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Sjogren syndrome and arthritis Flashcards

1
Q

Sjogren syndrome - definition

A

autoimmune disorder characterized by destruction of exocrine glands by lymphocytic infiltrates

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2
Q

Sjogren syndrome –> destruction of exocrine glands –> (especially …. glands)

A

lacrimal and salivary glands

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3
Q

Sjogren syndrome destruction of exocrine glands by

process

A

lymphocytic infiltrates

type IV hypersensitivity

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4
Q

Sjogren syndrome - age and sex

A

40-60 (female)

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5
Q

Sjogren syndrome - complications

A
  1. dental disorders
  2. mucosa-associated lymphoid tissue (MALT) lymphoma
  3. corneal damage
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6
Q

MALT lymphoma secondary to Sjogren syndrome may present as

A

a unilateral parotid enlargement

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7
Q

Sjogren syndrome - type … hypersensitivity

A

IV

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8
Q

Sjogren syndrome - clinical findings

A
  1. inflammatory joint pain
  2. xerophthalmia and subsequent corneal damage –> Keratoconjunctivitis sicca
  3. Xerostomia
  4. Bilateral parotid enlargment
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9
Q

Sjogren syndrome - primary or secondary disorder?

A

may be primary or secondary associated with other autoimmune disorder

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10
Q

example of other autoimmune disorder associated with Sjogren syndrome

A
  1. RA
  2. SLE
  3. systemic sclerosis
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11
Q

Sjogren syndrome - labs

A
  1. antinuclear antibodies (anti-ribonucleoprotein antibodies) –> SS-A (anti-Ro), SS-B (anti-La)
  2. ANA
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12
Q

etiology of osteoarthritis

A

mechanical - joint wear and tear destroys of articular cartilage

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13
Q

etiology of Rheumatoid arthritis

A

autoimmune - infl cytokines and cells induce pannus (proliferation tissue) formation –> erodes articular cartilage and bone

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14
Q

osteoarthritis is also called

A

degenerative joint disease

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15
Q

Rheumatoid arthritis - autoimmune destruction is mediated by

A

cytokines and III and IV hypersensitivity reactions

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16
Q

joint findings of osteoarthritis

A
  1. subchondral cysts
  2. sclerosis
  3. osteophytes (bone spurs)
  4. eburnations of the subchondral bone
  5. synovitis
  6. Heberden nodes (DIP)
  7. Bouchard nodes (PIP)
  8. 1st carpometacarpal (CMC)
  9. joint space narrowing
  10. synovial fluid non inflammatory (less than 2000 WBC)
    NO MCP
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17
Q

eburnations are

A

polished, ivory like appearance of the body

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18
Q

osteoarthritis of the hand - which joints

A
  • DIP (Heberden nodes)
  • PIP (Bouchard nodes)
  • 1st carpometacarpal (CMC)
    NO MCP
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19
Q

joint findings of Rheumatoid arthritis

A
  1. pannus formation in joints (MCP, PIP) - NOT DIP or 1st CMC
  2. subcutaneous rheumatoid nodules (fibrinoid necrosis) - soft tissue swelling
  3. ulnar deviation of fingers
  4. sublaxation
  5. swan neck deformity (rare)
  6. boutonniere deformity (rare)
  7. rare DIP involvement
  8. erosions
  9. joint space narrowing
  10. juxtaarticular osteopenia
  11. Synovial fluid inflammatory (WBC more than 2000)
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20
Q

swan neck deformity

A

DIP hyperflexion with PIP hyperextension

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21
Q

boutonniere deformity

A

PIP flexion with DIP hyperextension

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22
Q

predisposing factors of osteoarthritis

A
  1. age
  2. obesity
  3. joint trauma
  4. female
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23
Q

predisposing factor of Rheumatoid arthritis

A
  1. female (80% vs males)
  2. +Rheumatoid factor
  3. Anti-cyclic citrullinated peptide antibody (more specific)
  4. HLA-DR4
  5. SILICA exposure
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24
Q

Rheumatoid arthritis - HLA

A

HLA-DR4

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25
predisposing factor of Rheumatoid arthritis - more specific
Anti-cyclic citrullinated peptide antibody
26
Rheumatoid factor?
IgM against IgG antibody
27
osteoarthritis - classic presentation
pain in weight-bearing joint after use (at the end of the day), improving at rest. Asymmetric joint involvement Knee cartilage loss begins medially (Bowlegged) Non-inflammatory. No systemic symptoms
28
rheumatoid arthritis - classic presentation
Morning stiffness, pain and swelling lasting more than 30 mins and improving with use symmetric joint involvement. Systemic symptoms
29
systemic symptoms of Rheumatoid arthritis
1. fever 2. weight loss 3. lymphadenopathy
30
osteoarthritis - joints
limited number of joints (oligoarticulopathy) 1. hips 2. lower lumbar spine 3. knees 4. DIP 5. PIP
31
Heberden nodes - area
DIP
32
Bouchard nodes - area
PIP
33
Rheumatoid arthritis - joints
symmetric involvement | 1. PIP 2. MCP 3. Elbows 4. Knee 5. ankles
34
Rheumatoid arthritis can cause ..... in the Knee
Baker cyst
35
Rheumatoid arthritis - treatment
1. NSAID 2. glucocorticoids 3. disease-modifying against (methotrexate, sulfasalazine, hydroxychlorooquine, leflunamde) 4. biologics (TNF-a inhibitors)
36
osteoarthritis - treatment
1. acetaminophen 2. NSAID | 3. intra-articular glucorticoids
37
Rheumatoid arthritis vs osteoarthritis - according to joint involvement distribution
RA --> symmetrical | Osteoarthritis --> asymmetrical
38
Rheumatoid arthritis vs osteoarthritis - MCP
RA
39
Rheumatoid arthritis vs osteoarthritis - DIP
osteoarthritis (Heberden) | rare in RA
40
Rheumatoid arthritis - x-rays
joint-space narrowing loss of cartilage | osteopenia
41
Rheumatoid arthritis vs osteoarthritis - increased synovial fluid / wbc?
RA --> increased fluid | WBC --> less than 2000 in osteoarthritis, more in RA
42
causes of septic arthritis
1. Neisseria gonorrhoea (MCC) 2. S. aureus (2nd MCC) 3. Streptococcus
43
infectious arthritis - which joints
classically involves a single joint, usually the knee
44
infectious arthritis - presentation (clinical and labs)
1. warm,red, painful joint with limited range of motion fever 2. increased WBC and elevated ESR 3. Synovial fluid purulent (more than 50000 WBCs)
45
Gonococcal arthritis is an STD that presents as a
STI either purulent arthritis (eg. knee) or triad of polyarthralgias, tenosynovitis (hand) ,dermatitis (pustules)
46
Serenegative spondyloarthropathies - types
1. Psoriatic arthritis 2. Ankylosing spondylitis 3. Inflammatory bowel disease 4. Reactive arthritis
47
Serenegative spondyloarthropathies - characteristics
1. rheumatoid factor (-) 2. HLA-B27 strong association 3. Subtypes share variable occurrence of inflammatory back pain (morning stiffness, improves with exercise), peripheral arthrites, enthesitis (inflamed insertion sites of tendons eg. Achilles), dactylitis (sausage fingers), uveitis
48
Psoriatic arthritis - clinical presentation
- joint pain and stiffness associated with skin psoriasis and nail lesions - Asymmetric and patchy involvement - Dactylitis (sausage fingers)
49
Psoriatic arthritis - joints
axial and peripheral (DIP of hands and feet are MC)
50
Psoriatic arthritis and psoriasis - relation
Psoriatic arthritis seen in fewer than 1/3 of patients with psoriasis
51
Psoriatic arthritis - x ray
pensil in cup defority of DIP
52
Reactive arthritis is also called
Reiter syndrome
53
Reactive arthritis (Reiter syndrome) - clinical presentation
Classic triad 1. Conjunctivitis and anterior uveitis 2. Urethritis 3. Arthritis
54
causes of Reactive arthritis (Reiter syndrome)
weeks after GI infection (Shigella, Salmonella, Yersinia, Campylobacter) or chlamydia infection
55
Ankylosing spondylitis - sex
male
56
Ankylosing spondilitis causes (clinically) (and involves ...)
1. Symmetric involvement of spine and sacroiliac joints --> ankylosis (jonint fusion) and bamboo spine (vertebral fusion) 2. uveitis 3. aortic regurgitation
57
Ankylosing spondilitis - ankylosis
stiff spine due to fusion of joints
58
Ankylosing spondilitis - bamboo spine
vertebra fusion
59
gout is more common in (sex)
males
60
gout is an (definition)
acute inflammatory monoarthritis caused by precipitation of monosodium urate crystals in joints
61
gout is an .... caused by ....
acute inflammatory monoarthritis | precipitation of monosodium urate crystals in joints
62
gout is associated with
hyperuricemia
63
hyperuricemia can be caused by (name the mechanism and the proportions)
1. underexcretion of uric acid (90%) | 2. Overproduction of uric acid (10%)
64
hyperuricemia - causes of underexcretion of uric acid
1. idiopathic (largely) 2. medications (eg. thiazide diuretics, pyrazinamide) 3. Renal insufficiency
65
hyperuricemia - causes of overproduction of uric acid
1. Lesch-Nuchan syndrome 2. PRPP excess 3. increased cells turnover (eg. tumor lysis syndrome) 4. von Gierke syndrome
66
von Gierke syndrome - deficiency of
Glucose-6-phosphatase
67
Gout - crystals?
monosodium urate crystals
68
monosodium urate crystals - characteristics
1. needle shaped 2. (-) birefringent under polarized light 3. blue under perpendicular light 4. yellow under paraller light
69
gout - presentation of the joint
1. swollen 2. red 3. painful 4. Asymmetric joint distribution
70
gout - clinical presentation and classic manifestations
asymmetric joint distribution swollen, red, painful joint painful MTP joint of big toe (podagra) Tophus formation
71
Tophus formation - area
1. external ear 2. olecranon bursa (elbow) 3. Achilles tendon
72
tophi?
white, chalky aggregates of uric acid crystals
73
Acute gout attack tends to occur ...
after meal and alcohol consumption
74
meal can cause acute gout - mechanism
increased DNA/RNA
75
alcohol consumption can cause acute gout - mechanism
alcohol metabolites compete the same exertion sites in kidney as uric acid --> decreased uric acid secretion
76
gout treatment
acute --> 1. NSAID (eg. indomethacin) 2. colchicine 3. glucoroticoids Chronic (preventive) --> xanthine oxidase inhibitors
77
treatment of acute gout
1. NSAID (eg. indomethacin) 2. colchicine 3. glucoroticoids
78
treatment of chronic gout (prevention)
xanthine oxidase inhibitors: 1. allopurinol 2. febuxostat
79
pseudogout present with
pain and effusion with acute infalmmation (pseudogout) and/or chronic degeneration (pseudo-osteoarthritis) classically affects the knee
80
pseudogout is caused by
deposition of calcium pyrophosphate crystals within the joint space
81
x ray of pseudogout
chondrocalcinosis --> cartilage calcification
82
pseudogout - which joints
usually affects large joints (classically the knee)
83
pseudogout classically affects the (joint)
knee
84
pseudogout - sex and age
older than 50 | both sexes affected equally
85
diseases associated with pseudogout
Usually idiopathic 1. hemochromatosis 2. hyperparathyroidsm 3. Joint trauma
86
pseudogout - crystal characteristics
1. basophilic, rhomboid crystals 2. weakly birefringent under polarized light 3. blue under paraller light
87
pseudogout vs gout according crystals shape
pseudogout --> rhomboid | gout --> needle shape
88
pseudogout vs gout according crystals under polarized light
gout --> (-) birefringent | pseudogout --> weakly birefringent
89
pseudogout vs gout according crystals under paraller light
pseudogout --> bleu | gout --> yellow
90
seronegative spondyloarthropathies - inflammatory bowel disease ?
Crohn disease and ulcerative colitis are often accompanied by spondyloarthritis
91
seronegative spondyloarthropathies are more common in
MALES
92
infectious arthritis is AKA
septic arthritis
93
pseudogout treatment
acute --> 1. NSAID (eg. indomethacin) 2. colchicine 3. glucoroticoids Prophylaxis --> colchicine
94
Extraarticular manifestations of RA include
1. rheumatoid nodules (Fibrinoid necrosis with palisading histiocytes) in subcutaneous tissue and lung (+pneumonoconiosis --> Caplan syndrome) 2. intestinal lung disease 3. Pleuritis 4. pericarditis 5. anemia of chronic disease 6. AA amyloidosis 7. Sjogren syndrome 8. Carpal tunnel syndrome 9. Felty syndrome (neutropenia + splenomegaly)
95
HLA subtypes are associated with (all types and diseases)
HLA-A3 --> hemochromotosis HLA-B8 --> Addison disease, myasthenia gravis HLA-B27 --> seronegative arthritis HLA-DQ2/DQ8 --> celiac disease HLA-DR2 --> Multiple sclerosis, Hay fever, SLE, Goodpasture syndrome HLA-DR3 --> DM1, SLE, Graves disease, Hashimoto thyroditis, Addisson HLA-DR4 --> RA, DM1, Addison disease HLA-DR5 --> Pernicious anemia, Hashimoto
96
Felty syndrome
1. RA 2. neutropenia 3. splenomegaly

Musculoskeletal and Connective Tissue (19 decks)

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