polyarthritis Flashcards
what pattern of ROM indicates articular issues (arthritis)?
pain w passive and active ROM
what structures are moving with passive ROM?
joints, but no muscle/tendon
what ROM pattern indicates non-articular issues?
pain on active, no pain on passive ROM
what pattern of features indicate inflammatory arthritis?
stiffness >30min, systemic symptoms, specific joint patterns, nodules, rashes, organ involvement
how do the infection routes differ for kids and adults in septic arthritis?
adults-blood
kids-contiguous (growth plate)
what patterns indicate septic arthritis in regards to fluid appearance, volume, viscosity, WBC count, PMN?
opaque, high (5-50ml), low viscosity, WBC >50,000, PMN >75
what is the epidemiology of gout?
males (most common inflammatory arthritis in M>40), not in premenopausal females
what risk factors predispose pt to gout?
- metabolic syndrome, obesity, HTN, diabetes, dyslipidemia
- ETOH, meds, ASA, diuretics
- renal insufficiency, concurrent illness, past kidney stone
- FHx, myeloproliferative disorder
where does gout usually start?
big toe (monoarthritis) in 30s, spread to other joints (lower limbs first)
what crystals are implicated in pseudogout?
calcium pyrophosphate
how does pseudogout happen?
calcium deposition in joints through trauma
what percentage of seniors have chondrocalcinosis?
50%
what factors increase risk of pseudogout?
age, OA, neuropathic joints, hyperparathyroidism, hypothyroidism, hemochromatosis, hypo PO4/Mg, FHx
where does pseudogout likely happen?
knees
what factors are needed to Dx pseudogout?
birefringence in synovial fluid, rhomboid shaped crystals, XR shows chondrocalcinosis
what is the etiology of CREST?
- skin thickening doesn’t go above knees/elbows
- late/limited organ involvement
- calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasia, anti-centromere +
what is the etiology of diffuse scleroderma?
- skin thickening past elbows, knees, and on trunk/jaw/face
- internal organ involvement (lung and kidney) early and severe
- Scl-70+
what are the most common joints affected by RA?
MCP and wrist
then PIP, knees, shoulders, ankles, elbows, hips
what is the evolution of RA?
start as monoarthritis, then into small joint symmetrical polyarthritis in hands and feet
what are the extra-articular diseases associated w RA?
sc nodules, pulmonary/cardiac involvement, eye involvement, neuro/renal/muscular atrophy, rheumatoid vasculitis
what ethnicities are prone to SLE?
african and asian
what are the common features of lupus? (SOAP BRAIN MD)
serositis oral ulcer arthritis photosensitivity blood problems renal problems ANA+ immune test + neuro problems malar rash discoid rash
what is the defining factor of seronegative arthritis?
rheumatoid factor negative
what is the typical onset age of AS?
late teens-early 20s (males)
what population has a high prevalence of AS?
native american
what are the clinical features of AS?
alternating butt pain (SI)
inflammatory back pain (3mo, >1hr, worse w rest)
peripheral joint disease (hips, shoulders, knees)
in psoriatic arthritis, psoriasis usually ____ the arthritis
precedes
What even usually precedes reactive arthritis?
infectious diarrhea (salmonella, yersinia, shigella, campylobacter)
urogenital infections
T/F: reactive arthritis is due to bacterial infection in joints
False. Due to local immune response to systemic infection
what is the typical onset age of reactive arthritis?
20s, men
what are the symptoms of reactive arthritis?
arthritis, conjunctivitis, urethritis
asymmetric additive oligoarthritis in lower body
oral ulcers, circinate balanitis, keratoderma balanitis
what muscle groups are more commonly affected by inflammatory muscle disease?
proximal
what is the most severe consequence of temporal/giant cell arthritis?
blindness
what is a common feature of all the symptoms associated with fibromyalgia?
worse w stress
