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MOD 2 Quiz 2 > Rheumatology Approach to arthritis > Flashcards

Rheumatology Approach to arthritis Flashcards

1
Q

Types of Rheumatic disease?

A 
Noninflammatory
Collagen Vascular Disease
Inflammatory
Muscle Diseases
Infectious Diseases
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2
Q

Highest disease causing disability?

A

arthritis

more than cardiac, pulmonary, blind/deaf, hypertension, diabetes, stroke

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3
Q

Signs of inflammation?

A

erythema, swell, pain, heat

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4
Q

Most common cause of arthritis in adults?

A

osteoarthritis

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5
Q

Osteoarthritis prevalence?

A 
under 30 1%
40-50 10%
50-60 50%
65 75%
75 100%
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6
Q

Risk factors Osteoarthritis?

A 
obestiy
joint dysplasia
trauma
occupation
high bone density
family history
low vit D and C intake
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7
Q

Primary Osteoarthritis?

A

Localized (trauma, slipped capitol femoral epiphysis, occupation)

Generalized (congenital, idiopathic)

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8
Q

Secondary Osteoarthritis?

A

Dysplastic (Chondrodysplasia, Epiphyseal dysplasia, developmental)
Post Traumatic (acute, repetitive, surgical)
Endocrine and metabolic
Post-inflammatory
Structural

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9
Q

Clinical features of Osteoarthritis?

A 
History of joint pain
not systemic
no extra-articular symptoms
usually insidious
increases with age
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10
Q

Radiography for Osteoarthritis?

A

plain xray is the most useful
other types of imaging are rarely needed
-asymmetric narrowing, sclerosis, subchondral cysts, osteophytes (bone spur)

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11
Q

Natural history Osteoarthritis?

A

slowly progressive
hypertrophic rxn on xrays
cartilage loss
loss of function

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12
Q

Treatment goals Osteoarthritis?

A

control symptoms
maintain function
limit disability
avoid drug toxicity (disease does not kill, pharm does)

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13
Q

Treatment guidelines?

A

No opiod analgesics in hand, avoid in knee

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14
Q

Why avoid oral NSAIDs?

A

GI toxicity, ulcers, perforations

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15
Q

Capsaicin use?

A

for hand OA, not knee OA

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16
Q

Treat OA hand?

A 
evaluation
training in joint conservation
train in heat/cold
topical oral/NSAIDs
Capsaicin
Tramodol
No opiod analgesics
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17
Q

Treat OA knee?

A

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

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18
Q

Treat OA hip?

A 
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)
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19
Q

Diffuse Idiopathic Skeletal Hyperostosis?

A

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

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20
Q

Chondromalacia patellae?

A 
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
21
Q

Rheumatoid arthritis?

A

progressive, systemic, inflammatory disorder
unknown etiology
charaterized by:
symmetric synovitis, joint erosions, multisystem extraarticular manifestations

22
Q

RA and DIP?

A

generally it spares the DIP

23
Q

Common signs of RA?

A

ulnar deviation, sublux of MCP

synovitis, spongy feel, effusion bag of water, generally spare DIP

24
Q

Importance of early diagnosis?

A

progressive, benign
structural damage/disability occurs within the first 2-3 years of disease
slower progression of disease is linked to early development

25
Q

RA characteristics?

A 
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
26
Q

DIfferential Diagnosis?

A

thyroid disease, hemachromatosis, paraneoplastic, reactive arthritis, polyarticular gout

27
Q

Criteria for RA?

A 
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
28
Q

Is laboratory data diagnostic?

A

no, need to diagnose based on patient

29
Q

Lab data?

A

RF, Anti-CCP antibody, ESR, CBC, c reactive protein, phase reactants

30
Q

Radiographic data of RA?

A

obtain baseline films
ask for evidence of specific parameters
not diagnostic by itself
c1-c2 affected because its similar to MCP joints

31
Q

c1-c2?

A

similar to MCP, erode the dens, hyperextended neck

32
Q

RA of the skin?

A

rheumatoid nodules
vasculitis
still diseases
drugs

33
Q

RA of HEENT?

A

iritis, uveitits, conjunctivitis, scelritis, episceritis, sicca, hearing loss

34
Q

Sicca?

A

dry eyes, dry mouth

can cause ulcers

35
Q

RA of Pulmonary?

A 
intersitial lung disease
cricoarytenoid
pleura
drug
rhuematoid nodules
36
Q

Kaplans disease?

A

coalminer, smokers

nodules in lung that look like metastasis

37
Q

RA of GI?

A

mesenteric vasculitis
ulcer disease with and without treatment
pernicious anemia

38
Q

RA of renal?

A

intersitial renal diseas
proteinuria
drug effects
mesangial GN

39
Q

RA of Neuro?

A

C1-C2 subluxation
entrapment neuropathy
peripheral neuropathy
vasculitis

40
Q

RA of bone?

A

osteoporosis
avascular necrosis
osteomyelitis

41
Q

RA of hematologic?

A

Anemia, leukopenia, thrombocytopenia, lymphadeopathy, lymphoma

42
Q

RA of syndromes?

A

Sjorgens, Caplans, Feltys, Amyloid A, Vasculitis, Immunodeficiency, Depression

43
Q

Swan neck?

A

flex MCP, extend PIP, flex DIP

44
Q

Treatment of RA?

A

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

45
Q

Objectives of treat RA

A

preserve function
diminish symptoms
delay or prevent progession

46
Q

NSAIDs?

A

control symptoms, decrease swelling, decrease stiffness, provide symptom control, do not alter the course of the disease

47
Q

NSAIDs side effects?

A

GI, renal, hepatic, cardiac

48
Q

Steroids?

A

intra-articular, systemic, pulse

short time, no renal evidence to change disease course

49
Q

Methotrexate?

A

DMARD

MOD 2 Quiz 2 (13 decks)

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