/F: There is no genetic predisposition to osteoarthritis?

A

False

There is

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5
Q

Heberden’s nodes seen in Osteoarthritis are located at what joints?

A

DIP

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6
Q

Bouchard’s nodes seen in Osteoarthritis are located at what joints?

A

PIP

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7
Q

Are there specific laboratory findings for Osteoarthritis?

A

No

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8
Q

What changes may be seen on XR in a patient with osteoarthritis?

A

Osteophytes
Joint Space Narrowing
Bony Sclerosis

(Remember, XRs can appear normal early in the disease)

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9
Q

What are SIX non-pharmacological managements of osteoarthritis?

A
  1. Patient education about joint mechanics
  2. Psychosocial Support
  3. PT / OT
  4. Weight Loss
  5. Regular Exercise (Anything from stretching to water aerobics)
  6. Footwear-orthotics
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10
Q

What is the initial OTC choice for pain management in OA?

What would be an additional option?

A

Acetaminophen

NSAIDs (Ibuprofen, Naproxen, Celecoxib)

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11
Q

What are risk factors and contraindications for NSAID use?

A

Ulcer Disease
ASA Use
Renal Impairment

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12
Q

What TWO medications can be given as intra-articular joint injections to help improve pain in osteoarthritis?

A

Corticosteroids

Hyaluronic Acid

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13
Q

What are THREE surgical procedures indicated for osteoarthritis pain relief?

A

Arthroscopic Debridement
Osteotomy and Realignment (Typically in the knee)
Total Joint Replacement

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14
Q

Are men or women more likely to be affected by Rhuematoid Arthritis (RA)?

A

Women

Onset b/w 25 - 55

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15
Q

T/F: Rheumatoid Arthritis is not an autoimmune disease

A

False

It is

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16
Q

What TWO antibodies can be seen in patient’s serum before clinical presentation of RA?

A

Rheumatoid Factor

Anti-CCP (cyclic citrulinated protein)

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17
Q

Which human leukocyte antigen can be present in RA?

A

HLA-DRB1

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18
Q

What are the SIX cardinal signs of inflammation?

A 
Heat
Erythema
Swelling
Pain
Loss of Function
Stiffness
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19
Q

What joints in the hand does RA most commonly effect?

A

MCP
PIP

Also the wrist

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20
Q

What joint in the toes does RA commonly effect?

Does it effect the 1st MTP joint like in OA?

A

2nd-5th MTP joints

No involvement in the 1st MTP

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21
Q

Fever in a patient with RA may indicate the presence of what?

A

Vasculitis

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22
Q

Other than joint pain, stiffness, and deformity…..

What other symptoms may be present in RA?

A

Nodules
Eye Involvement
Pulmonary Involvement
Weight Loss

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23
Q

What are the FOUR criteria for RA diagnosis?

They need to have a score of what or higher?

A
  1. Number and site of joints involved
  2. Serological abnormality
  3. Elevated acute-phase response
  4. Symptoms duration

Need to score 6 ore higher

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24
Q

Which TWO deformities are seen in patients with RA?

HINT: One can also be seen in OA

A

Boutonneire Deformity

Swan Neck Deformity

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25
Q

T/F: Symetrical Edema can be seen in the hands of patients with RA

A

True

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26
Q

Is RA associated with a shorter or normal life expectancy?

A

Shorter

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27
Q

What pulmonary findings can often be seen on CXR in patients with RA?

A

Pulmonary Effusion

Nodules

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28
Q

Patients with RA can have an elevated Rheumatoid Factor, but this can also elevated in what other rheumatic disease?

A

Sjogren’s Syndrome

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29
Q

Which antibody present in early RA is sensitive up to 98%?

This helps to indicate rapid progression.

A

Anti-CCP antibodies

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30
Q

What are TWO labratory tests the indicate acute inflammation?

A

ESR

CRP

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31
Q

What class of medications is first line for RA treatment?

Which medication is preferred?

A

DMARDs

Methotrexate

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32
Q

What medications can be used in combination with methotrexate?

A

NSAIDs

Biologics

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33
Q

What can be given to help manage acute flares of RA?

A

Steroids

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34
Q

This arthritic disease typically onset before the age of 16?

A

Juvenile Idiopathic Arthritis

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35
Q

T/F: Oligoarthritis is the most common presentation of Juvenile Idiopathic Arthritis

A

True

Typically less than 4 joints are effected

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36
Q

___________ is described as an infection of the bone due to a blood borne pathogen. This can often occur after trauma or infection elsewhere

A

Osteomyelitis

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37
Q

What risk factors increase the risk for developing osteomyelitis?

A 
Immunocompromised
Debilitation
Wounds/Ulcers after surgery
Prosthetic Joints
Children
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38
Q

What is the most common pathogen involved in osteomyelitis in general?

In children?

Neonates?

A

General: Staph aureus

Children: Group A Strep

Neonates: Group B Strep

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39
Q

What are the symptoms osteomyelitis?

A

Pain, swelling, and erythema around a joint +/- the acute onset of fever, chills, and malaise with an obvious abscess

Children may refuse to use the infected joint

40
Q

What is a major complication of osteomyelitis?

A

Sepsis

41
Q

What labs can be helpful in working up osteomyelitis?

Imaging?

A

Labs:

CBC
ESR
CRP
Blood Cultures

Imaging:

XR
MRI / CT
Bone Scan (Avoid due to radiation)

42
Q

T/F: Osteomyelitis can be managed outpatient

A

False

43
Q

Osteomyelitis patients will require treatment with what until they become afebrile?

After that what should they be treated with?

A

IV ABx until afebrile

Then 6 weeks of PO ABx until ESR/CRP are normal

44
Q

If there is an abscess present in osteomyelitis……

How would it be managed?

A

Surgical Debridement

45
Q

Reiter Syndrome is also considered an ________ arthritis

A

Reactive Arthritis

46
Q

Reiter Syndrome typical follows an episode of what?

A

Acute bacterial GI infection, STI, or UTI

47
Q

What is the most common organism involved in reiter syndrome?

A

Chlamydia Trachomatis

48
Q

Why do they describe the signs and symptoms of Reiter Syndrome as “Cant see, Can’t Pee, Can’t Climb a Tree”?

A

Can’t See: Uveitis

Can’t Pee: Cervicitis/Urethritis

Can’t Climb a Tree: Arthritis

49
Q

T/F: Signs and Sx of Reiter Syndrome typically spontaneously resolve

A

True

50
Q

60 - 80% of Reiter Syndrome patients will be positive for what gene?

A

HLA-B27

51
Q

Other then a CBC…

What labs should be tested when working up Reiter Syndrome?

A

STI
Urine Analysis
Stool Culture

52
Q

Would you expect the synovial fluid in a patient with Reiter Syndrome to show signs of infection?

A

No

But there will be inflammatory markers

53
Q

Although no treatment is required for treatment of Reiter Syndrome…..

What can be done to manage this condition?

A

Treat Underlying Cause and Subsequent Infections

NSAIDs
PT during Recovery

54
Q

How does psoriatic arthritis typically present?

A 
Nail pitting, yellowing, keratosis
DIP involvement
Oligoarthropathy
"Sausage" like appearance to fingers and toes  
Psoriasis of the skin
55
Q

Would Rheumatoid Factor be present in a patient with Psoriatic Arthritis?

A

No

56
Q

What unique radiographic finding is evident in psoriatic arthritis?

A

“Pencil-in-cup-Deformity”

57
Q

When treating Psoriatic Arthritis, why should steroids be avoided?

A

They may exacerbate the psoriasis and are not effective for this type of arthritis

58
Q

How is psoriatic arthritis managed pharmacologically?

A

NSAIDs
Methotrexate

(Can give Anti-TNFs or Cyclosporine, but typically only when unresponsive)

59
Q

What is the name of the criteria used to diagnosis and classify Psoriatic Arthritis?

A

CASPAR

60
Q

Which joints/bones does ankylosing spondylitis effect?

A

Spine

SI Joint

61
Q

Are men or women more likely to be effected by Ankylosing Spondylitis?

A

Men

62
Q

How does ankylosing Spondylitis typical present?

A

Slow onset…..

Intermittent low back pain
Increasing stiffness in the morning
Gradual Loss of motion
Increased Kyphosis

63
Q

What long term complications are associated with ankylosing spondylitis?

A

Heart Disease

Pulmonary Fibrosis

64
Q

What extra articular manifestation is common in ankylosing spondylitis?

A

Uveitis

65
Q

Which gene is present in up to 90%of ankylosing spondylitis patients?

A

HLA-B27

66
Q

Ankylosing Spondylitis on XR often shows erosion of SI joints and akylosis of the spine.

This is referred to as ___________ spine

A

Bamboo Spine

67
Q

What is the primary treatment goal of Ankylosing Spondylitis?

What is the first line medczation?

Second line medications?

A

Primary Goal: Conserve ROM and Mobility

First-Line: NSAIDs

Second-Line: Ant-TNFs (Humira)

68
Q

Is infectious arthritis typically polyarticular or monoarticular?

A

Monoarticular

69
Q

Which joints are most commonly effected in infectious arthritis?

A

Knee
Hip
Shoulder
Ankle

70
Q

In infants, what is the most commonly infected joint?

A

Hips

71
Q

Is infectious arthritis considered a medical emergency?

A

Yes

72
Q

Is a prosthetic joint gets infected, what most likely will occur?

A

Removal of the prosthesis

73
Q

What is the most common, NON-gonoccocal septic arthritis?

A

Staph aureus

74
Q

In sexually active adults and teens what is the most common pathogen in monoarticular arthritis?

A

Nisseria gonorrhea

75
Q

A 22 y.o. male presents to the ED with right knee pain. He noted that he woke up this morning and his right knee was swollen, warm, and very tender. He was unable to bear weight without pain as well. He denied any injuries or trauma to the knee in the last month. He did note he felt chilly in his room this morning, but never measured his temperature. On examination, he is febrile and tachycardic. His right knee is grossly edematous when compared to the left and there is warmth, erythema, and diffuse tenderness. He has limited passive ROM secondary to pain in the knee. His examination is otherwise unremarkable.

Interestingly, you see that this patient was treated for a STI in the ED two days ago.

What is you suspected diagnosis and what organism may be responsible?

A

Infectious Arthritis

N. gonorrhea

76
Q

A 22 y.o. male presents to the ED with right knee pain. He noted that he woke up this morning and his right knee was swollen, warm, and very tender. He was unable to bear weight without pain as well. He denied any injuries or trauma to the knee in the last month. He did note he felt chilly in his room this morning, but never measured his temperature. On examination, he is febrile and tachycardic. His right knee is grossly edematous when compared to the left and there is warmth, erythema, and diffuse tenderness. He has limited passive ROM secondary to pain in the knee. His examination is otherwise unremarkable. You suspect there may be an infection in his right knee.

What is the most diagnostic procedure for confirming this diagnosis?

A

Arthocentresis (Aspiration) of the knee

Always send the aspirate for culture!

Also remember that a CBC, ESR, and CRP are helpful in this case

77
Q

What are the 4 C’s of synovial fluid analysis?

A

Color
Clarity
Cell
Crystals

78
Q

What color is ‘normal’ synovial fluid?

A

Pale, straw yellow

79
Q

The presence of sodium urate crystals in synovial fluid would be indicative of what condition?

A

Gout

80
Q

A 22 y.o. male presents to the ED with right knee pain. He noted that he woke up this morning and his right knee was swollen, warm, and very tender. He was unable to bear weight without pain as well. He denied any injuries or trauma to the knee in the last month. He did note he felt chilly in his room this morning, but never measured his temperature. On examination, he is febrile and tachycardic. His right knee is grossly edematous when compared to the left and there is warmth, erythema, and diffuse tenderness. He has limited passive ROM secondary to pain in the knee. His examination is otherwise unremarkable. Synovial fluid aspiration confirms infectious arthritis.

What is the recommended treatment for this patient?

A

IV ABx (Broad spectrum + vancomycin for MRSA)

2-6 weeks of PO ABx following completion of IV ABx or until Sx resolve

81
Q

increase in serum urate levels leading to gout is almost always a result of what?

A

Uric Acid Under Excretion and Overproduction

82
Q

What are some predisposing factors to gout?

A 
High Purine Diet
Alcohol
Surgery
Diuretics
Drugs
83
Q

Alcoholism or Vitamin B12 deficiency would lead to an ________ (under excretion/overproduction) of uric acid?

A

Overproduction

84
Q

Renal Insufficiency, Diuretics, or ASA would lead to an ________ (under excretion/overproduction) of uric acid?

A

Under Excretion

85
Q

Are deposits of uric acid (Tophi) more likely to effect proximal or distal joints?

A

Distal (ex: MTP)

86
Q

T/F: Everyone with hyperuricemia will develop gout

A

False

87
Q

A 57 y.o. obese male with a history of Vitamin B12 deficiency and remote alcoholism presents to your office with complaints of foot pain. Around 4 a.m. this morning, he woke up in severe pain. He localized the pain to his big toe on his right foot. He described it as a burning ache saying “it feels like my toe is on fire.” Just the lightest touch from even his bed sheets exacerbated the pain. He stated that he was perfectly fine when he went to bed last night, and he denied any trauma or injuries to the foot recently. He denied any fevers, chills, or weight loss. On examination, his 1st MTP on his right foot is significantly swollen, erythematous, and very warm to the touch. He has exquisite tenderness over the joint to even the lightest touch. He is afebrile and aside from being in significant pain, his exam is unremarkable.

What is the most likely diagnosis and how could this be confirmed?

A

Gout

Joint aspiration with the presence of….

Needle Shaped Crystals
Negative Bifringence

88
Q

T/F: Elevated serum uric acid levels is diagnostic of gout

A

False

it is not diagnostic

89
Q

What is the time between gout referred to as?

If hyperuricemia is not treated during the above time, what may occur?

A

Intercritical Stage

If hyperuricemia is not treated then the patient may experience more frequent gout flares

90
Q

A 57 y.o. obese male with a history of Vitamin B12 deficiency and remote alcoholism presents to your office with complaints of foot pain. Around 4 a.m. this morning, he woke up in severe pain. He localized the pain to his big toe on his right foot. He described it as a burning ache saying “it feels like my toe is on fire.” Just the lightest touch from even his bed sheets exacerbated the pain. He stated that he was perfectly fine when he went to bed last night, and he denied any trauma or injuries to the foot recently. He denied any fevers, chills, or weight loss. On examination, his 1st MTP on his right foot is significantly swollen, erythematous, and very warm to the touch. He has exquisite tenderness over the joint to even the lightest touch. He is afebrile and aside from being in significant pain, his exam is unremarkable. Joint aspiration shows needle shaped crystals with negative bifringence, confirming your suspicion of gout.

What medication can be given to abort the current gout flare?

A

Colchicine +/- NSAIDs

If you are planning on giving a steroid injection you need to r/o infection first

91
Q

What medication is recommended for gout prevention?

A

Allopurinol

92
Q

What lifestyle modifications can be recommended to prevent gout attacks?

A

Low protein/fat diet
Avoid EtOH
Control BP
Increase fluid intake

93
Q

Calcium Pyrophosphate Dehydrate Crystals in synovial fluid would be indicative of what?

A

Pseudogout

94
Q

What are common precipitating factors to gout?

A

Surgery
Illness
Hyperparathyroidism
Hematochromatosis

95
Q

Where is pseudogout more commonly seen?

A

Wrists
Knees
2nd & 3rd MCP

96
Q

Do pseudogout crystals (CPPD) have a negative or positive bifringence?

A

Positive

97
Q

Is chondrocalcinosis associated with gout or pseudogout?

A

Pseudogout

Clinical Med - Musculoskeletal (6 decks)

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