Symmetry: 1. Symmetric 2. Asymmetric

Symmetry: 1. RA, SLE, polymyalgia rheumatic, viral arthritides, serum sickness 2. Psoriatic, reactive, gout

Polyarticular Arthritis Flashcards by Emily Jernigan

Viruses that cause polyarthritis

Parvovirus B19 (acute, small joints, lacy/malar rash), hepatitis –> ACUTE, SELF LIMITED DX

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Bacterial that can cause polyarthritis

Directly through N. gonorrhoeae or indirectly though reactive arthritis bugs (Salmonella, Shigella, Campylobacter, Yersinia, Chlamydia)

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Gout is suspected in patients taking ____, degenerative changes in ______ and ______.

Taking diuretics

DIP (Heberden’s nodes) and PIP (Bouchard’s nodes)

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Inflammatory arthritis

Infectious arthritis, gout, rheumatoid arthritis, SLE, reactive arthritis

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Signs of inflammation arthritis

erythema, warmth, pain, swelling, systemically: fatigue, weight loss, fever, morning stiffness lasting longer than one hour

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Crepitus indicates

irregularities of articular cartilage –> OA, injury, previous inflamm. NEED TO PALPATE ALL JOINTS

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Distribution:
DIP and PIP
PIP and MCP
DIP, PIP, MCP
Large joints of LE

Distribution:
OA
RA
Psoriatic, crystal, sarcoidosis
Spondyloarthropathies

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Symmetry:

Symmetric
Asymmetric

Symmetry:

RA, SLE, polymyalgia rheumatic, viral arthritides, serum sickness
Psoriatic, reactive, gout

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Axial involement seen in what diseases

OA: lower back, neck
Spondyloarthropathies: insidious chronic LBP

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Migratory arthritis is

rapid onset of swelling in one or two joints with resolution over a few days, as symptoms resolve they emerge in another joint; seen in gonococcal arthritis, rheumatic fever, sarcoidosis, SLE, Lyme, bacterial endocarditis, Whipple’s

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Gout presents at this time in a pts life

20 yrs after puberty in men and 20 years after menopause in women

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What disease is associated with: pyoderma gangrenosum, HLAB27, aortic regurgitation, upper lobe lung, sacroilititis

ankylosing spondylitis

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What disease is associated with: malar rash, anemia, thrombocytopenia, leukopenia

Parvovirus B19 or SLE

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What disease is associated with: heliotrope, Gottron’s papules, eosinophilia, elevated CPK

dermatomyositis

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What is associated with: keratoderma blennorrhagicum, urethritis, prostatitis, diffuse lung fibrosis, HLA-B27,

reactive arthritis

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What is associated with: pyoderma gangrenosum, iritis/uveitis/conjunvtivitis, ischemic optic neuritis, oral ulcers, bloody sinusitis, lung nodules, hematuria/proteinuria, c-ANA

Wegener’s granulomatosis

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What disease are these sx associated with: worsen with activity esp following rest (gelling), morning stiffness less than 30, joint locking/instability, effects hands/knees/hips/spine, asymmetric

osteoarthritis

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first line tx for OA

encourage regular exercise, weight loss, PT, acetaminophen or NSAID (next line is glucoasamine/chondroitin –> opioid –> corticosteroid –> hyaluronic acid injection –> surgery, total knee replacement)

genetic association with RA and environmental trigger

HLA DR4 and DRB1

smoking

what presents like: stiffness multiple joints (wrists/PIP/MCP), morning stiffness >1hr, boggy swelling, arthralgias, fatigue, weight loss, low grade fever

Two blood problems associated with RA

anemia of chronic disease and GI bleeding from corticosteroids/NSAIDs

patients with liver disease or renal impairment can not take ______ for RA tx

methotrexate

positive signs for RA classification

1 joint with synovitis (with other causes ruled out), positive RF and positive ACCP, abnormal CRP and ESR, sx >6weeks –> need a score of 6/10 for RA

leading cause of death in patients with RA

accelerated atherosclerosis

felty syndrome

RA, splenomegaly, neutropenia, thrombocytopenia

first line nonbiologic treatment in patients with ACTIVE RA

methotrexate (unless contraindicated or not tolerated)

RA tx in patients with low disease activity

sulfasalazine or hydroxychloroquine

first line biologic treatment in patients with RA

TNF inhibitors

short term management of RA

corticosteroids and NSAIDs

remission of RA is seen mostly in this type of patient

males, non smokers, younger than 40, OR patients w/o elevated acute phase reactants or positive RF/Anti CCP in late onset disease

primary lesion in spondyloarthropathies

enthesitis

Which spondyloarthropathy: late teens to adult, males, HLAB27, sacroilitis, asymmetric arthritis, symm sacroilitis, enthesitis, uveitis, ulcers, aortic regurg, upper lobe fibrosis, syndesmophytes, inflammatory back pain, prostatitis, IgA nephropathy

Ankylosing spondylosis

Which spondyloarthropathy: late teens to adult, males, asymmetric sacroilitis, asymmetric arthritis, enthesitis, dactylitis, circinate balanitis, keratoderma blennorrhagicum, onycholysis, ulcers, aortic regurg, diarrhea, urethritis, cervicitis

reactive arthritis

Which spondyloarthropathy: 35 to 45 yoa, asymm sacroilitis, asymm arthritis, psoriasis, onycholysis, uveitis, ulcers, aortic regurg, pencil in cup in DIP

psoriatic arthritis

Which spondyloarthropathy: any age, symm sacroilitis, asymm arthritis, erythema nodosum, pyoderma gangrenosum, clubbing, uveitis, ulcers, aortic regurg, Crohn's, UC

IBD associated

Labs for spondyloarthropathy (+ and -)

+HLAB27, -RF, +ESR, +CRP, anemia of chronic disease, inflammatory synovial fluid

axial arthritis progresses from sacroiliac to cervical spine (what disease?) --> limited spinal mobility (what test?)

ankylosing spondylitis, Schober's test for spinal mobility (bamboo spine, squaring of vertebral bodies)

ethesitis is what and presents like

inflammation at Achilles tendon and plantar fascia calcaneal insertions; presents as heel pain, aggravated by rest and improved with activity

Reiter's syndrome is

nongonoccocal urethritis, conjunctivitis, arthritis

reactive arthritis organisms

Chlamydia, Ureaplasma, Shigella, Salmonella, Yersinia, Campylobacter

treatment of reactive arthritis begins with

NSAIDs and Sulfasalazine for chronic reactive arthritis and corticosteroids for controlling disease in individual joints

treatment of psoriatic arthritis for two components

skin: topical corticosteroids, retinoids, UV; joints: NSAID, oral corticosteroid or injections, and for second line MTX, sulfasalazine, cyclosporine, TNF-a inhib

treatment for IBD associated arthritis

NSAIDs used cautiously bc can exacerbate the bowel disease; Sulfasalazine