Week 2- Rheumatological Flashcards
types arthritis
degenerative
autoimmune
infectious
metabolic disturbances [depositional]
monoarticular, oligoarticular, or polyarticular
monoarticular= affecting 1 joint, oligoarticular= 4 joints or less
polyarticular= 5+ joints
degenerative arthritis
osteoarthritis
primary joint affected by OA
primary cystic arthrosis of the hip
seronegative spondyloarthritides (4)
- ankylosing spondylitis
- enteropathic arthritis(occurs with IBD)
- psoriatic arthritis
4. reactive arthritis [Reiter syndrome]
depositional types arthritis
- amyloid arthropathy
- calcium pyrophosphate dihydrate deposition disease [CPPD] (PSEUDO GOUT)
- gout
- hemophilic arthropathy
- hydroxyapatite crystal deposition disease [HADD]
calcium pyrophosphate dihydrate deposition disease
-pseudo gout
what Todd had
-A condition in which calcium crystals deposit in the joints, potentially causing pain
is RA triggered by genes or enviroment
both
-HLA-DRB1 gene binds exogenous antigens
-infection can trigger
labs associated with RA
-Rheumatoid factor
-activation of MMP-1 [matrix metalloproteinase; degrades cartilage]
pannus
RA
-a well-vascularized mass of granulation tissue termed
where is RA found
found from synovial membrane to cartilage to subchondral bone
Bouchard’s nodes
in RA inflammation of PIP
B= closer to body
B= Bouchards nodes
Heberden’s nodes
DIP = Heberden’s nodes
h= higher=heberdens nodes
radiographic features of RA
periarticular osteopenia marginal erosions
joint-space narrowing
joint destruction with deformities subluxation/dislocation
bony ankylosis
RA sxs aside joints
fatigue, weakness, anorexia, weight loss, and low- grade fever
anemia, vasculitis
rheumatic nodules
retinal and cardiac involvement
rheumatoid nodules are usually seen in pressure areas:
elbows, occiput, lumbosacral
EULAR criteria for RA
- joints affected (more joints=more points)
- labs (RF or ACPA)
- Acute phase reactants (elevated erythrocyte or CRP)
- Duration (sxs 6+ weeks)
most common type lupus (70%)
Systemic Lupus Erythematosus
lupus effects only 10%; involves skin
discoid lupus
drug-inducedlupusincludes10%
drug-inducedlupusincludes10%
remaining 10% is a combo of lupus and another autoimmune
remaining 10% is a combo of lupus and another autoimmune
lupus sxs
-polyarthritis without articular destruction
-malar [butterfly] rash
-photosensitivity [rash]
-glomerulonephritis
-pulmonary issues
-pericarditis
-hemolytic anemia, leukopenia, lymphopenia, or thrombocytopenia
lupus antibody test
anti-DNA antibody test (anti-dsDNA)
autoimmune disease of connective tissue characterized by excessive collagen deposition in the skin and internal organs
Systemic Sclerosis/Scleroderma
sxs scleroderma
-typical person has “stone facies” due to tightening of the facial skin with restricted motion of the mouth
-involvement of the esophagus leads to dysphagia
-pulmonary, vascular, renal and cardiac complications
ABCDCREST dx criteria for scleroderma
ABCD
1. Autoantibodies
2. Bibasilar pulmonary fibrosis
3. Contractures of digital joints
4. Dermal thickening proximal to wrists
ABCDCREST dx criteria for scleroderma
CREST
1. calcinosis [calcium deposits in the subcutaneous tissue that erupt through the skin]
2. Raynaud phenomenon
3. esophageal dysmobility
4. sclerodactyly [localized scleroderma of the fingers]
5. telangiectasia (broken capillaries)
inflammation and involvement of the axial skeleton [especially the spine] with an absence of RF
Seronegative Spondyloarthropathies
-mainly sacroilliac
chronic, systemic inflammatory disease of the joints of the vertebral column and sacroiliac joints manifested by pain and progressive stiffening of the spine
Ankylosing Spondylitis
-starts with SI joint
test for Ankolosings spondylitis
modified Schober test (access lumbar flexion)
-5 below iliac crest and 10cm above iliac crest)
type of arthritis develops after infection (usually bacterial/STIs)
reactive arthritis
reactive arthritis sxs (3)
- conjunctivitis
- urethritis
- arthritis
dactylitis
“sausage digit” which refers to soft tissue swelling of a whole digit
-seen in psoriatic arthritis
most common form arthritis
-progressive destruction of articular cartilage
osteoarthritis
causes of OA
- hormones and growth factors,
- drugs
- mechanical stresses
- extracellular environment
primary variants of OA
- joint space narrowing
- osteophytes
- subchondral sclerosis
causes of secondary OA
- congenital or acquired defects of joint structures
- trauma
- infection
- endocrinopathies
- crystal deposits
- osteonecrosis
- metabolic disorders
- inflammatory diseases
sxs of OA
- joint pain
- stiffness
- limited ROM
- joint instability
- deformity
- sarcopenia (loss of muscle)
breakdown of collagen in OA is driven by _____ enzyme
MMP
increased serum uric acid and urate crystals
gout
the accumulation of crystalline deposits in articular surfaces, bones, soft tissue, and cartilage
tophi
gout is associated with what substance
uric acid
is gout assocaited with overproduction or underexcredtoon of uric acid
under excretion
first joint affected by gout
MTP joint with redness and swelling
calcium pyrophosphate dehydrate into joint
[CPPD]
-into cartilgage
pseudo gout
(what Todd had)
