Polyarticular Arthritis Flashcards
Viruses that cause polyarthritis
Parvovirus B19 (acute, small joints, lacy/malar rash), hepatitis –> ACUTE, SELF LIMITED DX
Bacterial that can cause polyarthritis
Directly through N. gonorrhoeae or indirectly though reactive arthritis bugs (Salmonella, Shigella, Campylobacter, Yersinia, Chlamydia)
Gout is suspected in patients taking ____, degenerative changes in ______ and ______.
Taking diuretics
DIP (Heberden’s nodes) and PIP (Bouchard’s nodes)
Inflammatory arthritis
Infectious arthritis, gout, rheumatoid arthritis, SLE, reactive arthritis
Signs of inflammation arthritis
erythema, warmth, pain, swelling, systemically: fatigue, weight loss, fever, morning stiffness lasting longer than one hour
Crepitus indicates
irregularities of articular cartilage –> OA, injury, previous inflamm. NEED TO PALPATE ALL JOINTS
Distribution: DIP and PIP PIP and MCP DIP, PIP, MCP Large joints of LE
Distribution: OA RA Psoriatic, crystal, sarcoidosis Spondyloarthropathies
Symmetry:
- Symmetric
- Asymmetric
Symmetry:
- RA, SLE, polymyalgia rheumatic, viral arthritides, serum sickness
- Psoriatic, reactive, gout
Axial involement seen in what diseases
OA: lower back, neck
Spondyloarthropathies: insidious chronic LBP
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
Gout presents at this time in a pts life
20 yrs after puberty in men and 20 years after menopause in women
What disease is associated with: pyoderma gangrenosum, HLAB27, aortic regurgitation, upper lobe lung, sacroilititis
ankylosing spondylitis
What disease is associated with: malar rash, anemia, thrombocytopenia, leukopenia
Parvovirus B19 or SLE
What disease is associated with: heliotrope, Gottron’s papules, eosinophilia, elevated CPK
dermatomyositis
What is associated with: keratoderma blennorrhagicum, urethritis, prostatitis, diffuse lung fibrosis, HLA-B27,
reactive arthritis
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
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
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
RA
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
