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Clin Med I > RA/OA/Fibro > Flashcards

RA/OA/Fibro Flashcards

1
Q

Rheumatoid Arthritis

A

Autoimmune disease - chronic and systemic inflammatory dis
primarily involving the synovial joints
W>M btw 35-50yrs
-unknown etilogy

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2
Q

RA clinical Features

A
  • Symetrical polyarthritis
  • porgress periphery to more proximal
  • axial skel usually spared (exept cervical spine)
  • Gradual onset
  • may also have mysalsgias, fatugue, fever, sleep trouble
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3
Q

RA sx

A

Pain, stiffness, swelling of many joints

  • small joints of hand wrist and forefoot most common
  • morning stiffness!! > 1hr and gets better with movement
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4
Q

RA physical exam

A
  • Joint inflammation
  • tenderness to palpation
  • Swelling and palapable synovial thickening
  • SPARES DIP joints!!
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5
Q

RA hand

A 
Sym
MCP PIP
-reduced grip strength 
- flexor tendon tenosynovitis "trigger finger" 
- swan neck or boutonniere deformities 
*ulnar deviation
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6
Q

RA UE finding

A

Wrist: loss of extention and carpal tunnel**
Elbow:
loss of ext and ulnar nerve compression and Rhuematoid nodules
Should: frozen shoulder

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7
Q

RA LE

A 
Feet: MTP joints> callus formation, hallux valgus, hammer toes 
Kneed: effusion limited ROM 
*Popliteal(Bakers cyst)
Hips:
restriction
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8
Q

RA extrareticular manifestations

A 
Skin: subcutaneous nodules
Eye: scleritis, Seconfary Sjorgens synd
Pulm: pleural effusion, pleuritis
CV: **accelerated cardiovascular disease
MSK: osteoporosis
Felty syndrome: trias of RA splenomegaly and neutropenia
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9
Q

RA lab testing

A 
Rheumatoid Factor
anti-ccp antibodies 
-most specific for RA
ANA 
CBC 
- look for anemia, leukocytosis, thrombocytosis 
ESR/CRP
synovial fluid
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10
Q

RA tx

A

Early dx and refered
-Early use of DMARDs> treat to target
- Non biologic, biologics, JAK inhibit
Antiinflammatory agents only as adjusts to therapy
- maintain muscle strength and joint allignment

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11
Q

Osteoarthritis OA Pathogenisis

A

Biochemical breakdown of auticular cartilage
all joint tissues are involved not jus cartilage
Risk: ages, injury, gen, obesity, gender, joint shape
- porgressive joint narrrowing
- synovial inflammation
-osteophytes
- thickening of subconfral bone

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12
Q

OA sx

A

joint pain, stiffness, locomotor resistance

  • worse with joint usage
  • relived by rest
  • in later stage may be morning stiffness <30min
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13
Q

OA exam findingss

A 
tenderness to palpation
- reduced ROM
Bonuy enlagemtn 
-joint deformity in advanced damage 
- instability
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14
Q

OA hand pres

A
  • bilateral
  • Heberdens (DIP) node
  • Bouchards(PIP) nodes
  • first carpometacarpal joint often “squared of”
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15
Q

OA Knees/hips

A 
Knee: 
bilateral, joint tenderness, crepitus, limit ROM
Hip:
-unilateral
- restricted ROM
-pain around hip and groin
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16
Q

OA imaging

A

Xray

  • see narrowing of the joints
  • may see the bone spurs
17
Q

OA managment

A

Non pharm: excercise programs, weight loss, PT/OT, assistaed deviced when needed
Pharm:
Oral/topical NSAIDs, topical capsaicin, DUloxetine, Tramadol, Acetaminophen, Intrarticular injections, glucosamine
Surgical: joint

18
Q

Polymyagia Rheumatica PMR

A

Chronic inflammatory condition

  • proximal aching and stiffness
  • shoulder neck and pelvic girdle
  • morning stiffness >1hr
  • predominantly >50
  • associated with giant cell arteritis
19
Q

PMR presentation

A

Bilateral involvment
Shoulder and pelvic girdle pain
aching or stiffness> synovitis, tenosynovitis, bursitis
-commonly subdeltoid and subacromial bursitis
- often a sudden progression
-Morning stiffness

20
Q

PMR physical exam

A
  • Limited ROM (part abduction of arms)
  • normal muscle strength
  • peripheral synocvitis
21
Q

PMR diagnostic

A
  • Elevated ESR >40mm/hr
  • check CRP
  • may see normocytic anemis
  • neg ANA, RF, anti CPP abx
  • imaging to confirm bursitis/synovitis
22
Q

PMR dx citeria

A

> 50 yo

  • proximal and symetrical aching and morning stiff
  • elevated ESR
  • rapid resolution with low dose glucocorticoids
23
Q

PMR tx

A

Glucocorticoids 10-20mg/day

if cannot then MTX

24
Q

Fibromyalgia

A

widespred MSK pain and fatigue and cognitive distrubances, psych sx, and somatic sx
-cause is unknown
W>M
-20-50
- co-occurs with RA and SLE
may be a disroder of central pain processing

25
Q

FM clinical manifestations

A

-fatigue and poor sleep
-widepread often bilateral pain
- “fibro fog” cognitive dist
- also may have depression/anxiety
Somatic:
HA, pelvix pain, IBS, IC, sleep apnea, restell leg syndrome
>3mo

26
Q

FM dx

A
  • multiple soft tissue tenderness with NO soft tissue or joint swelling
  • no lab or imaging abnormalities
    Eval for coexisting condition
  • CBC, ESR, TSH, sleep study
  • dx from absense of other sytemic condtions accoutning for pain
27
Q

FM non pharm

A 
Excercise 
PT 
Cognitive behavioral therapy 
- sleep hygeine, relaxation
Pharm:
- Tricyclic antidepresents : 
- SNRI's
-Anticonvulsants

Clin Med I (14 decks)

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