Rheum final review pt1 Flashcards
What gender/age?
Sjorgen’s syndrome
Females
35-55
What gender/age?
SLE
Females
20-40
What gender/age?
Osteoporosis
Females
>50 (after menopause)
What gender/age?
OA
Females
Usu >65
What gender/age?
RA
Females 20-40
But >60: equal in both genders
What gender/age?
Fibromyalgia
Females
30-60
What gender/age? Mean age?
PMR, GCA, TA
Females
>50, mean age is 73
What gender/age?
Myositis
Females
5-15 & 30-50
What gender/age?
Gout
Males
40-60
The 3 basic presentations of joint sx are
Inflammatory (7), mildly inflammatory (1), & non-inflammatory (1).
What conditions is in each?
Inflammatory - RA, Gout & pseudogout, Spondyloarthropathies (Psoriatic arthritis, Ankylosing Spondylitis, Reactive arthritis, Enteropathic arthritis)
Mildly: Fibromyalgia (he says it really isn’t at all)
Non: Osteoarthritis
8 major risk factors for Osteoporosis
besides being being female, which is the #2 risk factor
Increased age - #1 risk factor Personal history of fracture as an adult Low BMD Mother or father had a hip frx Low body weight (3 months Rheumatoid Arthritis
FRAX scores that warrant therapy: (2)
10 year risk of major fxs > 20%
or
>10 yr risk for hip fracture is >3%
Remember in osteoporosis, ____ is very important for maintenance of bone health.
Estrogen
X-ray findings in RA (3)
MCP joints in RA, and wrist in RA –> differs RA from OA.
Mouse-bite corner erosion (slide 33)
Erosions and joint space narrowing
Rheumatoid nodules in lungs (slide 20)
Three basic presentations of joint symptoms:
- Inflammatory
- Non-inflammatory
- Fibromyalgia
Describe the presentation of inflammatory joint symptoms (2)
Morning stiffnes > 30 minutes
-Symptoms improve with activity
Describe the presentation of non-inflammatory joint symptoms (3)
Morning stiffness < 30 minutes
- Symptoms worse with activity - Swelling may or may not be present
Describe the presentation of Fibromyalgia joint symptoms (4)
- Stiffness in morning variable but may be prolonged
- Pain with activity
- Fatigue especially in the afternoon
- If patient over does it, may be “wiped out” the next day
With RA, where is it? What does it look like? Throughout the day?
Synovial inflammation (hallmark) Symmetric soft tissue swelling of joints Hand, wrist, foot involvement common Prolonged morning stiffness (>1/2 hour) Joint pain lasting >3 months And all the extra articular manifestations (slide 18)
Describe the 1987 ACR Criteria for RA
- how many joints involved?
- serology?
- what other test?
- duration of sx
a score of 6/10 is needed for classification of a patient as having definite RA)‡
A. Joint involvement (>10)
B. Serology (at least 1 test result is needed for classification): RF or ACPA test
C. Acute-phase reactants (at least 1 test result is needed for classification) abnormal CRP or ESR
D. Duration of symptoms§§ >6 weeks
2 lab tests that really dx RA:
higher levels in each means:
Rheumatoid factor
Anti CCp
higher lvls in each = worse prognosis
Synovial fluid analysis for these 4 conditions: OA, Trauma, Inflammation, bacteria
Osteo: Yellow, clear, WBC <2000
Inflam: Yellow, cloudy, WBC 3-50000, may have crystals
Bacteria: Purulent, opaque, 50-300000, may have crystals, and a positive culture
List the 5 tests you can do with synovial fluid
Color, clarity, WBC lvl, Crystals, Culture & Sensitivity
Purulent synovial fluid means it is:
septic
The unique sx within
ACR Criteria for KNEE OA
Stiffness <30 minutes
