Wed - Arthridities Flashcards
Clinical presentation of osteoarthritis
Where
loss of what
xray shows what
Affects: feet, knees, hips, spine, hands,
Progressive loss or articular cartilage
Gradual onset, intermittent and self-limited (use related pain)
Morning stiffness (<30 min)
Exam:
Localized pain, crepitus, joints feel bony upon palpation.
X-ray: sclerosis (new bone formation), osteophytes (spurs)
Joint space narrowing
NONINFLAMMATORY
inflammatory
vs
noninflammatory arthritis
Non - osteoarthritis
inflam - pretty much everything else
Clinical presentation of Rheumatoid arthritis
Women:men Risk factors Stiffness: when and how long? how many joints? advanced cases: what is seen in hands? labs?
Prevalence: 1% of adults, 5% of women ago 70. ^in native americans
Women:men = 2-3:1
30-50% In identical twins
Risk factors: smoking, peridontal disease
Morning stiffness (>1 hour)
swelling in >3 joints
swelling in ankles, knees, shoulders, elbows, wrists, hand
symmetric
Can cause rips in extensor tendons
Systemic, inflammatory.
Exam: painful, red, squishy joints ulnar deviation of proximal interphalanges in severe cases Pos anti CCP antibody Pos Rheumatoid factor (duh) ^CRP and ESR
5 extra articular manifestations of Rheumatoid arthritis
Subcutaneous nodules pulmonary nodules pericarditis inflammatory eye (spiscleritis, scleritis vasculitis
clinical manifestations that help diagnose systemic lupus
labs gender ratio type of rash EENT joints/digits genetics
Antinuclear antibodies (ANA) are present in 95% of patients Female:male 9:1 Butterfly rash photosensitivity oral ulcers arthritis reynauds (cold, light digets)
Strong familial aggregation
25-50% monozygotic twins
Juvenile idiopathic arthritis
gender ratio
chronic synovial inflammation
Girls > boys
Clinical pearls regarding gout Serum uric acid during an attack? hyperuricemia frequently following \_\_\_\_\_ what is not the initial treatment, but the long term? goal for UA levels?
- *Can have normal serum uric acid at time of gouty attack
- *hyperuricemia frequently results from diuretic therapy
- *Allopurinol NOT approptiate initial treatment
- *goal: keep uric acid level <6
clinical feature of ankylosing spondylitis What is it onset? what decreases pain gender ratio advanced form can cause
(inflammatory back pain) onset before age 40 pain decrease with exercise m>f can cause kyphosis, fusion of edge of bone irregular sacroilliac joints
clinical features of spondyloarthropaties
Lab tests show?
Digits show?
inflammatory of spine parts, i.e. sacroiliitis, peripheral joints, periarticular structures
seronegative (no CCP antibody)
sausage digits
pseudogout general Crystals made of? most common joint? x-ray shows? Complications with kidneys?
Calcium pyrophosphate dihydrate crystals (CPPD)
Knees most common
X-ray shows CHONDROCALCINOSIS* (calcium deposits in joint space)
M=F
no marker, no tophi
crystals rhomboid shaped
No renal complication
When gout involves the big toe, it is called:
podagra
Diagnosing gout
Gold standard: synovial fluid analysis
Serum uric acid levels (try to keep <6)
Triggers of gout
Alcohol trauma severe illness IV hydration medication high purine foods contrast dye
Tophi
solid uric acid deposits that occur in advanced gout (not generally painful)
usually:
helix of ear
periarticular regions
3 types of elbow bursitises (clinical findings relate to what disease?)
soft, but feels like it has material in it
just liquid
harder bursa
soft, but feels like it has material in it - gout
just liquid - septic joint
harder bursa - Rheumatoid arthritis
