Rheumatology H&P Lecture Powerpoint

Question 1

Osteoarthritis vs rheumatoid arhtritis

Answer 1

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

Question 2

Bouchard’s vs heberden’s node

Answer 2

Bouchards are in PIP joints and almost never seen in osteoarthritis and heberdens are in DIP nodes and more common in osteoarthritis

Question 3

Ulnar deviation

Answer 3

Common finding in rheumatoid arthritis causing displacement of digits to the ulnar side due to inflammation at the MCP joints

Question 4

Boutonniere deformity

Answer 4

Swelling of PIP flexion and extension of DIP from inflammation in PIP joints occurring in rheumatoid arthritis, can also be traumatic in origin

Question 5

Swan neck deformity

Answer 5

Hyperextension of PIP and flexion of DIP joints causing rheumatoid arthritis

Question 6

Polymyalgia rheumatica

Answer 6

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

Question 7

Definitive diagnosis of temporal arteritis (1)

Answer 7

-biopsy of temporal artery

Question 8

Systemic lupus erythematosus

Answer 8

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)

Question 9

Systemic sclerosis (scleroderma)

Answer 9

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)

Question 10

CREST acronym for systemic sclerosis (scleroderma)

Answer 10

calcinosus
raynauds
esophageal dysfunction
sclerodactyly 
Telangectasias

Question 11

Raynaud’s phenomena

Answer 11

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

Question 12

Psoriatic arthritis

Answer 12

Psoriasis with accompanying deformity of digits, often see distinct pencil in cup deformity*** as trademark feature

Question 13

Ankylosing spondylitis

Answer 13

Chronic inflammatory disease of axillary skeleton usually in men in their 30’s with low back pain, eventually calcification decreases mobility of spine

Question 14

Lab tests for suspected ankylosing spondylitis (1)

Answer 14

-HLAB27

Question 15

Gout

Answer 15

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

Question 16

Reiter’s syndrome (reactive arthritis)

Answer 16

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

Question 17

Origin points of joint symptoms in rheumatic disease (5)

Answer 17

• synovium
• cartilage
• peri-articular
• bone
• inflammatory or non inflammatory (do they have rubor (erythema) calor (heat) dolor (pain) tumor (swelling))

Question 18

Additive and migratory sequences of joint involvement in assessing rheumatological disease

Answer 18

Additive means the pain is taking on more than one joint, while migratory means that the pain is moving to a different joint

Question 19

Pain at rest vs following exercise can help differrentiate between these 2 pathologies

Answer 19

-RA and lupus are worse with inactivity but improve with movement and exercise while osteoarthritis (degenerative joint disease) is worse during or after exercise

Question 20

Gelling pattern/stiffness pattern

Answer 20

Refers to how individuals with RA have extensive morning stiffness for hours while lupus is shorter period

Question 21

Lupus associated drug reaction

Answer 21

Form of autoimmune disease brought on by some medications, some examples being procainamide and hydralazine (these resolve after discontinuation of drugs)