Rheum - Polyarticular Arthritis Flashcards
A patient with joint pain has soft tissue swelling and tenderness with normal passive range of motion?
Extra-articular soft tissue inflammation – bursitis or tendinitis
Causes of joint pain without inflammatory changes?
- Osteoarthritis
- Fibromyalgia
- Hypothyroidism
- Neuropathic pain
If polyarticular disease with acute Sx?
If acute and symmetric?
It’s less than six weeks consider: Viral infection(hepatitis B/C, Rubella, parvovirus)
If causing symmetric polyarthritis and fever consider: rheumatic fever
Symmetric peripheral polyarthritis characteristic finding of?
Rheumatoid arthritis or lupus
Psoriatic arthritis – findings?
- Usually peripheral joint involvement with 5+ joints
- Need skin rash/nail changes
- Sausage digits (caused by inflammation at periosteum, tendons, insertion points)
Reactive arthritis symptoms? Caused by what organisms?
Can’t see, can’t Pee, can’t climb a tree
GI and GU: Salmonella, Shigella, Campylobacter, Yersinia, or Chlamydia
Hand finding in Osteoarthritis vs RA?
Heberden’s nodes (DIP) and Bouchard’s nodes (PIP)
Swan neck deformity, boutonnière deformity, ulnar deviation
Rheumatoid nodules found where?
Extensor surfaces of proximal ulnar, lungs
Rheumatoid factor?
IgM that reacts to Fc portion of IgG
Radiologic findings in rheumatoid arthritis?
- Erosion of periarticular bone and cartilage
- Loss of joint space
- Joint space narrowing
Felty syndrome?
#Rheumatic arthritis #splenomegaly #neutropenia
Can also see lymphadenopathy, thrombocytopenia, leukopenia
Classic Disease modifying antirheumatic drugs? Drug of choice?
DoC: Methotrexate
hydroxychloroquine, sulfasalazine, gold, penicillamine
Biologic agents? Advantage over other DMARDS? Side effect?
TNF antagonists (etanercept, infliximab, adalimumab) reduce disease activity within weeks as opposed to months.
Reactivation TB
Drugs for patients who have failed Biologics and DMARDS?
Immunosuppressive agents – azathioprine, cyclosporine, cyclophosphamide, leflunomide
low-dose corticosteroids may have this effect on rheumatic arthritis?
Slow progression of bone erosions
Extra-articular findings in rheumatoid arthritis?
#Eyes – episcleritis, Keratoconjunctivitis sicca (Sjogren's) #heart - pericarditis #Lungs – pleural effusions and nodules #spine - cervical subluxation, compression #vasculitis – skin ulcers, bowel, nerves #Baker cyst #Anemia
Sicca syndrome?
#RA #Dry eyes and mouth
Specific RA tests?
Anti-CCP > RF
RA Scoring?
#joint involvement (Up to five points) #Elevated ESR or CRP #Duration longer than six weeks #RF or anti-CCP
6+ points = RA
Caplan syndrome?
#RA #Pneumoconiosis #Lung nodules
Most common cause of death in RA?
Coronary artery Disease
Patient with RA and erosive disease on x-ray needs at least?
Methotrexate to slow disease progression
RA pt undergoing surgery should get?
Cervical spine x-ray to rule out subluxation before intubation
Adverse effects of methotrexate?
#Liver toxicity #bone marrow suppression #pulmonary toxicity
Before you can give a patient a TNF inhibitor, need?
PPD
Patient with RA recently started on medication presents with eye problems – possible cause? Test?
Hydroxychloroquine can cause retinal toxicity
Dilated eye exam
Patient with RA recently started on medication presents with rash and hemolysis – drug?
Sulfasalazine
Patient with RA recently started on medication presents with nephrosis - drug?
Gold salts
Features of JRA OR Adult Still disease?
#Fever spikes #Salmon colored rash on chest
Also: #Splenomegaly #Pericardial diffusion #Mild joint symptoms
Treatment Of JRA/stills?
#Aspirin/NSAIDs #if no response, steroids #If steroid resistant, TNF drugs
