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MSK > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is osteoarthritis?

A

degenerative condition involving wear and tear of the cartilage and osseous hypertrophy at the articular margins

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2
Q

What are the clinical manifestations of osteoarthritis?

A
  • asymmetrical and/or monoarticular
  • deep, dull ache that is relieved with rest and worsened with activity
  • insidious onset, with progression taking years to present
  • morning stiffness < 30 minutes
  • osteophytes
  • carpometacarpal joint squaring of thumb
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3
Q

How do you diagnosis osteoarthritis?

A
  • joint space narrowing
  • osteophytes
  • sclerosis of subchondral bony end plates adjacent to diseased cartilage
  • subchondral cysts
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4
Q

What is Rheumatoid Arthritis?

A

chronic inflammatory autoimmune disease involving the synovium of joints
-inflammatory polyarthritis

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5
Q

What is the usual age to present with rheumatoid arthritis?

A

20 - 40 years

women > men (3:1)

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6
Q

Is genetic predisposition necessary for rheumatoid arthritis?

A

yes

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7
Q

What joints are most commonly involved with rheumatoid arthritis?

A

hands (MCP, PIP) and wrists

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8
Q

Characteristic Hand Deformities

A
  • ulnar deviation of the MCP joints
  • boutonniere deformities
  • swan-neck deformities
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9
Q

Buotonniere deformities

A

PIP flexed, DIP hyerextended

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10
Q

Swan-neck contractures

A

MCP flexed, PIP hyperextended, DIP flexed

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11
Q

What are the clinical manifestations of rheumatoid arthritis?

A

morning stiffness (present in all patients) - lasting hours

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12
Q

Cervical Spine involvement - Rheumatoid Arthritis

A
  • atlantoaxial subluxation and instability (C1/C2)

- all RA patients should have C-spine x-rays before any surgery

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13
Q

Caplan syndrome - RA

A

multiple rheumatoid nodules with possible cavitation

-occurs in RA patients with exposure to silica dust, asbestos fibers, or other pneumonconses

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14
Q

Other Systemic Manifestations with Rheumatoid Arthritis

A

subcutaneous rheumatoid arthritis

-pathognomonic for RA

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15
Q

Felty Syndrome

A
  • triad of long-standing seropositive RA, neutropenia, and splenomegaly
  • usually occurs fairly late in disease process (>10 years)
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16
Q

Diagnosis of Rheumatoid Arthritis

A
  • Rheumatoid factor

- Anti-cyclic citrullinated peptide/protein antibodies (ACPA/Anti-CCP)

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17
Q

Ankylosing Spondylitis

A
  • strong association with HLA-B27
  • bilateral sacroilitis is pathognomonic
  • characterized by “fusion” of spine in ascending manner
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18
Q

What are the clinical manifestations of ankylosing spondylitis?

A

enthesitis: inflammation at insertion point of tendons to bone
Extra-articular manifestations
-eye involvement (MC) - acute anterior uveitis

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19
Q

What needed for a diagnosis of ankylosing spondylitis?

A
  • sacroillitis - sclerotic changes of sacroiliac area

- “bamboo spine”

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20
Q

Psoriactic arthritis

A

dactylitis (“sausage fingers”)

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21
Q

What is needed for a diagnosing psoriatic arthritis?

A
  • x-ray of the fingers and/or toes demonstrates “pencil in a cup”
  • HLA-B27 positive
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22
Q

Reactive arthritis

A

inflammatory arthritis that occurs after certain infections involving the GI (campylobacter) and GU (chlamydia) tracts
-onset of symptoms usually about 1-4 weeks after initial infection

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23
Q

What are the clinical manifestations of reactive arthritis?

A
  • enthesitis: inflammation of sites of tendon attachment to bone
  • dactylitis: “sausage digit”
  • urethritis or cervicitis
  • ocular inflammation
  • keratoderma blennorrhagicum: waxy paular rash on the palms and solde
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24
Q

What is are the diagnostics of reactive arthritis?

A
  • synovial fluid: cloudy, viscous, non-hemorrhagic

- X-ray findings are fluffy periostitis = proliferative changes along the shaft of the bone

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25
Q

What is the most common cause of Septic arthritis?

A

Staphylococcus aureus

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26
Q

Gout

A

inflammatory monoarticular arthritis resulting from crystallization of monosodium rate within the joints
-hyperuricemia is the hallmark of the disease

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27
Q

What is the pathophysiology of gout?

A
  • increase in production of uric acid

- decreased excretion of uric acid

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28
Q

Stage 1 - Asymptomatic hyperuricemia

A
  • increased serum uric acid level with no clinical findings of gout
  • may be present without symptoms for 10-20 years or longer
  • should not be treated
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29
Q

Stage 2 - Acute gouty arthritis

A
  • peak age of onset 40-60 years of age in men
  • initial attack typically associated with sudden onset of exquisite pain
  • most often attacks the big toes at the first MTP joint (podagra)
  • painful, cellulitic changes
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30
Q

Stage 3 - Intercritical gout

A
  • asymptomatic period after initial attack
  • may not have another flare up for years
  • attacks tend to become polyarticular with increased severity over time
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31
Q

Stage 4 - Chronic tophaceous gout

A
  • usually noted in poorly controlled gout for more than 10-20 years
  • Tophi: conglomerations or urate crystals surrounded by giant cells in an inflammatory reaction
  • cause deformity and destruction of hard and soft tissues
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32
Q

What is needed to diagnosis gout?

A
  • negatively birefringent, needle-shaped crystals

- radiography: punched out erosions with overhanging rim of cortical bone in advanced disease

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33
Q

Pseudogout

A
  • calcium pyrophosphate crystal deposition in joint spaces
  • typically affects larger joints
  • classically monoartcular
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34
Q

What are the risk factors for pseudogout?

A
  • common in elderly patients with degenerative joint disease
  • hemochromatosis
  • hyperparathyroidism
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35
Q

What is needed to diagnosis psudogout?

A
  • weakly positively birefringent, rod-shaped and rhomboidal crystals in synovial fluid
  • radiography: chonrocalcinosis
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36
Q

Indications for Arthrocentesis

A
  • painful joint effusion
  • monoarticular inflammation of the joint
  • suspicion of systemic rheumatoid disorder of unknown etiology
  • articular inflammation of unknown cause
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37
Q

Contraindications for Arthocentesis

A
  • after total joint arthroplasty

- relatively contraindicated for patients on anticoagulant therapy

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38
Q

Complications for Arthocentesis

A
  • introduction of infection
  • bleeding
  • allergy to local anesthetic
  • pain
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39
Q

Who is SLE most commonly seen in?

A

Women of childbearing age and AA

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40
Q

What is the pathophysiology of SLE?

A

Environmental exposure triggers genetically predisposed pts:

  • smoking
  • exposure to UV lights
  • EBV
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41
Q

What are the 2 forms of SLE?

A
  • Spontaneous: systemic sxs

- Cutaneous: dermatologic sxs

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42
Q

What labs are done for SLE?

A
  • ANA
  • Anti-dsDNA
  • Anti-smith
  • Antiphospholipid antibody
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43
Q

What are the S/Sxs of SLE?

A
  • Malar butterfly rash
  • Photosensitivity
  • Discoid lesions
  • Oral ulcers
  • Alopecia
  • Reynaud phenomenon
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44
Q

What are the clinical manifestations of SLE?

A
  • Arthralgias (MC 1st sx) of wrist and fingers
  • Jaccoud arthropathy (reversible ulnar deviation of MCP joints
  • Cardiac: libman-sacks edocarditis
  • Pulmonary: pleuritis
  • Hem: hemolytic anemia
  • Renal: Proteinuria (>0.5g/day)
45
Q

Does drug induced lupus affect the CNS and Kidneys?

A

NO

46
Q

What are S/Sx of drug induced lupus?

A
  • Malar rash
  • Alopecia
  • NO ulcers.
47
Q

What labs are used to diagnose drug induced lupus?

A

Anti-histone antibodies (always present)

48
Q

What are some drugs that cause drug induced lupus?

A
  • Procainamide
  • Hydralazine
  • Isoniazid
  • Quinidine
  • Carbamazepine
  • Phenytoin
49
Q

Sjögren syndrome is MC’ly seen in who?

A

Women ages 40-50

50
Q

What is the pathology of Sjögren syndrome?

A

Lymphocyte infiltrate and destruction of lacrimal and salivary glands

51
Q

What are risks of Sjögren syndrome?

A
  • NHL

- MC COD is malignancy

52
Q

What are the 2 types of Sjögren syndrome?

A
  • Primary: dry eyes and mouth (SICCA sxs)

- Secondary: dry eye and mouth w/ connective tissue disease

53
Q

What are the clinical manifestations of Sjögren syndrome?

A
  • SICCA syndrome:
  • Dry eye (xerophthalmia): burning, redness, blurred vision, keratoconjunctivitis.
  • Dry mouth (xerostomia): tooth decay and depapillation of the tongue.
  • Chronic fatigue (MC non-sicca sx)
54
Q

What labs are used to diagnose Sjögren syndrome?

A

Ro (SS-A) and La (SS-B)

55
Q

What are the diagnostic tests for Sjögren syndrome?

A
  • Schirmer test: filter paper placed into eye to measure lacrimal gland output.
  • Salivary gland bx: most accurate.
56
Q

What is the OTC management for Sjögren syndrome?

A

Biotene and lemon drops

57
Q

What is another name for systemic sclerosis?

A

Scleroderma (hardening/thickening of the skin)

58
Q

What is the epidemiology of systemic sclerosis?

A
  • W>M (2-3x)

- 35-50 yoa

59
Q

What is the pathology of systemic sclerosis?

A

Chronic connective tissue disorder that leads to widespread fibrosis

60
Q

What are the 2 types of systemic sclerosis?

A
  • Diffuse

- Limited (CREST)

61
Q

What lab is done for diffuse systemic sclerosis?

A

Anti- topoisomerase antibody

62
Q

What lab is done for limited systemic sclerosis?

A

Anti-centromere antibody

63
Q

What does CREST stand for?

A
  • C: calcinosis cutis
  • R: reynaud’s phenomenon
  • E: esophageal dysmotility
  • S: sclerodactyly (claw like appearance of hands)
  • T: telangiectasias
64
Q

What are triggers for Reynaud’s phenomenon?

A

Cold temp and stress causes:

  • blanching then,
  • Cyanotic then,
  • Reactive hyperemia
65
Q

What is the MC cause of death from systemic sclerosis?

A

Pulmonary involvement

66
Q

What is the epidemiology of Idiopathic inflammatory myopathies?

A

W>M and AA

67
Q

What are the clinical manifestations of Idiopathic inflammatory myopathies?

A
  • Symmetrical proximal muscle weakness
  • Earliest and most severely affected muscle groups:
  • The neck flexors
  • Shoulder girdle
  • Pelvic girdle musculature
68
Q

What are the two types of Idiopathic inflammatory myopathies?

A
  • Polymyositis: no derm findings

- Dermatomyositis: skin rash

69
Q

What are some characteristics of Polymyositis?

A
  • Gradual increasing multiple myalgia

- W>M

70
Q

What lab is used to diagnose Polymyositis?

A

Anti-Jo-1 antibodies

71
Q

What are the clinical manifestations of Dermatomyositis?

A
  • Heliotrope rash: around eyes
  • Gottron papules: purplish, papular, erythematous, scaly lesion over the knuckles
  • V sign: rash on face, neck and anterior chest
  • Shawl sign: rash on shoulder, upper back, elbows and knees.
72
Q

There is an increase incidence of what with adults with Dermatomyositis?

A

Malignancy

73
Q

What is the epidemiology of Polymyalgia rheumatica?

A
  • 65-70 yo

- W>M

74
Q

Polymyalgia rheumatica has a strong correlation of what?

A

Temporal Arteritis

75
Q

What is the clinical manifestations of Polymyalgia rheumatica?

A

Stiffness and subjective weakness of shoulder and hip region (bilateral) after a period of inactivity/rest.

76
Q

What lab is elevated with Polymyalgia rheumatica?

A
  • ESR >50
77
Q

What is the epidemiology of Fibromyalgia?

A

Adult women

78
Q

What is the pathology of Fibromyalgia?

A

Chronic non-progressive course w/ waxing and waning intensity

79
Q

What is the etiology of Fibromyalgia?

A

Unknown

80
Q

What is the key to diagnose Fibromyalgia?

A

Multiple trigger points

81
Q

What are the S/Sxs of Fibromyalgia?

A
  • Stiffness and body aches (myalgia/arthralgia)
  • Fatigue
  • Pain is constant and aching
  • Aggravated by weather changes and stress
  • Sleep deprivation
  • GI issues
  • Anxiety
  • Depression
  • “fibro fog”
  • pain worse in the AM, alleviates w/rest, warmth, and mild exercise and meds
82
Q

What is the management of Fibromyalgia?

A

Stay active and engage in low intensity exercise (yoga and swimming)
- narcotics can worsen sxs.

83
Q

Is Takayasu arteritis large medium or small vasculitis?

A

Large

84
Q

Is Polyarteritis nodosa large medium or small vasculitis?

A

Medium

85
Q

Is Behçet disease large medium or small vasculitis?

A

Medium

86
Q

Is Granulomatosis with polyangiitis large medium or small vasculitis?

A

Small

87
Q

Is Eosinophilic granulomatosis with polyangiitis large medium or small vasculitis?

A

Small

88
Q

What is the epidemiology of Takayasu arteritis?

A
  • Young Asian women

- 10-20 yoa.

89
Q

What is the pathology of Takayasu arteritis?

A

Granulomatous vasculitis of the aortic arch and its major branches

90
Q

What are the S/Sx of Takayasu arteritis?

A
  • Decreased or absent peripheral pules
  • Discrepancies in blood pressure (arms vs legs)
  • Arterial bruits
  • Visual disturbances (hemorrhage of retinal arteries)
91
Q

What body systems are involved with Polyarteritis nodosa?

A

Nervous system and GI tract

92
Q

What is associated with Polyarteritis nodosa?

A
  • HBV
  • HIV
  • Drug rxns
93
Q

What is the pathophysiology of Polyarteritis nodosa?

A

Necrosis is segmented “rosary sign” as a result of aneurysms

94
Q

What is the clinical manifestations of Polyarteritis nodosa?

A
  • Livedo reticular
  • Gangrene
  • Ulcers
  • Subcutaneous nodules
  • Wrist drop
  • NO pulmonary involvement
95
Q

What is the diagnostic test for Polyarteritis nodosa?

A

Biopsy

96
Q

What is Behçet disease?

A

Autoimmune, multisystem vasculitis disease, unknown etiology

97
Q

What is the epidemiology of Behçet disease?

A

Middle eastern decent

98
Q

What is the clinical manifestations of Behçet disease?

A
  • Painful, sterile oral and genital ulcerations (pathergy)
  • Relapsing uveitis
    MC: oral ulcers
99
Q

What are the diagnostic test for Behçet disease?

A
  • Bx of involved tissue

- Make sure to r/o herpes and lichen planus

100
Q

Granulomatosis with polyangiitis involves what?

A

Predominantly involving the kidneys and upper/lower respiratory tract

101
Q

What is the MC cause of death of Granulomatosis with polyangiitis?

A

Renal disease- most die within 1 yr following diagnosis

102
Q

What are clinical manifestation of Granulomatosis with polyangiitis?

A

Upper respiratory:

  • Purulent or bloody nasal discharge
  • Painful oral ulcers
  • Cough
  • Hemoptysis
  • Dyspnea
  • Tracheal stenosis
  • Saddle nose
103
Q

What labs are use to diagnose Granulomatosis with polyangiitis?

A

c-ANCA (anti-neutrophil cytoplasm)

104
Q

What is the diagnostic test to confirm Granulomatosis with polyangiitis?

A

Open lung bx

105
Q

Eosinophilic granulomatosis with polyangiitis involves what?

A
  • Cardiac
  • Respiratory
  • Skin
  • GI
  • Renal
  • Neurologic
106
Q

What are the clinical manifestations of Eosinophilic granulomatosis with polyangiitis?

A
  • Subcutaneous nodules
  • Palpable purpura
  • Asthma
  • Dyspnea
  • Eosinophilia
107
Q

What are the diagnostics used for Eosinophilic granulomatosis with polyangiitis?

A

Eosinophils on skin or lung tissue bx

108
Q

What is the prognosis of Eosinophilic granulomatosis with polyangiitis?

A

Death usually related to cardiac or pulmonary complications.

  • 5 yr survival w/o tx
  • 10 yr survival w/treatment

MSK (11 decks)

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