Rheumatology Lecture Flashcards
How many Americans have an MSK or rheumatologic disorder?
50 million
What proportion of PCP visits are for MSK complaints?
1 in 5
The most common joint disorder is ____________.
osteoarthritis
List the structures that are considered intraarticular and extraarticular.
Intraarticular: •Cartilage •Subchondral bone •Synovium • Synovial fluid
Extraarticular: •Tendon • Muscle •Bursa • Ligament
What are symptoms of inflammatory arthritis?
- Pain with all directions of movement
- Swelling of the entire joint
- Limited ROM in all directions of movement
- Pain equal when active or passive
In inflammatory arthritis, look for these exam signs: ________________.
warm, redness, swelling, and pain
Classically, the morning stiffness of RA lasts ______________.
greater than an hour
In contrast to inflammatory joint disorders, osteoarthritis usually does not have _____________.
warmth, redness, or swelling (and the pain is milder)
Synovium lines the inside of the _______________.
joint capsule
Which joints are most commonly affected in OA?
- DIPs
- PIPs
- 1st MCP
- 1st MTP
- Weight-bearing joints
A synovial fluid aspirate with less than ___________ cells is considered non-inflammatory.
2,000 cells/mL
What are Heberden and Bouchard nodes?
Found in osteoarthritis, Bouchard and Heberden nodes are nodal swellings of the PIP (Bouchard) and DIP (Heberden) joints.
(Just remember that it goes alphabetically proximal to distal.)
An x-ray of the DIPs and PIPs of someone with osteoarthritis may show the ____________ sign.
seagull (osteophytes projecting from the sides of the phalangeal head)
Because of asymmetric weight distribution, osteoarthritis can cause ________________ of the joint.
asymmetric narrrowing
Based on the number of joints involved and distribution, list the types of inflammatory arthritis.
Monoarticular:
•Gout
•Pseudogout
• Septic joint
Oligoarticular, asymmetric (2-4 joints):
•Spondyloarthropathies
Polyarticular, symmetric (5 or greater):
•RA, SLE,
__________ is more of an indicator of chronic inflammation, while CRP is an indicator of acute inflammation.
ESR
Recall (from Step studying) that __________ is specific for RA.
anti-cyclic citrullinated protein
What is the upper limit for ESR?
20 mm/hr for females and 15 mm/hr for males
Citrulline is formed by _______________.
deamination of arginine
What immunofluorescent pattern can differentiate lupus from scleroderma?
Lupus presents with a circular halo around the nucleus, while scleroderma presents with a clumpy pattern in the nucleus (described as nucleolar).
Only a small percent of those with high __________ develop gout.
uric acid levels in the blood
Pseudogout more commonly affects the ______________.
wrist and knee (as opposed to the 1st MTP like in regular gout)
Nongonococcal septic arthritis is more common in which populations?
- IV drug abusers
* Immunocompromised patients
Aspirates of septic joints from a nongonococcal etiology will classically have WBC greater than __________.
50,000 (though this is not required for a diagnosis of septic arthritis)
What symptoms, other than arthralgia, accompany gonococcal arthritis?
- Skin lesions
- Fever
- Tenosynovitis
The above generally precede joint pain in s
True or false: PID is usually found concomitant with gonococcal arthritis.
False. PID, if it is present, generally occurs before the arthritic symptoms.
The only inflammatory arthritis that affects the DIPs is _______________.
psoriatic arthritis
RA usually spares the DIPs. OA is a non-inflammatory arthritis.
Psoriatic arthritis can present with skin lesions, nail lesions, arthritis, and ________________.
dactylitis
What causes the dactylitis seen in psoriatic arthritis?
Tendon swelling
Untreated, psoriatic arthritis can progress to _____________.
bone deformity with telescoping of the digits and the “pencil in cup” sign on x-ray
There are two classes of disorders that can cause inflammatory polyarthritis: ______________.
rheumatoid arthritis and connective tissue disease (including Sjogren’s, SLE, and sclerosis)
Palpation of a joint with rheumatoid arthritis will often demonstrate a ___________ feel.
spongy
Bone erosion from rheumatoid arthritis generally starts in the ____________ area.
bare (the area where the synovium connects to the sides of the bone)
What demographics are more affected by lupus?
- Females
- Age 15 - 45
- Non-white races
What is different about the arthritis seen lupus compared to rheumatoid arthritis?
SLE arthritis does not lead to erosions in the bone.
Ankylosing spondylitis always begins before age ________.
45
In terms of ROM, osteoarthritis can cause ______________.
loss of flexion (whereas ankylosing spondylitis causes global loss of ROM)
Impingement of the C5 nerve root causes loss of what motor function, what sensory function, and what reflex?
- Shoulder abduction
- Deltoid skin area
- Biceps reflex
Impingement of the C6 nerve root causes loss of what motor function, what sensory function, and what reflex?
- Wrist extension
- Thumb and index finger skin area
- Brachioradialis reflex
Impingement of the C7 nerve root causes loss of what motor function, what sensory function, and what reflex?
- Wrist flexion and finger extension (a movement that conveniently makes your forearm look like the number 7)
- Numb middle finger
- Decreased triceps reflex
Impingement of the C8 nerve root causes loss of what motor function, what sensory function, and what reflex?
- Finger flexion
- Number ulnar side of hand and forearm
- Decreased finger jerks
Impingement of the L4 nerve root causes loss of what motor function, what sensory function, and what reflex?
- Week quadriceps and foot inversion
- Numb inner leg
- Decreased quad reflex
Impingement of the L5 nerve root causes loss of what motor function, what sensory function, and what reflex?
- Weak toe extension
- Numb dorsum of foot
- Reflexes intact
Impingement of the S1 nerve root causes loss of what motor function, what sensory function, and what reflex?
- Weak gastrocnemius
- Numb lateral foot
- Decreased Achilles reflex
There are more than 150 bursa in the body. List the most common sites for bursitis.
- Prepatellar bursa
- Olecranon bursa
- Subacromial bursa
- Trochanteric bursa
- Ischial bursa
- Pes anserine bursa
- Retrocalcaneal bursa
What maneuver is done to evaluate for bicipital tendonitis?
Speed’s test: having the patient hold their arms at roughly 30º angles from midline with their palms up and then tapping downward on their wrists
Bicipital tendonitis often presents with _____________ pain.
anterior shoulder
DeQuervain’s tendonitis presents with ______________ pain.
radial wrist
What tendons are injured in DeQuervain’s tendonitis?
Extensor brevis and abductor longus
When the Achilles tendon is inflamed, you need to evaluate the patient for ______________.
Reiter’s syndrome (reactive arthritis)
What things are needed for a diagnosis of fibromyalgia?
- Pain present for more than 3 months
- Tenderness in 11 of the 18 common sites for fibromyalgia pain
- Pain above and below the waist (it’s diffuse)
