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Plastic Surgery( Grabb)Ali jasim > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

Radiographic changes of the hand, including erosions and
decalcification.

A

T

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2
Q

v upper extremity complaints are a hallmark of the RA disease

A

T

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3
Q

disease severity is commonly linked to the age of onset

A

T

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4
Q

A family history of RA increases the
lifetime risk from three-fold to five-fold

A

T

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5
Q

symmetric
hand pain lasting 6 weeks or longer without a known etiology should
prompt consideration of inflammatory arthropathy

A

T

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6
Q

Rheumatoid nodules are present
only in a minority of RA patients

A

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7
Q

Nodules present only in the hand

A

F Nodules are commonly located on
extensor pads associated with synovitis but can appear in multiple
extra-articular tissues including eyes, lungs, or vocal cords

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8
Q

Any synovial joint may be
affected, but hand involvement is often seen as a hallmark of disease

A

T

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9
Q

First joint that effected with RA ?why?

A

The metacarpophalangeal (MCP) joint, proximal interphalangeal (PIP) joint, and wrist are often affected first due to the relatively high synovial surface area.

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10
Q

Secondarily, large
joints such as the elbows, knees, hips, shoulders are affected

A

T

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11
Q

Even small articular surfaces, such as the ossicles of the middle ear, can be involved

A

T

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12
Q

patients may present with synovitic rheumatoid nodules around large
joints. Rheumatoid nodules may be unsightly, painful, irritating to
adjacent tendons, or cause nerve compression.

A

T

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13
Q

the distal interphalangeal joint (DIP) joint
is often spared in RA

A

T

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14
Q

early wrist erosions appear at the scaphoid waist, ulnar
styloid, and the distal radioulnar joint (DRUJ)

A

T

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15
Q

In RA, synovitis
typically affects the radiocarpal joint more than the midcarpal
joint

A

T

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16
Q

ynovitis around the wrist joint often involves the extensor compartments and may grow around the tendons

A

T

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17
Q

vaughan-jackson syndrome

A

process is
compounded by dorsal prominence of caput ulnae leading to progressive tendon ruptures from ulnar to radial along the dorsal wrist

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18
Q

Tendon ruptures are often sudden and are usually painless

A

T though
synovitis may be painful at the site before the rupture

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19
Q

Osteophytes
on the radius or carpus can also lead to tendon attrition

A

T

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20
Q

Mannerfelt
lesion

A

scaphoid osteophytes or synovitis can lead to attrition of the
flexor pollicis longus (FPL) tendon,

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21
Q

Tendon reconstraction achieved through tendon transfers

A

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22
Q

once a musculotendinous unit has ruptured, that muscle is no longer useful in the setting of RA.

A

T

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23
Q

patients often complain about the inability to fully extend their
fingers what are the causes ?

A
  • ulnar subluxation of the extensor tendon due to attenuation of the radial sagittal band
  • progressive subluxation and volar translation of the proximal phalanx on the metacarpal head
  • ## Very rarely, loss of extension can be due to compression on the posterior interosseous nerve
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24
Q

Passively correctable ulnar translation of the joint or tendons can be corrected with soft-tissue surgeries
such as extensor tendon centralization (typically a synovectomy and
radial sagittal band imbrication) or a cross-intrinsic tendon transfer
to apply more dynamic radial force

A

T

25
Q

if the digit is shortened, irreducible, or the articular erosions are severe

A

first-line management is often joint replacements with silicone metacarpophalangeal arthroplasty

26
Q

PIP joint, wrist, and elbow are treated with joint replacement in only
select cases

A

T

27
Q

swan neck and boutonniere deformities can occur in the
same hand in different digits

A

T

28
Q

swan neck less common than boutonniere deformities

A

F swan-neck is more
common than boutonniere

29
Q

In swan-neck, the anatomic
derangement occur in the PIP

A

In swan-neck, the anatomic
derangement can occur at any of the three joints of the finger (MCP,
PIP, or DIP joints)

30
Q

Treatment depends on the severity of
the deformity and whether the PIP joints are actively and passively
reducible

A

T

31
Q

Treatment depends on the severity of
the deformity and whether the PIP joints are actively and passively
reducible

A

T

32
Q

In contrast to swan-neck, the boutonniere deformity is caused by
pathology intrinsic to the PIP joint.

A

T

33
Q

Thumb deformities in RA

A

Type I: Boutonniere deformity (most common)
Type II: Boutonniere deformity with carpometacarpal (CMC)
joint dislocation or subluxation
Type III: Swan-neck deformity with metacarpal adduction
Type IV: Gamekeeper’s deformity (attenuation of MCP ulna collateral ligament)
Type V: Swan-neck deformity without metacarpal adduction
deformity

34
Q

Management for thumb anomalies is largely dependent on stabilization of the metacarpophalangeal (MP) joint and tendon reconstructions

A

T

35
Q

arthrodesis of the MCP joint is the best solution
to establish stability of the MCP joint.

A

T

36
Q

arthrodesis of the MCP joint is the best solution
to establish stability of the MCP joint.

A

T

37
Q

CMC arthroplasty can be considered if the CMC joint is painful,

A

T

38
Q

PIP joint IN RA

A

Attenuation of volar plate
Attenuation of transverse retinacular ligament
Dorsal translation of conjoint lateral band
Flexor tenosynovitis
Rupture of flexor digitorum superficialis

39
Q

MCP change

A

Attenuation of volar plate
Flexor tenosynovitis
Intrinsic tendon adhesion
Intrinsic muscle contracture
Rupture of extensor insertion
onto base of proximal phalanx

40
Q

SLE-related arthritis may present with similar findings
as RA

A

T

41
Q

SLE deformity is more likely to be the result of soft-tissue attenuation
and laxity with sparing of the MCP joints

A

T

42
Q

Most patients complain of
pain with activities, but also note limited motion, dissatisfaction with
appearance, and pain at rest

A

T

43
Q

JIA also appears to occur less
frequently in African American and Asian populations compared to
Caucasians

A

T

44
Q

Psoriatic hand deformity can include nail deformities in about 80%
of patients

A

T

45
Q

(15%) in patients with psoriatic
arthritis variants hjave nail deformities

A

T

46
Q

30% of patients with psoriasis develop Psoriatic arthritis

A

T

47
Q

Psoriatic arthritis associated with obesity, positive
family history, and HLA-B27 positivity

A

T

48
Q

Psoriatic
arthritis of the hands typically affects the DIP joint, in contrast to RA
where the DIP joint is typically spared

A

T

49
Q

A severe form of inflammatory arthropathy of the hands, known as arthritis mutilans

A

T

50
Q

Arthritis mutilans causes
acroosteolysis of the phalanges, pencil in cup joint changes, and telescoping (opera-glass hands) of the digits

A

T

51
Q

arthrodesis is the only surgical option that may maintain
digit length and reduce pain

A

T

52
Q

Multiple systems may be affected in SLE, but joints and skin are
involved in up to 90% of patients with the disease.

A

T

53
Q

In contrast to RA, erosive arthritis and loss of articular surfaces are not typical not typical with SLE

A

T

54
Q

Jaccoud arthropathy

A

erosive arthritis and loss of articular surfaces are not typical. This clinical constellation results in a classicJaccoud arthropathy
where the deformity is the result of soft-tissue laxity and ligamentous
shortening rather than from direct destruction of the joints

55
Q

Surgery for hand deformity in SLE is similar to
RA, but there is less need for arthroplasty and arthrodesis

A

T

56
Q

Surgical interventions for a plastic surgeon may include lipotransfer in scleroderma

A

T

57
Q

Dactylitis with fusiform swelling of a single digit (sausage
digit) is a hallmark finding.for Reiter Syndrome

A

T

58
Q

The glabrous skin on the plantar feet and palms of the hands may
develop keratoderma blennorrhagicum which is pathognomonic for reactive arthritis

A

T

59
Q

Treatment is largely medical and can be
similar to other inflammatory arthropathies

A

T

Plastic Surgery( Grabb)Ali jasim (92 decks)

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