Polyarthritis Flashcards by J P

articular diseases cause ____ for active ROM and ____ for passive ROM

pain, pain

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non- articular diseases cause ____ for active ROM and ____ for passive ROM

pain, no pain

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non-MSK related diseases cause ____ for active ROM and ____ for passive ROM

no pain, painful

psychological (?)

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features (stiffness, systemic symptoms, joint pattern, etc.) for inflammatory diseases

stiffness: morning, last >30 min
systemic symptoms (B symptoms): present
joint pattern: RA or PsA or other
other: nodules, rashes, other organ involvement

not confined to joints

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features (stiffness, systemic symptoms, joint pattern, etc.) for non-inflammatory diseases

stiffness: after inactivity, lasts few min
systemic: no
joint pattern: OA
other: no

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what is the number one route of infection for adult septic arthritis?

hematogenous

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what is a common route of infection for paediatric septic arthritis

contiguous spread from osteomyelitis

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what are some medical conditions that predispose to MSK infections

compromised host defence 
(hematological &amp; metabolic disorders, immunosuppressive drugs
direct penetration of joint 
joint damage (rheumatic, prosthetic joints)

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septic arthritis organism for neonates

staph
strep
coliform bacteria

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septic arthritis organism for children

staph

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septic arthritis organism for young adults

staph

neisseria gonorrhoeae

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septic arthritis organism for adult

staph

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septic arthritis organism for immunocompromised patients

gram negatives

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investigations for septic arthritis

aspirate, send for:
cell count and differential
crystal analysis
culture and sensitivity, including gram stain

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joint aspirate feature for OA

clear
1-10mL (slightly higher than normal)
high viscosity,
200-10,000 WBC/cubic mm (higher than normal)
<50 polymorphonuclear cells (slightly higher than normal)

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joint aspirate feature for inflammatory arthritis

opaque (abnormal)
5-50mL (higher than normal)
low viscosity (abnormal)
500-75,000 cell count (higher than normal)
>50 (higher than normal)

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joint aspirate feature for septic arthritis

opaque (abnormal)
5-50mL (higher than normal)
low viscosity (abnormal) 
>50,000 cell count (much higher than normal)
>75 (much higher than normal)

higher the white count, higher the % of PMN’s, higher the chance of septic arthritis

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what is gout and describe the epidemiology?

buildup of uric acid crystals in joints
most common cause of inflammatory arthritis in men over 40yr old
does not occur in premenopausal females

what are risk factors for gout

alcohol - purines 
obesity 
diabetes 
medication use 
renal insufficiency 
concurrent illness
past kidney stones 
FHx
myeloproliferative disorders

what is pseudogout?

deposit of calcium pyrophosphate crystals
set off inflammatory response
episodic mono-arthritis
knee & wrist

how to Dx pseudogout?

synovial fluid
birefringence
XR showing chondrocalcinosis

what is rheumatoid arthritis and its epidemiology?

autoimmune
prevalence of 1%
3:1 (F:M)
onset 20’s - 40’s

clinical presentation of rheumatoid arthritis

fluctuating joint pain and swelling 
morning stiffness > 1 hour 
alleviated by moving and heat 
systemic symptoms 
MCP + wrist > PIP + MTP > knees and shoulders and ankles > elbows and hips

what is the pattern of joint involvement in RA?

small joint, symmetrical, polyarthritis

may start as monoarthritis

what are extra-articular diseases of RA?

``` subcutaenous nodules pulmonary & cardiac involvement eye involvement neurologic renal muscular atrophy rheumatoid vasculitis ```

epidemiology of SLE

9 females : 1 male | African and Asian more common/severe presentation

common features of lupus

``` (SOAP BRAIN MD) serositis (lining of heart/lungs) oral ulcers arthritis photosensitivity cytopenias renal problems ANA positive antiDNA antibodies neurologic malar rash discoid rash ```

what are seronegative arthritis diseases

rheumatoid factor negative ankylosing spondylitis psoriatic arthritis reactive arthritis enteropathic arthritis

epidemiology of ankylosing spondylitis

males > females late teens/early 20s rare in black populations high prevalence in Native Americans (HLA B27)

Clinical presentation of ankylosing spondylitis

alternating butt pain (SI joints) inflammatory back pain worse with rest, improve with exercise morning stiffness > 60 min q/3 get peripheral joint disease

describe enteropathic arthritis

~5% of patients with IBD often indistinguishable from primary AS affects M/F equally usually follows onset of bowel disease

describe psoriatic arthritis

M=F 7-15% with curaneous psoriasis psoriasis precedes arthritis in 2/3 nail changes

describe reactive arthritis

mostly M follows infectious diarrhea (salmonella, yersinia, shigella, campylobacter, chlamydia)

clinical presentation of reactive arthritis

``` Sx appear 1-4 weeks post-infection TRIAD: arthritis, conjunctivitis, urethritis systemic features acute, asymmetric, additive oligoarthritis lower > upper limbs oral ulcers penile rash (circinate balanitis) keratoderma blenorrhagicum ```

describe scleroderma

``` skin thickening, calcinosis, fingertip ulcertation Raynaud's (fingers turning white) GI reflux symptoms, hypomotility renal insufficiency, malignant HTN pulmonary fibroisis ```

what are the 2 forms of scleroderma?

limited and diffuse

describe limited scleroderma

CREST ``` calcinosis raynauds esophageal dysmotility sclerodactyly telangiectasia ``` anti-centromere + skin thickening doesn't go above elbows or knees

describe diffuse scleroderma

spread above elbows and knees internal organ involvement early and severe scl-70 topoisomerase positive

what is inflammatory muscle disease

progressive symmetrical proximal muscle weakness pulmonary disease GI symptoms rash over eyelids, hands and neck, chest, shoulders

labs for inflammatory muscle disease

``` high creatine autoantibodies- anti-Jo-1 or anti-tRNA synthetase CXR: interstitial lung disease EMG: myopathic features muscle biopsy ```

describe granulomatous polyangiitis (wegener's) vasculitis

``` inflammation of blood vessels systemic features ENT lung skin neuro renal MSK ```

describe polymyalgia rheumatica

proximal muscle pain, weakness and stiffness difficulty rising from seated position reduced ROM in shoulders

describe temporal arteritis/giant cell arteritis

blockage of large blood vessels of the scalp, neck and arms due to inflammation severe headache, fatigue, scalp tenderness visual disturbance (double vision, blindness)

describe fibromyalgia

F>M common in those w chronic inflammatory conditions widespread msk pain, fatigue, headache, forgetfulness (fibro fog) Dx using symptom severity score