Week 3: Inflammatory arthritis Flashcards
What does “seronegative” refer to?
negative for rheumatoid factor, CCP or ANA
What is the general classification of inflammatory arthritis?
What are the five types of synovial fluid (type 0- type 4)
Gout will have inflammatory but with crystals
What is calcific tendonitis caused by?
calcium hydroxyapatite crystals in tendon. also causes crystal arthritis
What does SOAP BRAIN MD stand for?
Serositis (pleuritis, pericarditis)
Oral ulcers
Arthritis
Photosensitivity
Blood disorders (lymphocytosis or Coombs + hemolytic anemia)
Renal (nephrosis or nephritis)
ANA +
Immune
Neurologic
Malar rash
Discoid rash
….can also have alopecia…
What is scleroderma? What kinds are there? What are the features of CREST scleroderma?
Scleroderma: sclerosis of skin (laying down of collagen). Can be limited cutaneous (CREST) or diffuse.
Calcinosis
Raynaud’s
Esophageal dilatation
Sceryldactyl
Telangiestasia
What are extra-articular features of RA?
…dont’ forget atlanto-axial subluxation, nodules
What are the features of Sjogren’s syndrome?
-dry eyes
dry mouth
partoid gland enlargement
What are the kinds of seronegative spondyloarthropathies?
Psoriatic (one of the five varieties)
Reiter’s (doesn’t have to involve the spine)
In a patient with lupus should you follow ANA or ENA?
No, these won’t change over time. Can follow C3/C4 levels or DNA abs
In a patient with gout , when do you start treatment?
after 3 acute attacks. wait till the attack is over, then treat with allopurinol and something to prevent breakthrough attacks for the first couple months (e.g. prednisone…colchicine) until uric acid level is normal
What site is most involved in ankylosing spondylitis?
enthesis. it calcifies?
What do type A synoviocytes become in RA
they are moncyte derived and become dendritic APCs
Does inflammatory arthritis pain get better or worse with exercise?
Worse..vs OA gets better with exercise (after warmed up..)
Pattern recognition….
Psoriatic
RA
Lupus
Psoaritic: can involve DIPs (unlike RA and lupus), is usually asymmetric and oligoarticular (unlike RA), can lead to spondyloarthropathy, sausage digits
RA: polyarticular, asymmetric, never involved DIPs, erosions
Lupus: never has erosions
Are sicca symptoms assoiciated with seronegative spondyloarthropathies?
no..psoriasis, IBD are
what enzyme does allopurinol inhibit?
xanthine oxidase
Do seronegative or seropositive RA pts have a better prognosis?
seronegative
Key features of the seronegative ankylosing spondylopathies
Ankylosing spondylitis
- syndesmophytes
- enthesopathy
- sacroilitis
Psoriatic
Reiter’s
- conjunctivitis
- urethritis/cervicitis or dysentry
- arthritis
IBD
What is the difference in pathophys between gout and pseudogout? Joint distribution?
gout is from an elevation in uric acid, often has podagra and osteopenia on xray
pseudogout is from phagocytosis of IgG coated CPPD crystals by neutrophils who then release inflammatory mediators, knee/wrist/polyarticular and chondrocalcinosis on xray
What is the most common cause of monoarthritis is young, sexually active adults?
gonococcal arthritis- must do a cervical/urethral swab to r/o
What is the lab work-up for inflammatory arthritis?
- CBC
- anemia of CD
- throbocytopenia
- LE
- Kidney (Cr, Urinanalysis)
- lupus damaages kidney –> nephrotic
- ESR/CRP
- C3/C4
- ANA
- sensitive but not specific
- ENA
- esp in pregnany lupus ladies
- RF
- aCCP
temporal arteritis is a _____
vasculitis
What is non-pharm Tx for RA
good nutrition, exercise, taking naps, smoking cessation, physio, OT
