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clinical medicine exam 3 > RA and OA > Flashcards

RA and OA Flashcards

1
Q

what is rheumatoid arthritis

A
  • autoimmune
  • systemic, inflammtory disorder
  • primarily involves joints
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2
Q

these three characteristics indicate what disease:

  • inflammation
  • destruction of cartilage and bone
  • joint deformity and loss of function
A

rheumatoid arthritis

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3
Q

clinical presentation

  • symmetric polyarthritis
  • morning stiffness for at least 1 hr
  • pain and swelling
  • MCP and PIP
  • IP joints of thumbs
  • wrists
  • MTP joints of toes
  • cervical spine
  • soft, warm, tender joints
A

rheumatoid arthritis

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4
Q

physical exam findings:

  • tenderness
  • swelling
  • ulnar deviation of MCP joints
  • Boutonniere deformity of PIP joints (PIP flexion)
  • swan-neck deformity (DIP flexion)
  • interosseus muscle atrophy
A

rheumatoid arthritis

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5
Q

the presence of rheumatoid nodules is what type of prognostic sign

A

unfavorable: usualy means a more severe, progressive disease

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6
Q

felty syndrome

A

triad of

  • RA
  • splenomegaly
  • neutropenia
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7
Q

what is the most common cause of death in patients with rheumatoid arthritis

A

cardiovascular disease

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8
Q

name some extraarticular manifestations of rheumatoid arthritis

A
  • episcleritis
  • pleuritis
  • pericarditis
  • vasculitis
  • felty syndrome
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9
Q

what is the prefered initial imaging study in patients with suspected rheumatoid arthritis

A

radiography

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10
Q

radiologic findings

  • STS around joint
  • periarticular osteopenia
  • narrowing of joint space
  • subluxation/dislocation
  • eventuallu -> joint erosion and obliteration
A

rheumatoid arthritis

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11
Q

diagnostic lab testing for rheumatoid arthritis

A

rheumatoid factor

  • first autoantibody associated with RA
  • RF (+) 80%
  • elevated titers 3x upper limit of normal -> greater specificity

Anti-CCP antibodies

  • present in 60-70%
  • 90-98% specific for RA

elevated ESR and CRP

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12
Q

in rheumatoid arthritis, what would be typical of CBC

A
  • anemia (normocytic, normochromic)
  • leukocytosis
  • thrombocytosis
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13
Q

american college of rheumatology recommend who should be tested

A
  • have at least 1 joint with definite clinical synovitis
  • synovitis not better explained by another disease
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14
Q

nonpharmacologic treatment for rheumatoid arthritis

A
  • exercise
  • PT/OT
  • rest
  • smoking cessation
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15
Q

pharmacologic treatment for rheumatoid arthritis

A
  • NSAIDS and glucocorticoids together
  • DMARDs (disease modifying antirheumatic drugs)
    • Start ASAP
    • slows/halts disease progression, preserving joint function
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16
Q

list the synthetic (nonbiologic) DMARDs (disease modifying antirheumatic drugs)

A
  • methotrexate
  • sulfasalazine
  • hydrochloroquine
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17
Q

what are the side effects of methotrexate

A
  1. hepatotoxic
  2. cytotoxic
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18
Q

what are the side effects of sulfasalazine

A
  • hepatotoxic
  • nephrotoxic
  • myelosuppression
  • “sulfa” allergy
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19
Q

what are the side effects of hydroxychloroquine

A

vision changes

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20
Q

list the biologic DMARDs (disease modifying antirheumatic drugs)

A
  • etanercept (enbrel)
  • Infliximab (remicaid)
  • Adalmumab (humira)
21
Q

what is the risk of using biologic DMARDs (disease modifying antirheumatic drugs) to treat RA

A
  • inhibit inflammatory cytokines (TNF-a)
  • Risks: infection, malignancy, myelosuppression
22
Q

Risk factors for osteoarthritis

A
  • age
  • female
  • obesity
  • genetic
  • joint wear and tear
23
Q

pathogenesis of osteoarthritis

A
  1. damage to chondrocytes
  2. thinning of articular cartilage
  3. bone remodeling
    1. osteophytes
    2. joint space narrowing
24
Q

patients with osteoarthritis usually have what type of stiffness?

A
  • stiffness is usually worse after effort, may be described as evening stiffness
  • if they have morning stiffness, it is usually resolved < 30 minutes
25
Q

pain associated with osteoarthritis is exacerbated and relieved by what

A

exacerbated by activity and relieved by rest

26
Q

physical exam findings

  • crepitus
  • bony enlargement
  • hard and bony joints
  • decreased ROM
  • malalignment
  • tenderness to palpation
  • predilection for
    • hands
    • knee
    • hip
    • spine
A

osteoarthritis

27
Q

what clinical manifestations do patients with osteoarthritis usually have on thier hands

A
  • Heberden’s nodes (DIP)
  • Bouchard’s nodes (PIP)
  • first carpometacarpal joint
28
Q

what exam characteristics on commonly found on the knees in patients with osteoarthritis

A
  • osteophytes
  • effusions
  • crepitus
  • limitation of ROM
29
Q

what exam characteristics on commonly found on the hips in patients with osteoarthritis

A
  • restricted internal ROM
  • pain around hip/groin
  • may result in pain that is referred to knee
30
Q

what is the name for spine degenerative disk disease

A

cervical, lumbar spondylosis

*specialized terms for OA that affect the spine

31
Q

radiographic changes

  • joint space narrowing
  • osteophyte formation
  • subchondral sclerosis
  • subchondral cysts
A

osteoarthritis

*no joint obliteration as seen in RA

32
Q

laboratory findings of osteoarthritis

A
  • no specific test
  • negative RF and anti-CCP
  • normal ESR and CRP
33
Q

nonpharmacologic treatment of osteoarthritis

A
  • exercise program
  • weight loss
  • rest peroids
  • PT
34
Q

pharmacologic treatment of osteoarthritis

A
  1. Tylenol (if patient hasn’t already tried)
  2. NSAIDs
  3. Topical NSAID (diclofenac) or capsaicin
  4. intraarticular steroids
35
Q

polymyalgia rheumatica is associated with aching and morning stiffness if what joints

A

shoulders, hip girdle, and neck

36
Q

what disease is associated with giant cell (temporal) arteritis

A

polymyalgia rheumatica

37
Q

polymyalgia rheumatica affects what patient population primarily

A

>50 years of age

38
Q

clinical presentation

  • stiffness at least 30 minutes
  • ‘gel’ phenomenon
  • symmetric
  • shoulder pain > hip and neck
  • synovitis and bursitis
  • edema
  • decreased ROM
  • subjective weakenss
A

polymyalgia rheumatica

39
Q

diagnostic studies

  • elevated ESR
  • CRP
  • negative ANA, RF, CCP antibodies
A

polymyalgia rheumatica

40
Q

what clinical findings are enough to diagnose a person with polymyalgia rheumatica

A
  • proximally and bilat aching and morning stiffness
    • > 30 min
    • persisting > 2 weeks
    • 2/3 (neck or torso, shoulder/proximal region of arm, hips/proximal thight)
  • elevated ESR > 40
  • rapid resolution with low dose glucocorticoids
41
Q

initial treatment for polymyalgia rheumatica

A

glucocorticoids

15-20mg/day

42
Q

second line of treatment for polymyalgia rheumatica

A

methotrexate or TNF inhibitors

43
Q

what is fibromyalgia

A
  • soft tissue pain disorder
    • muscles, tendons, ligaments
  • widespread chronic musculoskeletal pain
  • **no tissue inflammation
44
Q

fibromyalgia commonly affects men or women

A

women

45
Q

clinical presentation

  • aching, stiffness, paresthesia
  • headache
  • fatigue
  • cognitive/mood disturbance
  • disturbed sleep
  • pelvic pain
  • IBS
  • painful bladder syndrome
A

fibromyalgia

46
Q

what laboratory studies indicate fibromyalgia

A

negative lab studies

47
Q

what clinical findings must be present to diagnose a patient with fibromyalgia

A
  • symptoms of widespread pain, occuring above and below waist, affecting R and L sides of body
  • 11-18 common tender points
48
Q

pharmacologic treatment for fibromyalgia

A
  • analgesics
  • cyclobenzaprine: Treats pain and stiffness caused by muscle spasms
  • anti-depressant
  • lyrica

*avoid narcotics

clinical medicine exam 3 (7 decks)

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