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MSK > Week 3: Inflammatory arthritis > Flashcards

Week 3: Inflammatory arthritis Flashcards

1
Q

What does “seronegative” refer to?

A

negative for rheumatoid factor, CCP or ANA

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2
Q

What is the general classification of inflammatory arthritis?

A
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3
Q

What are the five types of synovial fluid (type 0- type 4)

A

Gout will have inflammatory but with crystals

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4
Q

What is calcific tendonitis caused by?

A

calcium hydroxyapatite crystals in tendon. also causes crystal arthritis

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5
Q

What does SOAP BRAIN MD stand for?

A

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…

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6
Q

What is scleroderma? What kinds are there? What are the features of CREST scleroderma?

A

Scleroderma: sclerosis of skin (laying down of collagen). Can be limited cutaneous (CREST) or diffuse.

Calcinosis

Raynaud’s

Esophageal dilatation

Sceryldactyl

Telangiestasia

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7
Q

What are extra-articular features of RA?

A

…dont’ forget atlanto-axial subluxation, nodules

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8
Q

What are the features of Sjogren’s syndrome?

A

-dry eyes

dry mouth

partoid gland enlargement

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9
Q

What are the kinds of seronegative spondyloarthropathies?

A

Psoriatic (one of the five varieties)

Reiter’s (doesn’t have to involve the spine)

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10
Q

In a patient with lupus should you follow ANA or ENA?

A

No, these won’t change over time. Can follow C3/C4 levels or DNA abs

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11
Q

In a patient with gout , when do you start treatment?

A

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

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12
Q

What site is most involved in ankylosing spondylitis?

A

enthesis. it calcifies?

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13
Q

What do type A synoviocytes become in RA

A

they are moncyte derived and become dendritic APCs

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14
Q

Does inflammatory arthritis pain get better or worse with exercise?

A

Worse..vs OA gets better with exercise (after warmed up..)

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15
Q

Pattern recognition….

Psoriatic

RA

Lupus

A

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

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16
Q

Are sicca symptoms assoiciated with seronegative spondyloarthropathies?

A

no..psoriasis, IBD are

17
Q

what enzyme does allopurinol inhibit?

A

xanthine oxidase

18
Q

Do seronegative or seropositive RA pts have a better prognosis?

A

seronegative

19
Q

Key features of the seronegative ankylosing spondylopathies

A

Ankylosing spondylitis

  • syndesmophytes
  • enthesopathy
  • sacroilitis

Psoriatic

Reiter’s

  • conjunctivitis
  • urethritis/cervicitis or dysentry
  • arthritis

IBD

20
Q

What is the difference in pathophys between gout and pseudogout? Joint distribution?

A

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

21
Q

What is the most common cause of monoarthritis is young, sexually active adults?

A

gonococcal arthritis- must do a cervical/urethral swab to r/o

22
Q

What is the lab work-up for inflammatory arthritis?

A
  • 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
23
Q

temporal arteritis is a _____

A

vasculitis

24
Q

What is non-pharm Tx for RA

A

good nutrition, exercise, taking naps, smoking cessation, physio, OT

25
Q

What are some DMARDs

A

methotrexate (inhibits DHF reductase)

Hydrochloroquine (inhibits T-cells degranulations)

gold

sulfasalazine

etc..

biologics (anti-TNF alpha )

26
Q

What is the rheumatology ROS?

A

Rheumatology Review of Systems

  1. Rash
  2. Photosensitivity
  3. Mouth Ulcers
  4. Alopecia
  5. Raynaud’s
  6. Sicca symptoms
  7. Arthritis
  8. AM stiffness
  9. Psoriasis
  10. IBD
  11. Urethritis/Dysentery

MSK (8 decks)

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