Rheumatology Flashcards
What is the most destructive element in RA?
Pannus formation
What criteria needs to be fulfilled to diagnose RA?
Score of greater than or equal to 6/10 on ACR/EULAR classification criteria
Morning stiffness in major arthritides: duration and location for OA, RA, ank spon?
OA: < 30 mins; DIP, knees, hips
RA: > 1 hr; MCP, PIP, MTP joints
Ank spon: 3 hrs; lumbosacral spine
Synovial fluid testing numbers for RA
Low viscosity
WBC 1000-75000
Greater than 70% PMN’s
Transparent-cloudy
Where can erosions be seen in RA? Is DIP involved? Symmetric or asymmetric?
Ulnar styloid and metatarsal head of MTP joint;
no;
Starts maybe asymmetric, but progresses to symmetric
What is the pathology behind Boutonniere deformity? How to manage?
Weakness or rupture of terminal portion of extensor hood at PIP;
Boutonniere ring splint
For swan neck deformity, which of MCP, PIP, DIP are in flexion/extension?
MCP = flexed; PIP = extended; DIP = flexed
What is a concern with RA and cervical spine? With cervical flexion, what A-A space is considered abnormal?
Atlanto-axial joint subluxation, most common being anterior subluxations;
Greater than 2.5-3 mm
In what rheum pathologies do you see subcutaneous nodules?
RA, gout
What can be seen with RA pericarditis?
Chest pain, pericardial friction rub, EKG abnormalities (diffuse ST elevations)
Felty’s syndrome triad?
RA, splenomegaly, leukopenia
Mild RA requires what type of exercise program?
Isometric program
In OA, increased water content of OA cartilage leads to
damage of the collagen network
DISH hallmark is what?
Ossification spanning four contiguous vertebral bodies (3 or more intervertebral discs);
see ossification of ALL
What are the most common joints involved in oligoarticular JIA? Other key features?
Knee, followed by ankle, wrist, then elbows (KAWE)
ANA and HLA-B27 positive, RA neg; iridocyclitis such that ophthalmology referral mandatory, no erosions
With JIA, why avoid salicylates?
Reyes’ syndrome
Pseudogout has associations with which medical conditions?
Hypothyroidism, hypoMg, hypophos;
Hyperparathyroidism;
Amyloid, hemochromatosis
Hallmark of AS?
B/l sacroiliitis
Cervical ankylosis develops in ______ % of patients who have AS for _______ yrs or longer
75; 16
Triad of reactive arthritis? What can patients with this progress to?
Conjunctivitis, arthritis, non-gonococcal urethritis;
AS
Radiographic findings in Reactive arthritis?
- Lover’s heel (erosion and periosteal changes at insertion of plantar fascia and Achilles tendons)
- Asymmetric SI joint involvement
- Syndesmophytes
- Pencil-in-cup deformities
Psoriatic arthritis is associated with what other disease? What joints are most involved?
HIV; foot and ankle
Acronym for SLE criteria?
DOPAMINE RASH D: Discoid rash O: Oral ulcers P: Photosensitivity A: Arthritis M: Malar rash I: Immunologic disorder NE: Neuro disorder R: Renal disorder A: Abnormal ANA titer S: Serositis H: Hematologic disorder
Which type of poly/dermatomyositis is associated with malignancy?
Type 3
Juvenile dermatomyositis associated with
- generalized vasculitis
- heliotrope rash
- clumsiness
- female preponderance
- responds well to steroids
Among MCTD, RA, SLE, scleroderma, polymyositis, and Sjogren’s, which are both ANA and RF +?
RA, MCTD, Sjogren’s
For septic arthritis, most common organism in adults vs kids?
Gonorrhea for adults, S aureus in kids
Most common cause of septic arthritis in kids 6 mos to 2 yoa?
Haemophilus influenza
Sjogren’s could have involvement of which gland?
Parotid
How does hemophilic arthropathy manifest?
Blood in joint depositing hemosiderin into the synovial lining leading to synovial proliferation and pannus formation
Most likely causes of Charcot joint?
Syringomyelia for shoulder;
tabes dorsalis for syphilis at knee;
diabetic neuropathy for ankle
SCFE is linked with
endocrinopathies (hypothyroidism most common)
CRPS: describe the findings at the different stages
- Acute: Swelling, allodynia, hyperhydrosis, increased blood flow with temp and skin-color changes
- Dystrophic: persistent pain, atrophic skin changes, decreased temp
- Atrophic: Skin cool, glossy; atrophy
In CRPS, which extremity is affected most in kids vs adults? What is treatment for adults? What imaging is most impactful for adults?
Upper in adults, lower in kids;
Symp blocks;
Triple-phase bone scans
What is most common extensor tendon injury?
Mallet finger
