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32 Cards in this Set
- Front
- Back
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What does morning stiffness signify? (not the one you're thinking of...)
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ie. post prolonged immobility (rest) = manifestation of active inflammatory joint disease.
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what does duration of morning stiffness reflect ?
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desgree of disease activity. >45 min - 1 hr = inflammatory. degenerative < 30 min
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Whats the point of interpreting non-articular sx?
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reflect organ system involvement - give clues to Dx + emphasis inflammatory polyarthropathies.
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what does a Hx of ocular dryness suggest?
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Sjogrens syndrome
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what does a Hx of loose bowel movements signify?
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inflammatory bowel disease
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what do biphasic colour changes (hands) suggest?
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Raynauds phenomenon.
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what are non-articular sx called?
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extra articular manifestations.
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Inflammatory vs inflammatory factors are?
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Age, Sex, Joint pain, morning stiffness, aggravating factor, relieving factors, extra articular manifestations
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inflammatory arthritis can be differentiated by ???
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younger, Female >M, joint pain presnet, mornign stiffness >45 min, aggravated by Rest, relieved by activity, extraarticular manifestations present
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how can non inflammatory arthritis be categorized differently that inflam? based on differentiating factors.
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Older, F=M, joint pain present, morning stiffness <45 min, aggravated by activity, relieved by rest, NO extra articular manifestations.
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how do you assess joint inflammation?
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joint tenderness, ID presence of joint swelling due to increased intra-articular fluid (effusion)
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what is the significance of normal finding in skin + nail?
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skin - common target for extra articular manifestations for inflammatory arthritis'
nails - commonly affected by inflammatory and esp. psoriasis (psoriatic arthritis) |
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what is enthesitis?
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iinflammation at the site of tendon or ligament insertion into bone.
ex. at the site of insertion of the Achilles tendon or plantar fascia into the calcaneus Clinically tender at site of tendon/ligament insertion. |
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what disease are enthesitis found?
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= seronegative arthropathies
such as : ankylosing spondylitis psoriatic Reactive arthritis (Reiters syndrome) |
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what is the DDx for chronic inflammatory polyarthritis?
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1. RA
2. Connective tissue disease (SLE), Sjogren’s syndrome, dermatomyositis. - differentiated by extraarticular manifestations. 3. Seronegative spondyloarthropathies a) Ankylosing spondylitis b) Psoriatic arthritis c) Enteropathic arthritis (spondyloarthritis associated with Crohn’s disease or ulcerative colitis) d) Reactive arthritis (formerly known as Reiter’s syndrome) e) Undifferentiated spondyloarthritis. 4. Lyme arthritis 5. Crystalline arthritis (CPPD=pseudogout, Gout) 6. Infectious arthritis 7. paraneoplastic disease -assc. w underlying cancer |
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How does RA present?
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symmetric inflammatory arthritis in small joints of hands + feet (but can affect any synovial joint in body). spares DIP joints, thoracic spine, lumbar spine.
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What What are seronegative arthropathies? how does it differ from RA?
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= family of diseases that share several clinical features. differ from RA by AXIAL skeletal involvement, esp. SI joint. arthritis usually asymettric + oligoarticular (<5joints). may be associated w dactylitis (sausage digit) or enthesitis.
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what does seronegative refer to?
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negative rheumatoid factor
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What is Lyme arthritis? how does it present?
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= late manifestation of Lyme disease
characterized by intermittent of persistent inflammatory arthritis in a few large joints. early disease = Migratory arthralgias w/o frank arthritis Hx living in/travelling to an endemic area often Hx erythema migrans or other early disease manifestations. |
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what are laboratory features of joint inflammation?
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1. anemia
2. thrombocytosis (in the absence of dietary deficiency and blood loss) 3. elevated ESR (usually associated with elevation in acute phase reactants such as CRP) |
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What is RF? if present does it confirm RA Dx?
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a biologic marker seen in approximately 70% patients with rheumatoid arthritis. It is an antibody directed against the Fc portion of immunoglobulin G (IgG).
No - also present in : most other connective tissue diseases, some acute and chronic infectious states, and granulomatous diseases in the elderly. |
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What is anti-CCP (anti-cyclic citrullinated peptide) antibody?
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biologic marker for rheumatoid arthritis and, to date, is the most specific marker for the rheumatoid arthritis.
not always present but when it is - indicates pts have higher risk of joint damage. |
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what do you do with synovial fluid?
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analysis for 3C's : cell count and differential; crystal analysis; and culture and sensitivity.
Inflammatory fluid is turbid in appearance with a low viscosity, has elevated white cell count and a high percentage of polymorphonuclear cells. |
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what are the goals of RA tx?
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relief of symptoms
preservation of joint integrity maintenance of articular function |
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What are disease modifying anti-rheumatic drugs (DMARDs)?
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class of medications that modify the disease course by somehow modulating the abnormal immune response underlying the disease.
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when should a pt be started on DMARDS?
how long do they take to start working? |
as soon as Dx with RA
2-4 months. |
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What are potential side effects of methotrexate?
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include risk of infection, bone marrow suppression, hepatotoxicity, rashes, oral ulcers, gastrointestinal upset (especially nausea), hair loss and pulmonary toxicity.
Female patients should be counselled to avoid pregnancy because of teratogenicity. Alcohol use should be avoided because of an increased risk of hepatotoxicity. |
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How is methotrexate toxicity monitored?
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blood work (including CBC and liver enzymes)
done monthly at the initiation of the medication and every 4 – 8 weeks thereafter. |
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What clinical variables would you use to assess the response to therapy and to monitor for drug toxicity?
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Response to therapy is monitored largely based on clinical response: decreased pain and stiffness, decreased number of swollen or tender joints.
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what laboratory variables would you use to assess the response to therapy and to monitor for drug toxicity?
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non-specific acute phase reactants such as ESR and CRP (these change w disease activity)
N.B rheumatoid factor titre does not change with activity of disease. |
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What are the typical radiographic features of rheumatoid arthritis?
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periarticular osteopenia
symmetrical joint space loss marginal joint erosions |
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What are factors known to be poor prognostic factors for rheumatoid arthritis?
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• persistent synovitis*
• early erosive disease (demonstrated on x-ray)* • extra-articular findings (including subcutaneous rheumatoid nodules) • high titre rheumatoid factor* • positive serum anti-CCP autoantibodies* • poor functional status • socioeconomic factors • elevated acute phase response (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP])* |
