Rheumatology_UW Flashcards
What is pseudogout?
Form of acute arthritis induced by the release of calcium pyrophosphate dehydrate (CPPD) crystals from sites of chondrocalcinosis (calcification of articular cartilage) into joint space
How is pseudogout diagnosed?
Presence of rhomboid shaped, positively birefringent crystals on joint aspiration microscopy and radiographic evidence of chondrocalcinosis
How is pseudogout different from gout?
Gout = needle-shaped, negative birefringent crystals
Presentation of pseudogout?
Occurs in setting of recent surgery/medical illness and trauma. Acute pain, swelling, limited motion of involved joints (knee most common)
Hyperparathyroidism predisoposes to development what arthropathy?
Pseudogout. Hyperparathyoridism shows elevated calcium, depressed phosphorus levels.
Lumbar spinal stenosis is commonly caused by?
Degenerative joint disease in the spine
In lumbar spinal stenosis what alleviates/worsens pain?
Worsens when standing/walking downhill (due to extension of spine). Improves when sitting/walking uphill (due to flexion of spine)
How is lumbar spinal stenosis diagnosis confirmed?
MRI
What is polymyositis?
Slowly progrssive, inflammatory muscle disease that causes painless proximal muscle weakness (painless important)
What is the best diagnostic study for polymyositis?
Muscle biopsy. It shows mononuclear infiltrate around necrotic, regenerating muscle fibers.
Patients with RA are at increased risk for developing?
Osteopenia, osteoporosis and bone fractures espeically if other risk factors are present (postmenopausal state, smoking, osteporosis fam his, low body weight, xs alcohol intake)
What is the management of RA patients to reduce osteoporosis
Optimal Calcium and vit D intake, minimal steroids intake, increased physical activity and consideration of bisphophonate therapy
What are the common causes of avascular necrosis of the femoral head?
Chronic steroid use, alcoholism, hemoglobinopathies
What is the common presentation of avascular necrosis of the femoral head?
Progressive hip or groin pain without restriction of motion and normal radiograph of early stages.
What is the gold standard for diagnosis for avascular necrosis of the femoral head?
MRI
What population does fibromylagia present in? How does it present?
Young to middle-aged women. Presents with chronic fatigue, widespread pain and cognitive/mood disturbances. Clinical diagnosis.
How is diagnosis of fibromyalgia made?
Using widespread pain index and symptom severity score, which emphasize cognitive problems, fatigue and severity of somatic symptoms.
How does acute gout present
Acute monoarthritis affecting metatarsophalangeal joint or knees.
What does synovial fluid analysis show for acute gout?
Leukocytosis (50% neutrophils) and monosodium urate cyrstals that are negatively birefringent under polarizing microscopy.
What is the treatment for acute gout?
Drugs, Colchine, corticosteroids
Microscope with polarizer oriented North-south shows yellow needle-like cyrstals when parallel to polarizing axis and blue needelike cyrstals when perpendicular to polarizing axis: negatively or positively birefringent?
Negatively.
What are typical extra-pulmonary manifestations of sarcoidosis?
Anterior uveitis (red eye with leuckocytes in the anterior chamber), erythema nodosum in skin, arthitis in joints.
What are the classic lung findings on x-ray for sarcoidosis?
Bilateral hilar adenopathy and reticular opacities
“popping” sensation in the knee commonly occurs in what injury?
ACL injury
Injury of mechanism for ACL?
Rapid directional changes, pivoting on lower extremity with foot planted
What moves are highly sensitive for ACL injury?
Lachman test and anterior drawer sign. Laxity of tibia relative to the femur. Abilty to pull tibia forward easily.
Hemarthrosis usually occurs in ACL or MCL injuries?
ACL
Osteoarthritis aka degenerative joint disease presents in what age group and how?
Over 40. Indolesnt progressive anterior hip pain. Worsened by activity. Relieved by rest. Morning stiffness may occur but if it does, less thn 60 mninutes. Hip is not tener and systemic sx are absent.
Osteitis deformans is aka?
Paget’s disease of bone
What is the most common cause of asymptomatic elevation of alkaline phosphatase in an elderly patient?
Paget’s disease of bone
How is Paget’s disease of bone accidentally diagnosed in an elderly patient?
Elevation of alkaline phosphatase
What is Behcet’s syndrome?
Muti-systemic inflammatory condition
What is the criteria for diagnosis for Behcet’s sydnrome?
Recurrent oral ulcers plus two of the following - recurrent genital ulcers; eye lesions (including anterior and posterior uveitis); retinal vascularization; skin lesions including erythema nodosum, acneiform nodules and papulopustular lesions; and a positive pathery test.
Behcet’s syndrome is most commonly seen in what populations?
Turkish, Asian and Middle Eastern.
What antibodies are most likely present in a patient with systemic sclerosis?
Anti-topoisomerase I and anti-nuclear antibodies
What is systemic sclerosis?
Form of scleroderma with widespread organ involvement
Ankylosing spondylitis most often occurs in patients what age/sex?
20-30s. Mostly male. Ratio is 2-3:1 male:female
What are the sx of ankylosing spondylitis?
Limited spine mobility, progressive back pain of greater than 3 months of duration. Pain and stiffnesss worse in the morning and improves with exercises.
What finding on film is diagnostic of ankylosing spondylitis?
bilateral sacroiliitis
What is the most prominent extraarticular manifestation of ankylosing spondylitis?
Anterior uveitis (25-40% of patients) presents with monocular pain, blurring, photophobia
Nature of the pain from bone metastases?
Progressive pain that is constant and wakes the patient at night.
What is charcot joint?
AKA neurogenic arthropathy is a complication of neuropathy and repeated joint trauma.
Neurogenic arthropathy affects which joints and how does it manifest?
Weight-bearing joints and manifests with functional limitation, deformity and degenerative joint disease and loose bodies on joint imaging.
What is more common (>15% of adult patients) in dermatomyositis patients compared to the general population?
Internal malignangies. Age appropriate cancer screening is essential in these patients.
Dermatomyositis is characterized by?
Cutaneous findings (heliotrope rash and gottron’s papules) and symmetric proximal muscle weakness.
What is used for prevention vs. acute attacks of gout?
Prevention: Allopurinol (xanthine oxidase inhibitor) decreases uric acid production and probenecid (uricosuric drug => increases urinary excretion of uric acid). Treatment: Colchicine, NSAIDs and steroids.
Subacromial bursitis is the result of what kind of motion?
Repetitive overhead motions. Patients complain of patin with active range of motion of the shoulder, and passive internal rotation and forward flexion also elicits tenderness
What are the sx of PMR?
Age>50, bilateral pain and morning stiffness that lasts more than 1 hour, involvement of 2 of the following: 1) shoulders 2) hip/proximal thigh 3) neck or torso 4) constitutional sx (malaise, fever, weight loss)
What are the lab findings for PMR?
Elevated ESR (>40mm/h, sometimes >100mm/h), elevated CRP, normocytic anemia possible
What is the treatment of choice for uncomplicated PMR?
Low-dose steroids prednisone which provides rapid relief
PMR is frequently associated with?
Giant cell arteritis aka temporal arteritis. It is treated with high dose prednisone.
Gouty arthritis may present similarly to?
Septic arthritis and pseudogout
What is critical to achieving diagnosis of gout?
Synovial fluid analysis
American College of Rheumatology suggets using what for diagnosis?
Widespread pain index and symptom severity scale
Which medications are reserved for patients failing initial PMR measures of exercise and good sleep hygiene?
Tricyclic anti-depressants
Patients with suspected giant cell arteritis should immediately receive?
High dose IV systemic glucocorticoids to reduce progression of visual complications
What is the most specific sx of giant cell arteritis?
Jaw claudication
What is secondary amyloidosis and how does it present?
Complication of a chronic inflammatory condition (for example, IBD, RA, chronic infections) resulting in extracellular tissue deposition of fibrils into tissues and organs. Presents with multi-organ dysfunction.
What is the treatment for secondary amyloidosis?
Treatment of underlying disease.
What is Raynaud’s phenomenon?
Abnormal vasoconstriction of digital areteries in response to cold or emotional distress
Patients with suspected secondary Raynaud’s phenomenon should be tested for?
Autoantibodies and inflammatory markers
What is the main differences in clinical presentation and lab findings between primary and secondary Raynaud’s phenomenon?
Primary: usually women 40, symptoms of underlying disease, tissue injuryor digital ulcers, abnormal nail fold capillary exam
What is the treatment for primary and secondary Raynaud’s
Primary: avoid triggers and calcium channel blockers (like nifedipine, amlodipines )for persistent symptons. Secondary: treat underlying. CCB and aspirinfor sx and risk for digital ulceration, respectively
What is the most modifiable risk factor for osteoarthritis?
Obesity (and therefore weight loss). Pharmacologic therapy and exercise play integral roles in osteoarthritis therapy
Narrowed joint space, osteophytes and subchondral sclerosis or cysts in plain films is indicative of?
Osteoarthritis
What is a good drug choice for SLE with skin and joint involvement?
Hydroxychloroquine
What is the most serious side effect of hydroxychloroquine?
Retinopathy and corneal damage. Eye exams every 6 months is the only routine screening required with this drug use.
Synovial fluid analysis of osteoarthritis shows?
Fewer than 2000 WBC/ml, no organisms and no crystals