Reactive and rheumatoid arthritis Flashcards
What is another name for reactive arthritis
Reiters syndrome
Oligoarthritis that is precipitated by infection describes what kind of arthritis
Reactive arthritis
Where is reactive arthritis most commonly seen
Lower extremities
Which gender is more apt to get reactive arthritis
M 9:1
What gene is involved with reactive arthritis
HLA-B27
What is reactive arthritis often secondary to
GI or GU infections
Which GI bacteria can lead to reactive arthritis
shigella
salmonella
yersinia
campylobacter
What type of GU pathogens are involved with reactive arthritis
Chlamydia trichomatis
Ureaplasma urealyticum
What does asymmetric oligoarthritis mean in regards to reactive arthritis
Unpaired joint involvement
2-4 joints involved
What are common signs and symptoms of reactive arthritis
Joint stiffness/ decreased ROM
Joint effusion
Joint tenderness
What symptoms are associated with reactive arthritis
Enthesis
Dactylitis
Mucocutaneous lesions
ocular inflammation
cardiac manifestations
Where can mucocutaneous lesions occur with reactive arthritis
Circinate balanitis
Urethritis / cervicitis
Painless oral ulcers
Nail changes
What type of ocular inflammation is seen with reactive arthritis
Conjunctivitis
Iritis
scleritis
keratitis
What cardiac manifestations occur with reactive arthritis
Arotitis
Aortic regurge
Heart block
What is the reactive arthritis presentation PEARL to remember
Conjunctivitis (can’t see)
Urethritis (Can’t pee)
Arthritis (can’t climb a tree)
Balantitis (Can’t have sex with me)
What are supporting diagnostics for reactive arthritis
Synovial fluid
Elevated ESR and CRP
negative RF
What is the treatment with reactive arthritis
Mainstay is NSAIDs
2nd line is steroids
if persistent-> sulfasalazine or methotrexate
If a patient has chlamydia and is diagnosed with reactive arthritis, what additional treatment is required
6 months of targeted antibiotics
What is secondary to psoriasis
Inflammation arthritis
What gene is involved with psoriatic arthritis
HLA-B27
Who is at 5x greater risk for psoriatic arthritis
Those with severe skin conditions
What are the 5 different disease patterns seen with psoriatic arthritis
Systemic polyarthritis
Asymmetric mono- or oligoarthritis
Monoarthritis of DIP
Axial arthritis (spinal involvement)
Arthritis mutilans
Where on the body is psoriatic arthritis typically seen
Hands and feet
What is the preferred imaging for psoriatic arthritis and why
Xray
helps differentiate between other arthridities
When the DIP is involved with psoriatic arthritis, what deformity is seen
Pencil cup deformity
If someone presents with opera glass hands or telescoping, what do they have
Arthritis mutilans
What are the supporting diagnostics for psoriatic arthritis
Inflammatory synovial fluid
Elevated CRP / ESR
RF negative
What is the first line treatment for psoriatic arthritis
Biologic DMARD
-TNF inhibitor (etanercept, inflixamab, adulimumab)
-Abatacept
If you give a patient with psoriatic arthritis a corticosteroid, what will the outcome be
Precipitation of pustular psoriasis
What is a second line agent for psoriatic arthritis
Non-biologics
How is RA described
Inflammatory symmetric polyarthritis
Which gender is RA more common in
females
What does RA have a strong genetic association with
HLA-DR
What becomes inflamed with RA
The synovial membrane
What are the articular symptoms associated with RA
Insidious AM prodromal pain, swelling, morning stiffness
Pain / stiffness after rest periods
Symptoms improve with activity
What joints are effected first with RA
small joints
What joints are NOT effected by RA
DIP
T & L spine
What are the articular symptoms associated with RA
Hands and wrists
Gross deformities with late stage RA
What deformities are seen with late stage RA
Swan neck deformities (hyperextension of PIP)
Boutonniere deformities (flexion of PIP joint)
What are common presentations with RA
Dryness in eyes, mouth, mucous membranes
Scleritis, keratitis, episcleritis
interstitial lung disease
pericarditis
vasculitis
What is the first line of imaging with RA
Xray
What is the workup for RA
Anti-CCp antibodies - ACPA (most sensitive and specific)
+RF
Elevated ESR / CRP
What differentiates OA from RA
OA typically spares wrists and MCPs
OA is Relieved, not worse with rest
How is gout differentiated from RA
Gout has rate bite lesions on Xray and is typically monoarticular
How is septic arthritis differentiated from RA
Septic arthritis is usually monoarticular and has no anti-ccp
What is the mainstay treatment for RA
DMARDs
-Corticosteroids often given at start until DMARD can take effect
What steroid is generally given with initial DMARD treatment for RA
Prednisone
People with RA are at higher risk for what other diseases
Osteoporosis
Lymphoma
Infections
If someone under the age of 16 comes in with inflammatory arthritis that has lasted longer than 6 weeks, what is their likely diagnosis
Juvenile idiopathic arthritis
What gene is typically involved with Juvenile idiopathic arthritis
HLA
What is the most common joint effected by juvenile idiopathic arthritis
Knees
What is the most common juvenile idiopathic arthritis subtype
Oligoarticular
What age group is typically affected by oligoarticular JIA
Younger kids, generally girls
What type of patient is seropositive polyarticular JIA most often seen in
Teenage girls of color
What subtype of JIA is most similar to adult RA
seropositive polyarticular JIA
What type of JIA is most often seen in younger children (1-3y/o)
Seronegative polyarticular JIA
What RF factor will be seen with seronegative polyarticular JIA
RF negative but can transition to positive
What is systemic JIA
Arthritis in 1 or more joints with fever at least 2 weeks
What is the workup for JIA
Diagnosis of exclusion
What is osteoarthritis
Regular degenerative arthritis
What is the most common joint disease
Osteoarthritis
Who is osteoarthritis most commonly seen in
F>M
What is the general presentation of osteoarthritis
Asymmetrical progressive joint pain
-AM stiffness <15min
-joint line tenderness
What is the heberden node
DIP joint deformity
What is the Bouchard node
PIP joint deformity
What is the first line for diagnosis of osteoarthritis
Primarily clinical-> xray to confirm
Weight bearing bilateral knee xray
What are the pharmacologic options for osteoarthritis treatment
Acetaminophen is first line
NSAIDs are secondary-> more effective but more side effects
intra-articular injection
Arthroplasty
How often can you administer corticosteroid injections into a joint and why
Primarily given in the knee
They are toxic to chondrocytes and will spike blood glucose, therefore can only be given every three months
What is the biggest risk of intra-articular steroid injections
Infection
What kind of intra-articular injections can be given for OA
Corticosteroids
Hylaronic acid
What are hyaluronic acid injections indicated for
knee OA
When is a joint replacement indicated with OA
End-stage OA treatment
