Trigger Arthritis P2 Flashcards
highest remission rate of JIA
oligoarticular
how long do you have to have joint pain for JIA to be diagnosed
1+ joints for 6+ weeks
MC type of JIA
oligoarticular
child with asymmetrical joint pain in 4 or less joints for 6+ weeks
oligoarticular
up to 20% of children with this develope insidious asymptomatic uveitis which can lead to blindness!
oligoarticulr JIA
a leg length descrepency is commonly seen in this diagnosis
oligoarticular JIA
pink salmon rash on pressure areas present with spikes of fevers
systemic JIA
MC in males >10 in the lower extremities
enthesitis JIA
hallmark is an inflamed tendon insertion such as the tibial tubercle
Enthesitis JIA
Can also see LBP and sacroliitis int ehse kids!
what is the treatment for any JIA
Consider ALL treatments!
- NSAIDS
- MTX if that fails
- etanercept or infliximab if thats fails (TNF inhibitor)
- Local triamcinolone injectino for one or few joints.
- only use steroids in systemic/severe
- For uveitis use topical CS + dilators. if ineffective, can use MTX or cyclosporine or TNF inhibitors
what is the tx for uveitis and which diagonsis can cause uveitis
topical CS + dilators. if ineffective, can use MTX or cyclosporine or TNF inhibitors
oligoarticular JIA
A group of diseases that are negative for rheumatoid factor and all involve the axial skeleton describes… and includes which diagnoses?
seronegative spondyloarthopathies!
includes:
1. ankylosing spondylitis
2. psoriatic arthritis
3. reactive arthritis
4. arthritis associated w IBD
5. undifferentiated spondyloarthropathy
individuals with HLA-B27 who become infected w salmonella, shigella or enteric organisms are at a 20% increased risk of developing what
reactive arthritis
this is onset in late teens/early 20’s and is more common in male patients!
ankylosing spondylitis
back pain worse in the morning with associated stiffness that lasts for hours, activity makes it better!
might radiate to the butt.
ankylosing spondylitis
sympotms of this disease progress in a cephalad direction! leads to a flattened lumbar curve and a exaggerated thoracic curve
ankylosing spondylitis
What are some associated findings outside of the spine with ankylosing spondylitis
idk im worried she will ask
- acute arthritis of peripheral joints (dactylitis)
- anterior uveitis
- spondylitic heart disease (AV conduction defects w aortic regurg)
- pulmonary fibrosis
- cauda equina fibrosis
NO CONSTITUTIONAL S/S!!!!!
Xray of Spine shows sacroiliac joints w bilateral erosions and sclerosis as well as fused vertebral bodies. there seems to be inflammation where the annulus fibrosus attatches to vertebre
ankylosing spondylitis
How do you tx ankylosing spondylitis
- NSAIDS
- TNF inhibitors (etanercept, infliximab, adalimumab, golimumab)
- refer to PT ALWAYS
DO NOT use CS d/t worsening osteopenia
Nail pitting and “sausage” swelling of one or more digits suggests what underlying etiology
psoriatic arthritis (specifically enthesopathy type)
If you have elevation of ESR, negative RH, and high uric acid levels, what are you thinking?
psoriatic arthritis
high d/t active turnover of skin by psoriasis
Xray of the hand shows maginal erosions of bone and irregular desctruction of joint and bone
“sharpened pencil” sign in the phalanx
psoriatic arthritis
how do you differentiate psoriatic spondylitis and ankylosing spondylitis on XR?
psoriatic spondylitis = asymmetric sacroiliitis and syndesmophytes which are more coarse than those seen in AS
How do you treat psoriatic arthritis
- NSAIDS
- MTX if not responsive
- TNF inhibs if MTX doesnt work
CS less effective an can cause pustular psoriasis.
what 2 meds can exacerbate psoriasis?
- CS - can lead to pustular psoriasis during tapers
- antimalarials.
this diagnosis is precipitated by preceeding GI and GU infections. presents as asymmetric oligoarthritis of the LE
reactive arthritis
triad of arhritis, conjunctivitis/uveitis, and urethritis is associated with which diagnosis
reactive arthritis
A pt recently (bout a month ago) contracted an STD, he has been experiencing weight loss and fevers recently, but assumed they were just a result of his new STD diagnosis. he now is having pain and swelling in his left knee and right hip. Synovial fluid analysis of the left knee is culture negative but shows inflammatory markers… what is the likely treatment plan for this man and what does he have
reactive arthritis
tx: 1st NSAIDS, 2nd sulfasalazine or MTX, 3rd TNF inhibitors
which disease can literally present with 8 different exraarticular manifestations and what are they
def dont learn this if you dont wanna
reactive arthritis
How do you treat Arthritis associated with IBD
- tx IBD if its just peripheral arthritis
- NSAIDS (1st line for sponylitis)
- range of motion exercises, MTX, CS are all kinda on the same line after this
Risk factors include IV drug use, endocarditis, damaged or prosthetic joints, compromised immunity
septic arthritis
also loss of skin integrity but i felt like that would give it away!
MCC of septic arthritis
Staph A
MRSA and GBS also common but not as common as Staph A
What is the MC site for septic arthritis? How would this change if the pt used IV drugs?
MC = knee
“sternoclavicular and sacroiliac joint can be seen in IV drug users” but are incommon in regular people!!
synovial fluid analysis shows >100,000 leukocyte count with 90+% polymorphonuclear cells. gram stain and culture is positive for staph A!
what is likely diagnosis
septic arthritis
what is the treatment of a pt w septic arthritis?
- hospitalize!!
- empiric 3rd gen ceph. (rocephin, cefotaxime, ceftaidime) + vanc!
- adjust abx when cultures return
- URGENT ortho surg consult!!
- drainage of joint typically done w debridement via arthroscopy
when would you do OPEN surgicla drainage of a septic arthritic joint
- conservative tx fails
- concomitant osteomyelitis requiring debridement
- involved joint cnanot be drained by more conservative measures
more common in women who are pregnant or menstruating and otherwise healthy!
gonococcal arthritis
2-10 small asymptomatic necrotic pustules distributed over the extremities especially on the palms and soles
gonococcal arthritis
Urethral, thraot, cervical and rectal cultures should ALL be done in which diagnosis
gonococcal arthritis
treatment of gonococcal arthritis
- Azithromycin + 3rd gen ceph (rocephin, cefotaxime, coftizoxime)
- draining not typically requirted
what are the three diagnoses that can use etanercept
- ankylosing spondylitis
- psoriatic arthritis
- rhemoatoid arthritis
