Week 3 - Approach to Inflammatory Arthritis Flashcards
What are some main features of inflammatory arthritis?
Prolonged morning stiffness (<0.5 hrs)
Mornings are worst for pain
May get night pain
What is inactivity stiffness suggestive of?
Non-inflammatory arthritis (ex. OA)
What is a typical presentation of Ankylosing spondylitis?
Morning stiffness, night pain, onset age 20s-30s
What should you worry about in a monoarthritis?
INFECTION, Infection, Infection!
What is the most important investigation for monoarthritis?
- What is the most important test on this?
Tap the joint to collect synovial fluid.
- ask for C & S
Describe the synovial fluid in OA.
Thick, transparent, viscous fluid
What is the thickness in OA synovial fluid due to?
Mucins & hyaluronic acid cause the thickness
Describe synovial fluid in RA.
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.
What makes the synovial fluid watery in RA?
Synovial mucins are degraded
Compare the WBCs in OA and RA and infection.
OA has low WBC count & is mostly mononuclear.
RA has high white count & is mostly PMNs.
Infection also has high WBC count & PMNs.
Who typically gets gout?
Males or post-menopausal women.
Name an arthritis that is asymmetric.
Psoriatic Arthritis
What causes joint erosions?
- what never does?
RA –> joint erosions
Lupus does not have joint erosions.
Name some types of arthritis that are usually symmetrical.
RA
Lupus
What are the lab tests for RA?
RA factor (not very specific; 85% sensitive) CCP (very specific for RA; only ~60% sensitive)
What is oligoarthritis?
2-5 joints affected
What are some types of inflammatory arthritis that are seropositive (for ANA)?
RA
SLE
Mixed connective tissue disorder
Name some seronegative types of inflammatory arthritis
RA (15%) Psoriatic Arthritis (-CCP, -RF) Seronegative Spondyloarthropathies (SSA) ~= Ankylosing Spondylitis - Reactive Arthritis - Arthritis of IBD
Common causes of septic joint
Staph aureus Strep CNS Gonoccocal Fungal TB
What is reactive arthritis?
What is the mechanism?
Indirect arthritis from bacteria
- from Urethritis or Chlamydia
- may also be a complication of salmonella/shigella
Mechanism: molecular mimicry
In what type of arthritis is hair loss common in?
Lupus
What type of arthritis is Dry eyes/dry mouth suggest?
Inflammatory arthritis
In what type of arthritis is a rash common in?
- name some typical types of rashes associated with this condition
Lupus
maculopapular rash
photosensitivity/malar rash
dyscoid rash
In what type of arthritis is recurrent mouth or nasal sores common in?
Lupus
In what type of arthritis is red painful eyes/iritis common in?
Seronegative spondylarthropathies
- reactive arthritis
- ankylosing spondylitis
What is iritis
Red painful eyes with blurred vision
Why is travel hx important in diagnosis arthritis?
May be due to IBD or gastrointestinal bacteria
Where are Heberden’s nodes?
What type of arthritis are Heberden’s nodes associated with?
Located at DIP.
Associated with OA.
Where are Bouchard’s nodes?
What type of arthritis are Bouchard’s nodes associated with?
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.
What is pannus? what happens with this?
Hypertrophied synovium
- eats away at cartilage and synovial membrane lining the joint
What would you see on an X-ray of an RA hand?
- Erosions/loss of bone (osteopenia)
- loss of joint space
- sometimes see cysts
What is a Boutineer deformity?
Flexed at PIP, hyperextended at DIP
What is seen on an OA hand X-ray?
“disease of addition” (except for joint space loss)
- Subchondral sclerosis (whitening of bone)
- osteophytes
What is the difference between an OA knee x-ray and
In OA, only weight-bearing parts of joint are affected.
In RA, the entire joint is affected.
What is onycholysis?
What type of arthritis is this associated with?
Whiteningyellowing and thickening of the nail;
Associated with Psoriatic Arthritis.
Which joints are typicaly affected in PsA?
- Non-symmetric, oligoarthritis
- Tendency to affect DIP
- Periostitis/whiskering where tendons attach to bones
- May cause sclerosis
- Sausage joints
Where does Psoriasis (rash) normally affect?
Scalp, behind ear, over extensor part of elbow & knee, and nails
What is pencil in cup deformity?
- what is it associated with?
- tip of proximal phalange is eroded
- associated with Arthritis Mutilans (mutilating arthritis that can occur in Psoriatic Arthritis)
What does not involve the DIPs?
RA & Lupus
What differentiates RA and Lupus?
Erosions in RA; no erosions in Lupus
does PsA have erosions?
Yes
Which types of arthritis show sclerosis?
OA & PsA
RA & Lupus do not
What is the pneumonic criteria for SLE?
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
What’s involved in the SLE review of systems?
Rash - malar, photosensitivity, maculopapular
Mouth Ulcers
Hair Loss
Raynaud’s Syndrome (very non-specific)
What disease should be investigated for someone with complete and asymmetrical Raybaud’s phenomenon?
What other diseases may be associated with Raynaud’s
Scleroderma
or RA, or Lupus, or Mixed connective tissue disease
What is the mechanism for Raynaud’s?
Vasospasm of digital arteries (especially in the cold)
What is scleroderma?
Chronic idiopathic systemic autoimmune disease involving fibrosis of skin
(Laying down type I collagen)
Scleroderma used to be called CREST syndrome. What does CREST stand for?
C - Calcinosis R - Raynaud's E - Esophageal dysfxn S - Sclerydactyly T - telangiectasias
What is calcinosis?
Tuberous calcium growths on knuckles
What is sclerodactyly?
Permanent flexion deformity due to tight skin
What is telangiectasia?
Red spots on the mouth/face; can barely open the mouth (skin is bound down)
What is mixed connective tissue disease?
Features of RA, Lupus, Scleroderma, Inlam. muscle disease
High Positive ANA
What disease shows pencil-in-cup deformity?
Psoriatic arthritis (with arthritis mutilans)
What disease is HLA-B27 associated with?
Spndyloarthropathies (Ankylosing spondylitis)
Name some spondyloarthropathies
Ankylosing Spondylitis
Reactive Arthritis
Psoriatic Spondylitis
IBD
