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106 Cards in this Set

  • Front
  • Back
Morning stiffness is associated w/ what types of arthritis?

Note: this is known as gelling
Note: the pain generally improves w/ activity
What characteristics are NOT usually seen in RA (3)?
Involvement of DIP joints
Involvement of lumbar spine
Monoarticular involvement
What is a valgus deformity of the knee?
When the knee is bent in more medially

Think "knock-kneed"
What is a varus deformity of the knee?
When the knee is bent out more laterally

Think "bow-legged"
What main conditions are on the differential for acute MONOarticular arthritis (4)?
What group of women are usually affected by gout?
POST-menopausal (almost exclusively)
What is the best test to diagnose gout?
Polarized microscopy of synovial fluid
What are the crystals involved in gout composed of?
Monosodium urate
What drugs impair uric acid excretion (3)?
Breakdown of causes of gout
(w/regards to uric acid handling)
90% due to under-excretion
10% due to overproduction
Most commonly involved joint in gout
1st MTP

NOTE: gout is NOT the only disorder that can affect this joint
What types of food are a risk factor for gout?
Purine-rich food
What drugs are used to treat gout (3)?
NSAIDs (indomethacin)
What drugs can be used to prevent gout (2)?

NOTE: urate lowering drugs can actually precipitate an attack of gout
Drugs that qualify as DMARDs (5)
TNF-alpha inhibitors
What are the X-ray findings early on in gout?

What about late in the disease?
Typically normal

Later, can find asymmetric, erosive arthritis w/ "punched out" erosions
What are the crystals in pseudogout composed of?
Calcium Pyrophosphate Dihydrate
What joints are most commonly involved in pseudogout (2)?
What is different between one's predisposition for gout and pseudogout?
Dietary factors and meds are NOT precipitating factors in pseudogout
What is the hallmark radiographic finding in pseudogout?
(calcifcation of articular cartilage)
What sex is pseudogout more common in?

What about gout?

What is the treatment for pseudogout?
NSAIDs/corticosteroids for acute attacks

Daily colchicine can help prevent recurrence
What joints does OA usually NOT involve?
What are bony swellings on the DIPs called?

What disease are they related to?
Heberden's nodes

What are bony swelling on the PIPs called?

What disease are they related to?
Bouchard's nodes

Which knee deformity is commonly seen in OA?
VARUS deformity
Which knee deformity is commonly seen in RA?
VALGUS deformity
What are osteophytes?

What disease are they commonly seen in?
Bony proliferations @ the margin of a joint

In what circumstance are intra-articular steroids contraindicated?
Possible septic arthritis

Steroids may suppress the immune response
What is Sjogren syndrome?
Autoimmune disorder

Immune cells destroy glands that produce tears and saliva
What is a Schirmer's test?

What condition is it used to test for?
Test whether eyes produce enough tears to stay moist

Used in Sjogren's syndrome
What aged patients is polymyalgia rheumatica typically seen in?
Almost exclusively in elderly
What type of condition is fibromyalgia?
(inflammatory vs non)

NOTE: despite this, DOES have some inflammatory symptoms
(ie morning stiffness)

SO, corticosteroids are NOT indicated
90% of pts w/ ankylosing spondylitis are positive for what?

NOTE: 8% of the population is HLA-B27 positive
What part(s) of the skeleton does ankylosing spondylitis affect most often?
Axial skeleton
(including the sacroiliac joints)
What ages pts. does ankylosing spondylitis usually affect?
YOUNG pts.
(unusual after 50 y.o.)
How long may it take for X-ray findings to show up in ankylosing spondylitis?
Up to 10 years
What drugs may have a role in slowing the progression of ankylosing spondylitis?
TNF inhibitors

NOTE: methotrexate and sulfasalazine have little effect on spinal disease
What is the best therapy for polymyositis?
Most pts. respond to systemic steroids alone
Which is more common in adults?

Polymyositis or dermatomyositis

What about in children?

In children, dermatomyositis is more common
What are Gottron's papules?

What condition are they assoc. w/?
Raised, scaly, ertyhematous lesions over MCPs and PIPs

What is a heliotrope rash?

What condition is it assoc. w/?
Violaceous rash over the eyelids

What condition is often assoc. w/ a V-neck pattern rash?
(sun-exposed areas_
What are common lab findgings in polymyositis?
Elevated CPK and aldolase
What is the treatment for polymyositis/dermatomyositis?
High dose corticosteroids

Methotrexate/azathioprine added if myositis relapses
What conditions did we cover that can have a positive ANA (5)?
Pauciarticular JRA
Polyarticular JRA
A subset of polyarteritis nodosa has been assoc. w/ what disease?
Hepatitis B
What parts of the body does polyarteritis nodosa commonly affect (5)?
What parts of the body does polyarteritis typically spare (2)?
Cerebral vessels
What is the treatment for polyarteritis nodosa?
High dose corticosteroids
Immunomodulatory agent (ie cyclophosphamide)
What is keratoderma blennorrhagica?

What disease is it assoc. w/?
Papulosquamous lesions on the soles and the palms

Reiter's syndrome
What is the treatment for Reiter's?
NSAIDs for pain
Tetracycline and sulfasalazine for refractory cases
What age group does pauciarticular JRA typically affect?
Children < 6 y.o.
What is iridocyclitis?

What disease is it a complication of?
Inlfammation of the iris and ciliary body

Pauciarticular JRA
What joint is commonly involved in pauciarticular JRA?
The knee
What lab test abnormality is common in pauciarticular JRA?
60% of pts are ANA positive
In polyarticular JRA, what is the joint distribution like?
Symmetric arthritis, similar to adult RA

NOTE: this arthritis tends to be chronic
Which JRA usually has a negative ANA and RF?
Systemic-onset JRA
(aka Still's disease)
What are the distinguishing charactertistics of systemic-onset JRA (4)?
Daily spiking fevers
Evanescent rash
What does pauciarticular mean, in terms of number of joints?
< 4
Which of the JRAs actually is more common in males than in females?
Juvenile spondylitis
When does juvenile spondylitis usually present?
(what age group)
"Late onset" for the JRAs
Occurs in 9 - 16 year olds
What is the 1st line therapy for JRA?

If these fail, DMARDs and corticosteroids may be used
What joints are commonly involved in SLE related arthritis?
Small joints of the hand
99% of SLE pts. are ANA positive

What are the limitations of this test in identifying pts.?
Sensitive, but NOT specific
What are the limitations of Anti-dsDNA and anti-Sm Abs in IDing SLE cases?
Specific, but NOT sensitive
Beyond NSAIDs and steroids, what other treatments are there for SLE?
Mycophenalate mofetil
The classic case of non-gonococcal arthritis involves how many joints?
It's a mono-articular arthritis
What pathogen is usually assoc. w/ non-gonococcal arthritis?
Staph aureus
In gonococcal arthritis, what should be cultured?

NOTE: joint is low yield in these cases
What joints are often involved in arthritis due to Pseudomonas (2)?
Erythema migrans is assoc. w/ what condition that can cause arthritis?
Lyme disease
What is Libman-Sacks endocarditis?

What disease is it assoc. w/?
Non-bacterial, thrombotic endocarditis

How many joints does Lyme arthritis typically involve?

What types of joints?
Mono- or pauciarticular

Involves LARGE joints

NOTE: the arthritis is often late in the disease and is intermittent
Elevations of these may be indicative of recent strep infection (2)?
DNase B
Conditions assoc. w/ dactylitis (2)?
Reiter's syndrome
Psoriatric arthritis
What are syndesmophytes?

What condition are they assoc. w/?
Like osteophytes, but vertical, in between vertebrae

Psoriatric arthritis
Why must you be careful w/ using corticosteroids to treat psoriatic arthritis?
Steoid taper can worsen the cutaneous psoriasis
What Abs to all MCTD pts. have?
High titer anti-RNP Abs
In Sjogren's syndrome, what type of infiltrate is seen in glands?
What drugs is used in Sjogren's syndrome that may also help in SLE?
What type of staining is used to view the eyes of Sjogren's pts.?
Rose bengal stain
What arteries does PAN primarily affect?
Small and medium arteries
Is microscopic polyangitis granulomatous?
What lab test is positive in a majority of microscopic polyangiitis cases?
Positive ANCA (70%)
What lab test is often positive in Wegener's granulomatosis?
Positive c-ANCA (50 - 90%)
Wegener's and microscopic polyangiitis both often involve the kidney

What is unusual about the involvement in these?
Often NOT assoc. w/ hypertension
What artery is commonly involved in Giant cell arteritis?
Superficial temporal artery

NOTE: other branches of the carotids as well
What common symptoms presents in 90% of cases of Giant cell arteritis?
Moderate - severe headache
What lab test is markedly elevated in giant cell arteritis?
20 - 40% of giant cell arteritis pts. experience what symptom?
Visual loss
Giant cell arteritis is linked w/ what other condition?
Polymyalgia rheumatica
What is the treatment for polymyalgia rheumatica?
Small doses of corticosteroids
Vast majority of PMR patients are over what age?
65, it is a disease of the elderly
What is pathergy?

What disease is it assoc. w/?
Sterile pustule formation @ needle prick sites

Behcet's disease
Behcet's disease is most common in people of what descent (2)?
Eastern mediterranean
What JRA is characterized by an evanescent rash?
Still's disease (aka systemic-onset JRA)
In what condition might the serum ferritin be markedly elevated?
Adult Still's Disease
What is often the 1st complaint in relapsing polychondritis?
Ear pain and swelling
In scleroderma, what is the skin thickening a result of?
Dermal collagen accumulation
What are the signs of limited scleroderma?

Calcinosis cutis
Raynaud's phenomena
Esophageal dysmotility
What Ab do many CREST syndrome pts. have?
Anti-centromere Ab
What Ab do many diffuse scleroderma pts. have?
Prognositically, how do limited and diffuse scleroderma compare?
Limited -- good

Diffuse -- poor
What is unique about the use of corticosteroids in diffuse scleroderma?
NOT helpful

May actually contribute to the development of renal crisis
What other disease develops early in diffuse scleroderma pts.?
Interstitial lung disease