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MSK > Week 3 - Approach to Inflammatory Arthritis > Flashcards

Week 3 - Approach to Inflammatory Arthritis Flashcards

1
Q

What are some main features of inflammatory arthritis?

A

Prolonged morning stiffness (<0.5 hrs)
Mornings are worst for pain
May get night pain

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2
Q

What is inactivity stiffness suggestive of?

A

Non-inflammatory arthritis (ex. OA)

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3
Q

What is a typical presentation of Ankylosing spondylitis?

A

Morning stiffness, night pain, onset age 20s-30s

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4
Q

What should you worry about in a monoarthritis?

A

INFECTION, Infection, Infection!

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5
Q

What is the most important investigation for monoarthritis?

- What is the most important test on this?

A

Tap the joint to collect synovial fluid.

- ask for C & S

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6
Q

Describe the synovial fluid in OA.

A

Thick, transparent, viscous fluid

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7
Q

What is the thickness in OA synovial fluid due to?

A

Mucins & hyaluronic acid cause the thickness

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8
Q

Describe synovial fluid in RA.

A

Thin and watery; slightly turbid due to protein content & high WBC count; so many proteases/enzymes created by synovitis and synovial tissue so it breaks down the mucins.

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9
Q

What makes the synovial fluid watery in RA?

A

Synovial mucins are degraded

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10
Q

Compare the WBCs in OA and RA and infection.

A

OA has low WBC count & is mostly mononuclear.

RA has high white count & is mostly PMNs.

Infection also has high WBC count & PMNs.

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11
Q

Who typically gets gout?

A

Males or post-menopausal women.

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12
Q

Name an arthritis that is asymmetric.

A

Psoriatic Arthritis

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13
Q

What causes joint erosions?

- what never does?

A

RA –> joint erosions

Lupus does not have joint erosions.

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14
Q

Name some types of arthritis that are usually symmetrical.

A

RA

Lupus

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15
Q

What are the lab tests for RA?

A 
RA factor (not very specific; 85% sensitive)
CCP (very specific for RA; only ~60% sensitive)
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16
Q

What is oligoarthritis?

A

2-5 joints affected

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17
Q

What are some types of inflammatory arthritis that are seropositive (for ANA)?

A

RA
SLE
Mixed connective tissue disorder

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18
Q

Name some seronegative types of inflammatory arthritis

A 
RA (15%)
Psoriatic Arthritis (-CCP, -RF)
Seronegative Spondyloarthropathies (SSA) ~= Ankylosing Spondylitis
 - Reactive Arthritis
 - Arthritis of IBD
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19
Q

Common causes of septic joint

A 
Staph aureus
Strep
CNS
Gonoccocal
Fungal 
TB
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20
Q

What is reactive arthritis?

What is the mechanism?

A

Indirect arthritis from bacteria

  • from Urethritis or Chlamydia
  • may also be a complication of salmonella/shigella

Mechanism: molecular mimicry

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21
Q

In what type of arthritis is hair loss common in?

A

Lupus

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22
Q

What type of arthritis is Dry eyes/dry mouth suggest?

A

Inflammatory arthritis

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23
Q

In what type of arthritis is a rash common in?

  • name some typical types of rashes associated with this condition
A

Lupus

maculopapular rash
photosensitivity/malar rash
dyscoid rash

24
Q

In what type of arthritis is recurrent mouth or nasal sores common in?

A

Lupus

25
Q

In what type of arthritis is red painful eyes/iritis common in?

A

Seronegative spondylarthropathies

  • reactive arthritis
  • ankylosing spondylitis
26
Q

What is iritis

A

Red painful eyes with blurred vision

27
Q

Why is travel hx important in diagnosis arthritis?

A

May be due to IBD or gastrointestinal bacteria

28
Q

Where are Heberden’s nodes?

What type of arthritis are Heberden’s nodes associated with?

A

Located at DIP.

Associated with OA.

29
Q

Where are Bouchard’s nodes?

What type of arthritis are Bouchard’s nodes associated with?

A

Located at PIP.
Most commonly seen in OA, but can be seen in RA.
*Note: RA spares the DIP joints and usually affects the MCP & PIP joints.

30
Q

What is pannus? what happens with this?

A

Hypertrophied synovium

- eats away at cartilage and synovial membrane lining the joint

31
Q

What would you see on an X-ray of an RA hand?

A
  • Erosions/loss of bone (osteopenia)
  • loss of joint space
  • sometimes see cysts
32
Q

What is a Boutineer deformity?

A

Flexed at PIP, hyperextended at DIP

33
Q

What is seen on an OA hand X-ray?

A

“disease of addition” (except for joint space loss)

  • Subchondral sclerosis (whitening of bone)
  • osteophytes
34
Q

What is the difference between an OA knee x-ray and

A

In OA, only weight-bearing parts of joint are affected.

In RA, the entire joint is affected.

35
Q

What is onycholysis?

What type of arthritis is this associated with?

A

Whiteningyellowing and thickening of the nail;

Associated with Psoriatic Arthritis.

36
Q

Which joints are typicaly affected in PsA?

A
  • Non-symmetric, oligoarthritis
  • Tendency to affect DIP
  • Periostitis/whiskering where tendons attach to bones
  • May cause sclerosis
  • Sausage joints
37
Q

Where does Psoriasis (rash) normally affect?

A

Scalp, behind ear, over extensor part of elbow & knee, and nails

38
Q

What is pencil in cup deformity?

- what is it associated with?

A
  • tip of proximal phalange is eroded

- associated with Arthritis Mutilans (mutilating arthritis that can occur in Psoriatic Arthritis)

39
Q

What does not involve the DIPs?

A

RA & Lupus

40
Q

What differentiates RA and Lupus?

A

Erosions in RA; no erosions in Lupus

41
Q

does PsA have erosions?

A

Yes

42
Q

Which types of arthritis show sclerosis?

A

OA & PsA

RA & Lupus do not

43
Q

What is the pneumonic criteria for SLE?

A

SOAP BRAIN MD

S - Serositis (Pleuritis/Pericarditis)
O - Oral ulcers
A - Arthritis (inflammatory)
P - Photosensitivity Rash

B - Blood disorders (Hemolytic Anemia, ITP, Lymphocytopenia)
R - Renal Involvement (Nephrosis/Nephritis)
A - ANA positive
I - Immunological phenomena (+Sm or DNA Ab or APL Ab)
N - Neurological disorder

M - Malar Rash & Maculopapular Rash
D - Discoid rash

44
Q

What’s involved in the SLE review of systems?

A

Rash - malar, photosensitivity, maculopapular
Mouth Ulcers
Hair Loss
Raynaud’s Syndrome (very non-specific)

45
Q

What disease should be investigated for someone with complete and asymmetrical Raybaud’s phenomenon?
What other diseases may be associated with Raynaud’s

A

Scleroderma

or RA, or Lupus, or Mixed connective tissue disease

46
Q

What is the mechanism for Raynaud’s?

A

Vasospasm of digital arteries (especially in the cold)

47
Q

What is scleroderma?

A

Chronic idiopathic systemic autoimmune disease involving fibrosis of skin
(Laying down type I collagen)

48
Q

Scleroderma used to be called CREST syndrome. What does CREST stand for?

A 
C - Calcinosis
R - Raynaud's
E - Esophageal dysfxn
S - Sclerydactyly
T - telangiectasias
49
Q

What is calcinosis?

A

Tuberous calcium growths on knuckles

50
Q

What is sclerodactyly?

A

Permanent flexion deformity due to tight skin

51
Q

What is telangiectasia?

A

Red spots on the mouth/face; can barely open the mouth (skin is bound down)

52
Q

What is mixed connective tissue disease?

A

Features of RA, Lupus, Scleroderma, Inlam. muscle disease

High Positive ANA

53
Q

What disease shows pencil-in-cup deformity?

A

Psoriatic arthritis (with arthritis mutilans)

54
Q

What disease is HLA-B27 associated with?

A

Spndyloarthropathies (Ankylosing spondylitis)

55
Q

Name some spondyloarthropathies

A

Ankylosing Spondylitis
Reactive Arthritis
Psoriatic Spondylitis
IBD

MSK (11 decks)

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