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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
Q

predisposing factor of Rheumatoid arthritis - more specific

A

Anti-cyclic citrullinated peptide antibody

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26
Q

Rheumatoid factor?

A

IgM against IgG antibody

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27
Q

osteoarthritis - classic presentation

A

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

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28
Q

rheumatoid arthritis - classic presentation

A

Morning stiffness, pain and swelling lasting more than 30 mins and improving with use
symmetric joint involvement. Systemic symptoms

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29
Q

systemic symptoms of Rheumatoid arthritis

A
  1. fever
  2. weight loss
  3. lymphadenopathy
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30
Q

osteoarthritis - joints

A

limited number of joints (oligoarticulopathy)

  1. hips
  2. lower lumbar spine
  3. knees
  4. DIP
  5. PIP
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31
Q

Heberden nodes - area

A

DIP

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32
Q

Bouchard nodes - area

A

PIP

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33
Q

Rheumatoid arthritis - joints

A

symmetric involvement

1. PIP 2. MCP 3. Elbows 4. Knee 5. ankles

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34
Q

Rheumatoid arthritis can cause ….. in the Knee

A

Baker cyst

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35
Q

Rheumatoid arthritis - treatment

A
  1. NSAID 2. glucocorticoids
  2. disease-modifying against (methotrexate, sulfasalazine, hydroxychlorooquine, leflunamde)
  3. biologics (TNF-a inhibitors)
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36
Q

osteoarthritis - treatment

A
  1. acetaminophen 2. NSAID

3. intra-articular glucorticoids

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37
Q

Rheumatoid arthritis vs osteoarthritis - according to joint involvement distribution

A

RA –> symmetrical

Osteoarthritis –> asymmetrical

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38
Q

Rheumatoid arthritis vs osteoarthritis - MCP

A

RA

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39
Q

Rheumatoid arthritis vs osteoarthritis - DIP

A

osteoarthritis (Heberden)

rare in RA

40
Q

Rheumatoid arthritis - x-rays

A

joint-space narrowing loss of cartilage

osteopenia

41
Q

Rheumatoid arthritis vs osteoarthritis - increased synovial fluid / wbc?

A

RA –> increased fluid

WBC –> less than 2000 in osteoarthritis, more in RA

42
Q

causes of septic arthritis

A
  1. Neisseria gonorrhoea (MCC)
  2. S. aureus (2nd MCC)
  3. Streptococcus
43
Q

infectious arthritis - which joints

A

classically involves a single joint, usually the knee

44
Q

infectious arthritis - presentation (clinical and labs)

A
  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
Q

Gonococcal arthritis is an STD that presents as a

A

STI either purulent arthritis (eg. knee) or triad of polyarthralgias, tenosynovitis (hand) ,dermatitis (pustules)

46
Q

Serenegative spondyloarthropathies - types

A
  1. Psoriatic arthritis
  2. Ankylosing spondylitis
  3. Inflammatory bowel disease
  4. Reactive arthritis
47
Q

Serenegative spondyloarthropathies - characteristics

A
  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
Q

Psoriatic arthritis - clinical presentation

A
  • joint pain and stiffness associated with skin psoriasis and nail lesions
  • Asymmetric and patchy involvement
  • Dactylitis (sausage fingers)
49
Q

Psoriatic arthritis - joints

A

axial and peripheral (DIP of hands and feet are MC)

50
Q

Psoriatic arthritis and psoriasis - relation

A

Psoriatic arthritis seen in fewer than 1/3 of patients with psoriasis

51
Q

Psoriatic arthritis - x ray

A

pensil in cup defority of DIP

52
Q

Reactive arthritis is also called

A

Reiter syndrome

53
Q

Reactive arthritis (Reiter syndrome) - clinical presentation

A

Classic triad

  1. Conjunctivitis and anterior uveitis
  2. Urethritis
  3. Arthritis
54
Q

causes of Reactive arthritis (Reiter syndrome)

A

weeks after GI infection (Shigella, Salmonella, Yersinia, Campylobacter) or chlamydia infection

55
Q

Ankylosing spondylitis - sex

56
Q

Ankylosing spondilitis causes (clinically) (and involves …)

A
  1. Symmetric involvement of spine and sacroiliac joints –> ankylosis (jonint fusion) and bamboo spine (vertebral fusion)
  2. uveitis
  3. aortic regurgitation
57
Q

Ankylosing spondilitis - ankylosis

A

stiff spine due to fusion of joints

58
Q

Ankylosing spondilitis - bamboo spine

A

vertebra fusion

59
Q

gout is more common in (sex)

60
Q

gout is an (definition)

A

acute inflammatory monoarthritis caused by precipitation of monosodium urate crystals in joints

61
Q

gout is an …. caused by ….

A

acute inflammatory monoarthritis

precipitation of monosodium urate crystals in joints

62
Q

gout is associated with

A

hyperuricemia

63
Q

hyperuricemia can be caused by (name the mechanism and the proportions)

A
  1. underexcretion of uric acid (90%)

2. Overproduction of uric acid (10%)

64
Q

hyperuricemia - causes of underexcretion of uric acid

A
  1. idiopathic (largely)
  2. medications (eg. thiazide diuretics, pyrazinamide)
  3. Renal insufficiency
65
Q

hyperuricemia - causes of overproduction of uric acid

A
  1. Lesch-Nuchan syndrome
  2. PRPP excess
  3. increased cells turnover (eg. tumor lysis syndrome)
  4. von Gierke syndrome
66
Q

von Gierke syndrome - deficiency of

A

Glucose-6-phosphatase

67
Q

Gout - crystals?

A

monosodium urate crystals

68
Q

monosodium urate crystals - characteristics

A
  1. needle shaped
  2. (-) birefringent under polarized light
  3. blue under perpendicular light
  4. yellow under paraller light
69
Q

gout - presentation of the joint

A
  1. swollen
  2. red
  3. painful
  4. Asymmetric joint distribution
70
Q

gout - clinical presentation and classic manifestations

A

asymmetric joint distribution
swollen, red, painful joint
painful MTP joint of big toe (podagra)
Tophus formation

71
Q

Tophus formation - area

A
  1. external ear
  2. olecranon bursa (elbow)
  3. Achilles tendon
72
Q

tophi?

A

white, chalky aggregates of uric acid crystals

73
Q

Acute gout attack tends to occur …

A

after meal and alcohol consumption

74
Q

meal can cause acute gout - mechanism

A

increased DNA/RNA

75
Q

alcohol consumption can cause acute gout - mechanism

A

alcohol metabolites compete the same exertion sites in kidney as uric acid –> decreased uric acid secretion

76
Q

gout treatment

A

acute –> 1. NSAID (eg. indomethacin) 2. colchicine 3. glucoroticoids
Chronic (preventive) –> xanthine oxidase inhibitors

77
Q

treatment of acute gout

A
  1. NSAID (eg. indomethacin) 2. colchicine 3. glucoroticoids
78
Q

treatment of chronic gout (prevention)

A

xanthine oxidase inhibitors:

  1. allopurinol
  2. febuxostat
79
Q

pseudogout present with

A

pain and effusion with acute infalmmation (pseudogout) and/or chronic degeneration (pseudo-osteoarthritis)
classically affects the knee

80
Q

pseudogout is caused by

A

deposition of calcium pyrophosphate crystals within the joint space

81
Q

x ray of pseudogout

A

chondrocalcinosis –> cartilage calcification

82
Q

pseudogout - which joints

A

usually affects large joints (classically the knee)

83
Q

pseudogout classically affects the (joint)

84
Q

pseudogout - sex and age

A

older than 50

both sexes affected equally

85
Q

diseases associated with pseudogout

A

Usually idiopathic

  1. hemochromatosis
  2. hyperparathyroidsm
  3. Joint trauma
86
Q

pseudogout - crystal characteristics

A
  1. basophilic, rhomboid crystals
  2. weakly birefringent under polarized light
  3. blue under paraller light
87
Q

pseudogout vs gout according crystals shape

A

pseudogout –> rhomboid

gout –> needle shape

88
Q

pseudogout vs gout according crystals under polarized light

A

gout –> (-) birefringent

pseudogout –> weakly birefringent

89
Q

pseudogout vs gout according crystals under paraller light

A

pseudogout –> bleu

gout –> yellow

90
Q

seronegative spondyloarthropathies - inflammatory bowel disease ?

A

Crohn disease and ulcerative colitis are often accompanied by spondyloarthritis

91
Q

seronegative spondyloarthropathies are more common in

92
Q

infectious arthritis is AKA

A

septic arthritis

93
Q

pseudogout treatment

A

acute –> 1. NSAID (eg. indomethacin) 2. colchicine 3. glucoroticoids
Prophylaxis –> colchicine

94
Q

Extraarticular manifestations of RA include

A
  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
Q

HLA subtypes are associated with (all types and diseases)

A

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
Q

Felty syndrome

A
  1. RA
  2. neutropenia
  3. splenomegaly

Musculoskeletal and Connective Tissue (19 decks)

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