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31 Cards in this Set

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most serious cause of acute monoarthritis?
non-gonococcal bacterial infxn (staph and strep!!)
most common way of (non-gonoc) bacterial spread to joint?
hematogenous
classic triad of gonococcal infection
1) migratory tenosynovitis 2) vesiculopustular skin lesions, 3) oligoarthralgia
XR findings in chronic gout
oval/round peri/intra-articular bony erosions with sclerotic margin ("rat bite lesions"
what is chondrocalcinosis?
degenerative joint disease characterized by accumulation of calcium pyrophosphate crystals in/near articular tissues
3 kinds (?) of chondrocalcinosis
pseudogout (not as bad as gout); pseudo-osteoarthritis (usually knees, symmetric); pseudorheumatoid arthritis
lab findings of chondrocalcinosis
arc rod shaped often intracellular calcium pyrophosphate dihydrate (CPPD) crystals, positively birefringent (vs gout--neg)
pathogenesis of RA?
chronic autoimmune mediated primarly by T lymphocytes aginst synovium (similar to type IV)
7 Diagnostic criteria for RA
1. morning stiffness >1hr, 6wks+ 2. swelling 3+jnts simultaneously 3. swelling of wrist, MCP, PIP 4. symmetric swelling 5. hand XR changes (erosions/demineralization); 6. subQ nodules 7. anbl RF or anti-CCP
lab characteristic for RA (8)
inc'd ESR, anemia, thrombocytosis, WBC nl or slight inc'd, hypergammablogulinemia/hypocompletementemia, RF, aCCP, inc'd WBC in synovial fluid
RA in nervous system
myelopathy!!, mononeuritis multiplex, n. entrapment (carpal tunnel)
DDx of RA
other CT d/o (Sjogren's!), sarcoidosis, SBE, chronic polyarticular gout
urate level goal of gout treatment?
sr urate <5-6mg/dL
treatment of choice for acute gout
NSAIDs, esp. indomethacin (inhibit PG synthesis and urate crystal phagocytosis)
major adverse effect of colchicine?
diarrhea
MOA of colchicine
inhibits microtubules and somehow this leads to inhibition of leukocyte migration and phagocytosis ; also inhibits LTB4
indication for colchicine use in gout?
for those who can't take NSAIDs; good for prevention but can't give to people with renal/heart problems
what are uricosuric agents?
increase urinary excretion of uric acid. Ex: probenecid, sulfinpyrazone
major side effect of probenecid?
GI irritation. Also, allergic dermatitis. (rarely, aplastic anemia)
MOA of allopurinol?
inhibits xanthine oxidase
categories of RA treatment
NSAIDS, DMARDS--anti inflamm, immunosuppress, cytokine tx (TNFalpha inhib), corticosteroids
what is enthesitis?
inflammation of tendon/ligament insertion site
gene associated with seronegative spondyloarthropathies
HLA B-27
XR features of AS?
BILATERAL sacroiliitis, squaring of lumbar vert bodies, symmetic marginal syndesmophytes, bamboo spine, fusion of facet joints
triad of Reiter's syndrome/reactive arthritis
1.urethritis 2. conjunctivitis 3. arthritis
sausage digits possibly seen in which seronegatives?
Reiter's and psoriatic
how is Reiter's different from AS on XR?
Reiter's: ASYMMETRIC sacroiliitus, ASYMMETRIC syndesmophytes, involvement of upper spine is LESS common
possible mucocutaneous manifestations of Reiter's syndrome?
painless oral ulcers, psoriasis-like rash on feet (keratoderma blennorrhagicum), circinate balanitis
5 clinical pattersn of psoriatic arthritis
1. oligoarthritis (most common) 2. pseudorheumatoid polyarthritis 3. axial involvement (like Reiter's) 4. arthritis mutilans 5. DIP involvement with nail pitting/dystrophy
Which seronegatives show SYMMETRIC sacroiliitus?
AS and arthritis assoc'd with IBD (sxs do NOT parallel bowel dz activity unless it's the peripheral joint involvement)
Best treatment for axial involvemtn of seronegatives?
TNFalpha inhibitors