Rheumatology Approach to arthritis Flashcards
Types of Rheumatic disease?
Noninflammatory Collagen Vascular Disease Inflammatory Muscle Diseases Infectious Diseases
Highest disease causing disability?
arthritis
more than cardiac, pulmonary, blind/deaf, hypertension, diabetes, stroke
Signs of inflammation?
erythema, swell, pain, heat
Most common cause of arthritis in adults?
osteoarthritis
Osteoarthritis prevalence?
under 30 1% 40-50 10% 50-60 50% 65 75% 75 100%
Risk factors Osteoarthritis?
obestiy joint dysplasia trauma occupation high bone density family history low vit D and C intake
Primary Osteoarthritis?
Localized (trauma, slipped capitol femoral epiphysis, occupation)
Generalized (congenital, idiopathic)
Secondary Osteoarthritis?
Dysplastic (Chondrodysplasia, Epiphyseal dysplasia, developmental)
Post Traumatic (acute, repetitive, surgical)
Endocrine and metabolic
Post-inflammatory
Structural
Clinical features of Osteoarthritis?
History of joint pain not systemic no extra-articular symptoms usually insidious increases with age
Radiography for Osteoarthritis?
plain xray is the most useful
other types of imaging are rarely needed
-asymmetric narrowing, sclerosis, subchondral cysts, osteophytes (bone spur)
Natural history Osteoarthritis?
slowly progressive
hypertrophic rxn on xrays
cartilage loss
loss of function
Treatment goals Osteoarthritis?
control symptoms
maintain function
limit disability
avoid drug toxicity (disease does not kill, pharm does)
Treatment guidelines?
No opiod analgesics in hand, avoid in knee
Why avoid oral NSAIDs?
GI toxicity, ulcers, perforations
Capsaicin use?
for hand OA, not knee OA
Treat OA hand?
evaluation training in joint conservation train in heat/cold topical oral/NSAIDs Capsaicin Tramodol No opiod analgesics
Treat OA knee?
weight loss
strength exercise
manual therapy in conjunction with supervised exercise
use insoles
thermal agents
walking aides
acetaminophen, topical NSAIDs, oral NSAID, injection
avoid opiods
no nsaids with chronic renal stage IV, V
do not use chondroitin, topical capsaicin, glucosamine
Treat OA hip?
self manage weight loss CV exercise thermal agents, manual therapy in conjunction with supervised exercise actaminophen oral NSAIDs Tramadol intraarticular injection no recommendations (topical NSAIDs, Duloxetine, Opioid, Hyaluronate)
Diffuse Idiopathic Skeletal Hyperostosis?
DISH
bone hypertrophy at the ligament and tendon insertions
usually aymptomatic
associated with Type II diabetes
most common in the thoracic spine on the right
following calcifications
Chondromalacia patellae?
affects mainly young women localized OA at the patellae may be a precursor to OA of the knee in early stages Xray are normal diagnosed based on Physical exam
Rheumatoid arthritis?
progressive, systemic, inflammatory disorder
unknown etiology
charaterized by:
symmetric synovitis, joint erosions, multisystem extraarticular manifestations
RA and DIP?
generally it spares the DIP
Common signs of RA?
ulnar deviation, sublux of MCP
synovitis, spongy feel, effusion bag of water, generally spare DIP
Importance of early diagnosis?
progressive, benign
structural damage/disability occurs within the first 2-3 years of disease
slower progression of disease is linked to early development
RA characteristics?
may be abrupt or insidious peak incidence women in their 50s joint pain less related to use prolonged stiffness with inactivity not limited to the MSK system
DIfferential Diagnosis?
thyroid disease, hemachromatosis, paraneoplastic, reactive arthritis, polyarticular gout
Criteria for RA?
morning stiffness >1 hr arthritis of > 3 joint areas arthritis of finger of joints symmetric joint swelling (must be present for at least 6 wks) serum RF Rheumatic nodules typical radiographic changes
Is laboratory data diagnostic?
no, need to diagnose based on patient
Lab data?
RF, Anti-CCP antibody, ESR, CBC, c reactive protein, phase reactants
Radiographic data of RA?
obtain baseline films
ask for evidence of specific parameters
not diagnostic by itself
c1-c2 affected because its similar to MCP joints
c1-c2?
similar to MCP, erode the dens, hyperextended neck
RA of the skin?
rheumatoid nodules
vasculitis
still diseases
drugs
RA of HEENT?
iritis, uveitits, conjunctivitis, scelritis, episceritis, sicca, hearing loss
Sicca?
dry eyes, dry mouth
can cause ulcers
RA of Pulmonary?
intersitial lung disease cricoarytenoid pleura drug rhuematoid nodules
Kaplans disease?
coalminer, smokers
nodules in lung that look like metastasis
RA of GI?
mesenteric vasculitis
ulcer disease with and without treatment
pernicious anemia
RA of renal?
intersitial renal diseas
proteinuria
drug effects
mesangial GN
RA of Neuro?
C1-C2 subluxation
entrapment neuropathy
peripheral neuropathy
vasculitis
RA of bone?
osteoporosis
avascular necrosis
osteomyelitis
RA of hematologic?
Anemia, leukopenia, thrombocytopenia, lymphadeopathy, lymphoma
RA of syndromes?
Sjorgens, Caplans, Feltys, Amyloid A, Vasculitis, Immunodeficiency, Depression
Swan neck?
flex MCP, extend PIP, flex DIP
Treatment of RA?
early treatment
90% of radiographic erosions occur within the first 2 years of synovitis onset
early intervention with DMARDs may prevent long term disability and premature mortality
Objectives of treat RA
preserve function
diminish symptoms
delay or prevent progession
NSAIDs?
control symptoms, decrease swelling, decrease stiffness, provide symptom control, do not alter the course of the disease
NSAIDs side effects?
GI, renal, hepatic, cardiac
Steroids?
intra-articular, systemic, pulse
short time, no renal evidence to change disease course
Methotrexate?
DMARD
