Rheumatology Flashcards
Differences between Osteoarthritis and RA (Talk about OA), Onset, fast/slow progression, how are joints, morning stiffness? how movement effects joints, is it symmetrical? asymmetrical?
Occurs later in life, slow progression, joints achy with no swelling, begins on one side, morning stiffness which goes away with 1 hour, whole body symptoms not present
Differences between Osteoarthritis and RA (Talk about RA), Onset, fast/slow progression, how are joints, morning stiffness? how movement effects joints, is it symmetrical? asymmetrical?
occurs at anytime in life, rapid progression (weeks to months), joints are painful, red, swollen and stiff, affects small and large joints symmetrically, stiffness lasts longer than an hour, frequent fatigue, feeling ill
what does it mean when OA is detectable by radiograpgh?
joint fails, need replacement
what kind of test is needed in the pre-radiographic phase of OA to detect diease?
MRI
Herbeden’s nodes are seen with which disease and where are they located?
OA, distal (closer to fingertips)
Bouchard’s nodes are seen with which disease and where are they located?
OA, proximal (closer to wrist)
when is OA usually seen in women
after menopause
Hand OA diagnostic criteria (3 of the following)
-hard tissue enlargement of at least 2 of the following joints:
2nd and 3rd DIP
2nd and 3 PIP and/or
first MCP
-hard tissue enlargement of 2 or more DIP joints
-Fewer than 3 swollen MCP joints
-Deformity of at least 1 of the joints listed
Hip OA diagnostic criteria: Hip pain and 2 of the following
ESR<20, Osteophytes on xray, joint space narrowing on xray
Knee OA diagnostic criteria: Knee pain, osteophytes and 1 of the following
age older than 50, stiffness lasting less than 30 minutes and/or crepitus
are synovial fluid analysis and lab tests diagnostic for OA?
no
what does c-reactive protein show?
pain and stiffness
when do you do radiographic studies with OA?
when there is a change symptoms
when do you do ultrasound or MRI with OA?
we don’t usually, maybe to r/o meniscal tears or tumors
Drugs recommended for OA of hand, knee and hip
NSAIDs
Intraarticular glucocorticoid injection are good for which problems
OA of hand, knee and hip
when is Arthroplasty used to treat OA
when all other conservative treatments have failed with severe OA
which disease is characterized by uncontrolled proliferation of synovial tissue
RA
HLA (human leukocyte antigen) class II genotypes
RA genes, can make RA worse
can smoking make RA worse?
yes
what do CCPs (Citrulline-containing) peptides do in RA
they initiate RA cascade, this test is specific to RA
What does the RA cascade release that invades the joints
cytokines( interleukins)
Are Rheumatoid Factor-(IgG class)polyclonal antibodies specific to RA?
No can be present in SLE, scleroderma
Tumor necrosis factor-alpha( TNF-a) is one of the main cytokines that trigger what?
proliferative rheumatoid synovium
7 criteria for RA diagnoses
- ) Morning stiffness for at least 1 hour
- ) Soft tissue swelling of 3 more joints
- ) Hand joint involvement
- ) Symmetric arthritis
- ) Rheumatoid nodules
- ) Serum Rheumatoid factor positive
- ) Xray changes show loss of erosions or loss of density
Boutonniere deformity
flexion of the PIP joints and hyperextension of the DIP joints due to rupture of extensor tendons over the fingers
In RA, Proliferation of the synovium on the palmar aspect of the wrist may cause compression on which nerve? and what can this cause?
median nerve and carpal tunnel could develop
In RA,Laxity in the cervical regions may allow compression of the vertebral artery which affects motion and could cause what?
HA
Are shoulder involvement in RA an early or later stage?
later
Baker cyst are found where and with what problem?
found behind the knee, RA
What feet deformities are found with RA?
Hallux valgus, Hammer toe, Rheumatoid nodule
why is a urinalysis important when testing for connective tissue diseases?
microscopic hematuria or proteinuria may be present
Will RA increase or decrease alkaline phosphatase?
increase it
RA radiology findings
erosions on the margins of bone, joint space narrowing, osteopenia, and eventual misalignment and subluxation of the bones
How fast should patients be referred if RA is suspected?
3 months
methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine are what kind of drugs?
DMARDs
RA < 6 months is considered what stage?
early
RA 6-24 months is considered what stage?
intermediate
RA >24 months is considered what stage?
late
When a patient is on DMARDs what do you need to monitor? and which disease can’t you give these too?
LFTs and CBC, can’t give to liver disease patients
steroid treatment for lupus can put patient at risk for what?
osteoporosis and cataracts
ACR and CRP are used to monitor what in RA?
to see how well meds are working
CBC, CMP, ANA, U/A Anti-dsDNA, Antiphospholipid antibodies Anti-SM antibodies Plain films if needed Guided by clinical presentation
is used for diagnostic testing for?
Lupus
Polyarthritis
multiple joint arthritis
Vasculitis
inflammation of the blood vessels
mild lupus treatment
NSAIDS
treatment for Cutaneous (affecting the skin) manifestations-
Plaquenil (HCQ)
lupus treatment for multiple organ involvement
Glucocorticoid steroids
what are Cellcept, Imuran, Cytoxan used for?
lupus, immunosuppressants
what is Benlysta used for?
lupus, immunosuppressant
what does lupus put you at greater risk for
lymphoma, breast cancer, abnormal pap and skin cancer
who is more at risk for a lupus flare
age <25, nonwhite, poor people and family/life stressors, patients with more disease complications
an isolated lupus flare can be treated with what?
increased steroids
Lab work up for RA
Rheumatoid factor Sedimentation rate (ESR) C-reactive protein (CRP) CBC (to see if anemic) Urinalysis CMP
Why is a urinalysis important to do?
Microscopic hematuria or proteinuria may be present in many connective tissue diseases
What will X-rays show with RA?
erosions on the margins of bone, joint space narrowing, osteopenia, and eventual misalignment and subluxation of the bones
