Rheumatology H&P Lecture Powerpoint Flashcards
Osteoarthritis vs rheumatoid arhtritis
Degeneration of the cartilage resulting in bone on bone eruption at a joint associated with aging and genetic predisposition often asymmetric, while rheumatoid is swollen inflammation of the synovial fluid and is autoimmune in nature
Bouchard’s vs heberden’s node
Bouchards are in PIP joints and almost never seen in osteoarthritis and heberdens are in DIP nodes and more common in osteoarthritis
Ulnar deviation
Common finding in rheumatoid arthritis causing displacement of digits to the ulnar side due to inflammation at the MCP joints
Boutonniere deformity
Swelling of PIP flexion and extension of DIP from inflammation in PIP joints occurring in rheumatoid arthritis, can also be traumatic in origin
Swan neck deformity
Hyperextension of PIP and flexion of DIP joints causing rheumatoid arthritis
Polymyalgia rheumatica
Acute onset arthritis in patients 50+ that develop severe pain and stiffness in hips, shoulders, and neck, high sed rate, associated with giant cell arteritis (temporal arteritis - vasculitis of small and medium vessels in face typically temporal artery that can also affect opthalmic artery which can result in blindness), unknown origin, treated with steroids for period of time
Definitive diagnosis of temporal arteritis (1)
-biopsy of temporal artery
Systemic lupus erythematosus
Autoimmune disorder that can affect joints but also nearly every organ system, can have cutaneous manifestation in mailar (butterfly) rash with nasolabial sparing in sun exposure, can affect kidneys, can be diagnosed via ANA (autonuclear antibodies)
Systemic sclerosis (scleroderma)
Thickening due to excess collagen fibers due to collagen vascular disease resulting in fibrosis of many organ systems (often the skin but most concern is with the lungs causing pulmonary fibrosis)
CREST acronym for systemic sclerosis (scleroderma)
calcinosus raynauds esophageal dysfunction sclerodactyly Telangectasias
Raynaud’s phenomena
Cold or emotions causing vasospasm obstructing blood flow resulting in color changes from white to blue to red as blood flow ceases and eventually returns, severe untreated can result in loss of digits
Psoriatic arthritis
Psoriasis with accompanying deformity of digits, often see distinct pencil in cup deformity*** as trademark feature
Ankylosing spondylitis
Chronic inflammatory disease of axillary skeleton usually in men in their 30’s with low back pain, eventually calcification decreases mobility of spine
Lab tests for suspected ankylosing spondylitis (1)
-HLAB27
Gout
Non autoimmune condition, crystal deposition disease where uric acid crystals end up deposit in joints either due to urea produciton or decreased renal excretion, most often manifests at first metatarsal phalanx, called podagra in that case
Reiter’s syndrome (reactive arthritis)
Form of arthrtitis that follows infection from pathogen such as shigella, campylobacter, chlamydia, C diff, etc. that sees urethritis, conjunctivits, and arthritis of single joint, treated with NSAIDS
Origin points of joint symptoms in rheumatic disease (5)
- synovium
- cartilage
- peri-articular
- bone
- inflammatory or non inflammatory (do they have rubor (erythema) calor (heat) dolor (pain) tumor (swelling))
Additive and migratory sequences of joint involvement in assessing rheumatological disease
Additive means the pain is taking on more than one joint, while migratory means that the pain is moving to a different joint
Pain at rest vs following exercise can help differrentiate between these 2 pathologies
-RA and lupus are worse with inactivity but improve with movement and exercise while osteoarthritis (degenerative joint disease) is worse during or after exercise
Gelling pattern/stiffness pattern
Refers to how individuals with RA have extensive morning stiffness for hours while lupus is shorter period
Lupus associated drug reaction
Form of autoimmune disease brought on by some medications, some examples being procainamide and hydralazine (these resolve after discontinuation of drugs)