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NMSP - Exam 2 > RA, Seronegative Athropathies and Gout > Flashcards

RA, Seronegative Athropathies and Gout Flashcards

1
Q

If a patient presents with SYMMETRICAL arthritis, what should you be thinking?

A

RA

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2
Q

What are some systemic symptoms with RA and what markers are elevated?

A 
Fatigue
Fever
Myalgia 
Anemia
-- Elevated ESR/CRP
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3
Q

What genetic marker is RA associated with?

A

HLA-DR4

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4
Q

Describe the pathophysiology of RA

A
  • Joint changes precede synovitis
  • Infiltration of inflammatory cells activates T cells
  • B cells produce autoantibodies and cytokines
  • Pannus invades cartilage and bone
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5
Q

Describe the pathophysiology of RA

A
  • Joint changes precede synovitis
  • Infiltration of inflammatory cells active T cells
  • B cells produce autoantibodies and cytokines
  • Pannus destroys cartilage and bone
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6
Q

An RA score greater than ___/10 indicates RA

A

> 6/10

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7
Q

Where do articular manifestations start with RA?

A

Hands/feet and C1-C2 (not axial spine)

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8
Q

Why should you not flex the neck of RA patients?

A

C1-C2 may sublux

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9
Q

What finger deformities are associated with RA?

A

Swan-neck
Boutonniere
Ulnar deviation

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10
Q

When will RA patients have stiffness?

A

Morning stiffness > 1 year

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11
Q

Pyoderma Gangrenosum

A

– Can be seen with RA

= Tender purple papule –> necrotic non-healing ulcer

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12
Q

Rheumatoid Vasculitis

A

– Can be seen with RA

= Digital infarct

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13
Q

Patients with RA have an increased risk of what?

A

Heart manifestations – CAD

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14
Q

What other autoimmune disease that affect the secretions of the eye/mouth/vagina can occur with RA?

A

Sjogren’s Syndrome

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15
Q

Spondyloarthropathies are disorders that share clinical features and have (-)?

A

(-) serum markers

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16
Q

What HLA is often associated with the Spondylarthropathies?

A

HLA-B27

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17
Q

What HLA is often associated with the Spondylarthropathies?

A

HLA-B27

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18
Q

What locations in the body do Spondylarthropathies often affect?

A

Spine

SI joint

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19
Q

What are 4 Spondyloarthropathies?

A

Ankylosing Spondylitis
Reactive Arthritis
Psoriatic Arthritis
Enteropathic Arthritis

20
Q

What are the symptoms of Ankylosing Spondylitis?

A

Low back pain
Decreased mobility
Plantar Fasciitis (heel pain)

21
Q

What test can be used to assess the lumbar spinal immobility with Ankylosing Spondylitis?

A

Schober test

– restricted forward flexion

22
Q

Besides restricted forward flexion of the spine, what else will be seen on physical exam with Ankylosing Spondylitis?

A

Decreased chest expansion

23
Q

How will the vertebrae look with Ankylosing Spondylitis?

A

Squaring and shiny corners (sclerosis)

24
Q

What are Syndesmophytes and what are they seen with?

A

Bony bridges between vertebrae that cause ankylosis (fusion)

– seen with Ankylosing Spondylitis

25
Q

Reactive Arthritis is often associated with?

A

Infection

26
Q

What is Dactylitis?

A

Swollen finger or toe

27
Q

What are some symptoms of Reactive Arthritis?

A
  • can’t see, can’t pee, can’t climb a tree

- - also see: Dactylitis

28
Q

What manifestation can Reactive Arthritis cause on the glans penis?

A

Circunate balantis

29
Q

What manifestation can Reactive Arthritis cause on the soles of the feet?

A

Keratoderma Blennorrhagicum

30
Q

With imaging, how does the SI joint look with Reactive Arthritis?

A

Asymmetrical SI

31
Q

What hand changes can be seen with Psoriatic Arthritis?

A

Nail pitting

Pencil in cup deformity on imaging

32
Q

Pitting nails, arthritis and pencil-in-cup deformity is likely?

A

Psoriatic Arthritis

33
Q

What is Enteropathic Arthritis?

A

Arthritis associated with Crohn’s disease or Ulcerative Colitis

34
Q

Enteropathic Arthritis may have extra-articular symptoms as well. Which IBD is more often seen with them?

A

Crohn’s Disease

35
Q

Enteropathic Arthritis affects ___ joints of LE and ____ joints of UE

A

Larger joints of LE

Smaller joints of UE

36
Q

When does the stiffness present/improve with Ankylosing Spondylitis?

A

Morning stiffness that improves with exercise

37
Q

What type of crystals and shape present with Gout?

A

Monosodium Urate Crystals

  • Needle shaped
  • (-) birefringent
38
Q

Where does Gout usually present first?

A

1st MTP joint

39
Q

Acute gout is often worse when?

A

At night

40
Q

Chronic gout will present in what odd locations as well?

A

Ear, forearms and renal insufficiency

41
Q

Do you treat asymptomatic hyperuricemia?

A

NO

42
Q

Do you treat acute gout with agents to lower uric acid?

A

NO

43
Q

Pseudogout

A

Calcium Pyrophosphate Deposition Disease

44
Q

Pseudogout often occurs where?

A

Knee or larger joints

45
Q

What shape are the crystals with Pseudogout?

A

Rhomboid shape

- (+) birefringent

46
Q

Chrondrocalcinosis is seen with?

A

Pseudogout

= Calcium deposits in the cartilage

NMSP - Exam 2 (29 decks)

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