Rheumatic Diseases Flashcards
How many rheumatoid diseases have been identified?
more than 100 identified
prevalence of 46 million in US
What is cause of CRPS?
believed to be due to either CNS or PNS dysfunction (or both)
CPRS I: no underlying nerve injury
CPRS II: known nerve injury
What is CPRS?
Severe pain out of proportion to injury and which worsens over time
Who gets CPRS?
Young women, but can occur in either sex at any age
What are symptoms of CRPS?
intense burning of hot pain joint stiffness and or inflammation motor dysfunction skin hypersensitivity altered skin temperature changes in skin color (red, blotchy, purple) changes in skin texture (shiny, thin, sweaty) changes in nail or hair growth
What is stage 1 of CRPS?
1-3 months severe pain muscle spasm joint stiffness excessive hair growth skin color temperature changes
What is stage 2 of CRPS?
3-6 months pain intensifies swelling decreased hair growth nail changes osteomalacia hypotonia
What is stage 3 of CRPS?
>6 months changes to skin and bone become irreversible intractable pain atrophy joint deformity
What is juvenile rheumatoid arthritis?
Juvenile idiopathic arthritis, juvenile chronic arthritis
Most common form of arthritis in kids
onset prior to age 16
unknown etiology- genetic vs. environmental factors
What are 3 general types of JRA?
Pauciarticular (40-50%)
Polyarticular (30%)
Systemic or Still’s disease (20%)
What is pauciarticular JRA?
four or few joints affected, usually leg and jaw
What is polyarticular JRA?
five or more joints affected (can be as many as 40)
What is systemic or Still’s disease?
inflammation outside the joints (pericarditis, pleuritis), usually accompanied by fever and rash
What are pauciarticular and polyarticular forms commonly associated with?
Iridocyclitis: asymptomatic but can cause permanent visual loss if untreated
How do they diagnose JRA?
no single test- based on symptomology and clinical findings
Symptoms can include arthritis, fever, rash, fatigue, anemia, loss of appetite, irritability, reduced mobility
RF and ANA may be negative or positive
All forms can interfere with physical growth and cause joint deformity
What is treatment for JRA?
Treatment and prognosis mirror adult disease
Cautious use of corticosteroids
Approximately 50% have complete remission
What is ankylosing spondylitis?
Inflammatory disease of the axial skeleton
Who gets ankylosing spondylitis?
Prevalence of 1:1,000
3:1 male to female ratio
What is pattern of ankylosing spondylitis?
onset at SI joint with ascending pattern
Inflammation->Erosion->Healing= bony fusion of fibrous ligaments
May affect patellar tendon and plantar fascia
What are symptoms of ankylosing spondylitis?
Mild to moderate flares and remissions
Back pain and morning stiffness
May have fever, fatigue, anemia, weight loss
Uveitis, valvular deficiencies, spinal cord, compression are less common
Treatment focuses on pain relief, preservation of ROM, and prevention/correction of deformity
What is systemic lupus erythematosus?
Autoimmune connective tissue disorder
Common in women of childbearing age (70-90%)
Clinical presentation ranges from benign to life threatening
Chronic with cycling exacerbation/remission
Diagnosed based on clinical findings supported by lab results (+ ANA)
What are symptoms of SLE?
Photosensitive malar rash (butterfly rash)
Arthritis (usually symmetric polyarthritis)
Cortical and trabecular bone loss
Anemia, leukopenia, thrombocytopenia
Cardiopulmonary manifestations (fibrosis, pericarditis, thrombus, etc)
Nephropathy (proteinuria, elevated BUN and creatinine)
Neuropsychiatric disorders
What is treatment for SLE?
Aimed at early identification of flares, reversal of inflammation, prevention of organ complications
NSAIDs, corticosteroids, anti-malarials, methotrexate, immunosuppressants
Aggressive treatment of HTN, renal dysfunction
What is scleroderma?
Inflammation, degeneration, and fibrosis of skin, vasculature, joints, and tendons, muscle, GI tract, lung, heart, kidney
What are early features of scleroderma?
swelling and cyanosis of fingers, Raynaud’s heartburn, myositis, and arthritis are common early features
Who gets scleroderma? prognosis?
Affects females > males (4:1)
Unpredictable course- can be fatal
What are treatments of scleroderma?
Treatments are palliative
NSAIDs, immunosuppressants, corticosteroids, anticoagulants, anti hypertensives
What is reactive/infectious arthritis?
Infection of joint by bacterial, fungal, or viral agents
Gram-positive aerobes predominate
Can also be gonorrhea, chlamydia, lyme disease, others
80-90% are monoarticular, but can be polyarticular
what are risk factors for reactive arthritis?
Known infection Very old or young age Presence of another systemic disease Recent invasive procedure Prosthetic joint Immunosuppresion IV drug use
How is reactive arthritis diagnosed? Prognosis?
Arthrocentesis, blood culture, radiographs or joint scans
Good prognosis with early diagnosis/treatment: joint aspiration, antibiotic coverage, surgical drainage, maintain/preserve ROM and strength
What is gout?
Elevated uric acid levels (hyperuricemia)
Deposition of monosodium urate (MSU) crystals
Primarily affects adult males (4:1)
What does gout result from ?
Diuretic, aspirin, or cyclosporine use
Renal insufficiency
Enzymatic abnormalities
Alcoholism
Where does gout normally occur? How is it diagnosed?
Affects MTP of great toe in 75% of cases
Presence of MSU is diagnostic
What is treatment?
Onset may be dramatic and unexplained
Rest, NSAIDs, corticosteroids
What are characteritics of polymyalgia rheumatic?
Systemic inflammatory disease in those >50 yrs
Malaise, fatigue, fever, anorexia, weight loss, chronic symmetrical aching of proximal muscle and joints, prominent in neck shoulders and pelvis
symptoms worst in morning
How is polymyalgia rheumatica diagnosed? Prognosis?
Diagnosis based on elevation of ESR and exclusion of neoplasm, infection, muscle disease
Prompt recovery following corticosteroid treatment
