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MSK > Seropositive arthropathies > Flashcards

Seropositive arthropathies Flashcards

1
Q

What are the 4 types of seropositive arthropathies?

A
  1. RA
  2. SLE
  3. Scleroderma
  4. Dematomyositis
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2
Q

Hx of RA

A

Symmetrical
polyarthritis (small
joint involvement)
AM stiffness (>1 h)

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3
Q

Hx of SLE

A 
Multisystemic disease: rash,
photosensitivity, Raynaud’s,
alopecia, cardiac and
pulmonary serositis, CNS
symptoms, glomerulonephritis
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4
Q

Hx of scleroderma

A 
Skin tightness, stiffness
of fingers, Raynaud’s,
heartburn, dysphagia,
pulmonary hypertension,
renal dysfunction,
dyspnea on exertion
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5
Q

Hx of dermatomyositis

A 
Heliotrope rash
(periorbital), Gottron’s
papules (violaceous
papules over knuckles and
IP joints) ± poikiloderma
Shawl sign macular
erythema over chest and
shoulder
Proximal muscle
weakness ± pain
Dyspnea on exertion
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6
Q

What is dermatomyositis?

A

Dermatomyositis (DM) is a connective-tissue disease related to polymyositis (PM) that is characterized by inflammation of the muscles and the skin.

It may also affect the joints, the esophagus, the lungs, and the heart.

Rare

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7
Q

RA O/E

A 
Effused joints (c.f. Lupus)
Tenosynovitis
Nodules
Joint deformities
Bone-on-bone crepitus
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8
Q

SLE O/E

A

Confirm historical findings
(rash, serositis, renal, CVS, etc.)
± effused (typically small)
joints (can be minimal, look for soft tissue swelling c.f. RA)

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9
Q

Scleroderma O/E

A 
Skin tightness on dorsum
of hand, facial skin
tightening, telangiectasia,
calcinosis, non-effused
joint, inspiratory crackles
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10
Q

Dermatomyositis O/E

A

Rash, proximal muscle
weakness, inspiratory
crackles

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11
Q

Which seropositive arthropathies have reduced WBC?

A

RA & Lupus

Scleroderma & dermatomyositis both have normal WBC

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12
Q

Specific serology of RA

A 
Rheumatoid factor (80%)
Anti-CCP (80%)
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13
Q

Specific serology of lupus

A 
ANA +ve in 98%
Anti-dsDNA +ve in 50-70%
Anti-SM +ve in 30%
reduced C3, C4, total
hemolytic complement
False positive VDRL (in lupus
subtypes)
high PTT (in lupus subtypes;
e.g. anti-phospholipid Ab)
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14
Q

Synovial fluid of seropositive arthropathies

A
  • RA: inflammation. leukocytosis (>10,000)
  • Lupus: mild inflammation with +ve ANA
  • Scleroderma & dermatomyositis: not specific
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15
Q

Radiographic features of RA

A
  • Periarticular osteopenia
  • Joint space narrowing
  • Erosions (c.f. lupus)
  • Absence of bone repair
  • Symmetric/concentric
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16
Q

Radiographic features of lupus

A

Non-erosive
± osteopenia
± soft tissue swelling

17
Q

Define RA

A
  • chronic, symmetric, erosive synovitis of peripheral joints (i.e. wrists, MCPs, MTPs)
  • characterized by a number of extra-articular features
18
Q

What is RA an independent risk factor for?

A

Atherosclerosis & CV disease

RA is associated with increased overall mortality/morbidity from all causes:
CV disease, neoplasm (especially lymphoma), infection.

19
Q

Common Px of RA

A
  • Morning stiffness >1 h, improves with use
  • Symmetric joint involvement
  • Initially involves small joints of hands and feet
  • Constitutional symptoms
20
Q

What does the 1987 American Rheumatism association RA criteria consist of?

A 
RA is at least 4 of:
• Morning stiffness >1 h for >6 wk
• Arthritis ≥3 joints for >6 wk
• Arthritis of hand joints for >6 wk
• Symmetric arthritis for >6 wk
• Rheumatoid nodules
• Serum RF positive
• Radiographic changes (erosions or periarticular osteopenia)

Criteria are 91-94% sensitive and 89% specific for RA.

21
Q

What is the hallmark of RA?

A

hypertrophy of the synovial membrane

activated rheumatoid synovium (pannus) grows into and over the articular surface;
inflammatory mediators lead to release of metalloproteinases and collagenases resulting in
destruction of articular cartilage and subchondral bone

22
Q

Who gets RA?

A
  • prevalence 1% of adult population
  • F:M = 3:1
  • age of onset 20-40 yr
  • genetic predisposition: HLA-DR4/DR1 association (93% of patients have either HLA type)
23
Q

Joint deformities of RA

A
  • ŠŠswan neck deformity, -boutonnière deformity
  • ŠŠulnar deviation of MCP, radial deviation of wrist joint
  • ŠŠhammer toe, mallet toe, claw toe
  • ŠŠflexion contractures
24
Q

What is a common syndrome in RA?

A

Sjögren’s syndrome:
keratoconjunctivitis sicca and
xerostomia (dry eyes and mouth)

25
Q

Rx of RA

A
  1. DMARDs:
    - standard of care and should be started as soon as possible
    - methotrexate
    - delayed onset of action (8-12wk)
  2. Biologics:
    - indicated if inadequate response to DMARDs
    - abatacept, rituximab, tocilizumab
    - reassess every 3-6 mo and monitor disease severity
  3. NSAIDs
  4. Corticosteroids
    - local: intraarticular injections
    - systemic: low dose (5-10 mg/d) useful for short term to improve symptoms if NSAIDs
    ineffective, to bridge gap until DMARD takes effect

Surgery available for synovectomy, joint replacement, joint fusion, reconstruction/tendon
repair

26
Q

Poor prognostic features of RA

A

young age of onset, high RF titer, elevated ESR, activity of >20 joints, and presence of EAF.

27
Q

Side effects of steroids

A
  • Weight gain
  • Osteoporosis
  • Avascular necrosis (AVN)
  • Cataracts, glaucoma
  • Peptic ulcer disease (PUD)
  • Susceptibility to infection
  • Easy bruising
  • Acne
  • Hypertension
  • Hyperlipidemia
  • Hypokalemia, hyperglycemia
  • Mood swings

MSK (8 decks)

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