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78 Cards in this Set
- Front
- Back
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___ is a slow, progressive breakdown and fragmentation of articular cartilage due to glycosaminoglycan loss. This is...
-Rheumatoid arthritis -Osteoarthritis -SLE |
Osteoarthritis
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__ is an ivory like bone that replaces the lost cartiliage.
-bone sclerosis (eburnation) -primary osteoarthritis -secondary osteoarthritis |
bone sclerosis (eburnation)
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__ is caused by conditions that damage cartilage (obesity, trauma, prior information, metabolic or congenital conditions.
-bone sclerosis -primary osteoarthritis -secondary osteoarthritis |
secondary osteoarthritis
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__ is an idiopathic cause that may have a genetic component.
-bone sclerosis -primary osteoarthritis -secondary osteoarthritis |
primary osteoarthritis
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In what joints will a patient c/o pain in when presenting with osteoarthritis.?
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PIP, DIP, 1st metacarpal jts, hips, knees, apopyseal joints of spine.
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A pt. with osteoarthritis will c/o pain with prolonged inactivity, period of use, and morning stiffness of __.
-<30 min ->30 min |
<30 minutes.
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What are some common signs of osteoarthritis?
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bony enlargements, decr. ROM, coarse crepitus, Heberden's nodes, Bouchard's nodes.
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Where are Heberden's nodes found ?
-PIP -DIP -facet joints |
DIP joints
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what might you see on xray of a pt with suspected osteoarthritis?
-asymmetric tinning of joint space -osteophytes -subchondral sclerosis -cyst formation -all of the above |
all of the above
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what is the purpose of doing synovial fluid analysis?
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to exclude any other arthropathies
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What cell type is predominate in the analysis of synovial fluid in an OA pt?
-lymphocyte -monocytes -basophils |
monocytes
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What are the 3 types of tx for OA?
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-Meds (tylenol, nsaids, joint injections
-Nutritional supplements -PT |
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__ is a systemic destructive arthropathy that is autoimmune in nature.
-Osteoarthritis -SLE -Rheumatoid arthritis |
RA
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the synovium of an RA pt is infiltrated with what???
-T lymphocytes -B lymphocytes -plasma cells -macrophages -IL-1, IL-6, TNF |
all but B lymphocytes
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__ is a agent that causes inflammation in pt's with RA. This substance cause repeated exacerbations of RA.
-TNF -macrophages -T lymphocytes |
TNF
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T/F
RA pt's are not at increased risk for CVD. |
false; these pt's are at increased risk for CV morbidity
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T/F
RA pt's do not often have Joint ankylosis. |
true story...
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What are common symptoms of RA that a pt may present with?
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joint swelling
pain malaise fatigue wt. loss CP SOB dry eyes skin changes |
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What are common signs of RA?
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-symmetric joint involvement
-morning stiffness >1 hr -atrophy around affected joints -joint enlargement -swan neck joints -boutonniere deformities -ulnar deviation -trigger fingers |
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__ nodules are pathognomonic of RA.
-herberden's -rheumatoid -bouchard's |
rheumatoid nodules are pathognomonic
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What lab values should be evaluated if you suspect RA?
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RF
anti-CCP (citrulline containing proteins) Abs elevated ESR, CRP |
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Name the diagnostic criterion for RA...yeah there are lots...
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-morning stiffness >1 hour for 6 weeks
-swelling of 3 joints for 6 weeks -symmetric joint swelling -XR changes including erosion or decalcification -rheumatoid nodules -serum RF + |
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What is the 1st line treatment of a pt with RA?
-methotrexate -nsaids -minocycline -auranofin |
nsaids are first
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Name 3 DMARDS for the tx of RA.
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-minocycline
-methotrexate -auranofin |
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__ disease commonly manifesting as polyarthritis.
-RA -SLE -OA |
SLE
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If you see a malar rash, what dx should you be thinking about?
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SLE
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What drugs can induce SLE?
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procanimide
hydralazine isoniazid diphenylhydantoin penicillamine |
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Is SLE usually a male or female disease?
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90% females
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__ is a thickening of the skin and internal organs that is autoimmune mediated thru lymphocytes.
-SLE -scleroderma -Sjogren's syndrome |
Systemic Sclerosis Scleroderma
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Name the 4 stages of systemic sclerosis scleraderma.
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1) proliferative vascular lesions
2) obliterative microvascular disease 3) ischemia 4) atrophy, fibrosis |
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what parts of the body are affected early on in scleroderma?
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thickening & hardening of the skin over the fingers, hands, and face.
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90% of scleroderma patients will also be diagnosed with what other disease process?
-OA -RA -Raynaud's phenomenon -Sjogren's syndrome |
Raynauds disease is found in 90% of scleroderma patients which presents as stage 2, vascular obliteration found most commonly in distal extremities.
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What are the primary 5 organ systems affected by scleroderma? All except which?
-GI -Pulmonary -Renal -Cardiac -MS -Nervous system |
not MS system
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All except one are a GI complication of scleroderma.
-GERD -gastric ulcerations -esophagitis -stricture formation |
gastric ulcers are not common
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What are the pulmonary complications of scleroderma?
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pulmonary fibrosis
pulmonary HTN DOE increased risk of lung CA |
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What renal lab values should you evaluate if you suspect scleroderma?
-proteinuria -elevated Cr -bilirubinuria -alkalotic urine -A & B -A & D |
A & B, proteinuria and mildly elevated Cr.
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T/F
HTN is an uncommon consequence seen in pt's with scleroderma |
false, HTN is common.
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What are the common cardiac complications of a pt. with scleroderma?
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-pericarditis
-pericardial effusion -CHF -conduction disturbances |
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Name some common nervous system complications of scleroderma.
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peripheral neuropathy
myopathy HA seizures CVA |
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What does the mneumonic CREST mean?
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C-calcinosis
R-Raynaud's disease E-esophageal dysmotility S-sclerodactyly T-Telengiectasia syndrome |
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How do you evaluate a pt presenting with s/s of scleroderma?
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-clinical picture
-autoAb's -UA-mild proteinuria -antitopoisomerase I (Scl-70); anticentromere Ab -skin Bx |
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What is the management of scleroderma?
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supportive
gastric acid suppression lubricating creams immunomudulators |
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__ aka Sicca Syndrome; is a chronic progressive inflammatory process of exocrine glands that is primarily a female disease, often diagnosed in the 5th decade.
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Sjogren's Syndrome
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T/F
Sjogren's syndrome probably is a genetic component with environmental and pathological triggers. |
true
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What sx's will pt's c/o if presenting with Sjogren's syndrome?
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dry mouth and eyes with difficulty swallowing. burning itchy dry eyes, dry skin and Raynaud's disease.
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What signs might you find if you are suspecting Sjogren's syndrome?
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dry mucus membranes
severe dental caries firm parotid glands decreased tearing |
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Which type of anemia is most commonly found in Sjogren's syndrome?
-normocytic, normochromic anemia -micrcytic, hypochromic anemia -normocytic, hypochromic anemia |
normochromic, normocytic anemia
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What other lab results could you expect out of Sjogrens patient?
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elevated ESR, CRP
elevated anti-Ro (SS-A), anti-La (SS-B) Abs, RF |
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If you have any doubt a dx of Sjogren's syndrome, what can you do next ?
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lip Bx to evaluate labial exocrine gland involvement when Dx in question
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What is the treatment of Sjogren's syndrome?
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supportive
careful oral hygiene artificial saliva saliva gland stimulants (Pilocarpine) artificial tears moisturizing creams |
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__ is a chronic progressive joint inflammation of the axial skeleton; that is most commonly found in white males.
-Reiter's syndrome -ankylosing spondylitis -Psoriatic arthritis |
ankylosing spondylitis
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What are common sx's of Ankylosing Spondylitis?
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intermittent lumbar back pain that is worse upon arising, morning stiffness that improves with exercise, fatigue, and malaise
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What signs should you be looking for if you suspect a pt has Ank. Spondylitis?
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ascending spinal inflammation; loss of lumbar lordosis; thracic kyphosis; neck flexion, stooped posture
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What lab tests can you order if u suspect AS?
-ESR -CBC -HLA-B27 -calcium -A & C |
A & C, elevated ESR and + HLA-B27
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What would show on XR of a pt with AS?
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sacroilitis
squaring of vertebral bodies ligamentous ossification joint fusion bamboo spine |
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What is the medical treatment of AS?
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ASA
NSAID's anticytokine agents (anti-TNF) PT-to maintain mobility |
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What surgical intervention can be done with AS?
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atlantoaxial subluxation-surgery
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__ is a sterile joint inflammation following infectious at nonarticular sites.
-AS -psoriatic arthritis -Reiter's syndrome |
Reiter's syndrome
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All of the following is associated with Reiter's Syndrome except which?
-C. Trachomatis -Shigella -S. Pneumonia -Yersinia -Campylobacter -C. Diff -Salmonella |
Not S. Pneumoniae
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95% of Reiter's syndrome will resolve within...
-6 weeks -3 months -6 months -12 months |
6 months
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What is the classic triad of Reiter's Syndrome?
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Can't see, can't pee, can't climb a tree!!
-conjunctivitis -nongonoccal urethritis -arthritis |
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The arthritis of Reiter's Syndrome commonly affects what joints?
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oligoarticular involving LE joints
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What is "enthesitis"?
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inflammation of a tendon or tendon bone insertions of plantar fascia, achilles tendon, spondylitis, mucocutaneous lesions
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What is "keroatoderma blenorrhagicum"??
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kyperkeratotic rash on soles or palms
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What labs would you see in a pt you suspect Reiter's in?
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ele ESR
ele WBC normochromic anemia |
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What is the mgt of Reiter's syndrome?
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Kill offending bacteria (Doxy for Chlamydia), NSAID's; uveitis may require intraocular steroids.
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__ is an inflammatory condition affecting peripheral or spinal joints; genetic predisposition w/ HLA +non HLA loci; MC female; dermatitis severity does not correlate w/ arthritis.
-AS -Reiter's syndrome -Psoriatic Arthritis -Arthritis |
Psoriatic Arthritis
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What is the most destructive form of arthritis?
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Arthritis mutilans-severe osteolysis + finger telescoping
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what will XR show in a pt. with Psoriatic Arthritis?
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distal phalanges swelling, "pencil in a cup" (acro-osteolysis) apperance
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What help is running a RF and ANA if you suspect Psoriatic Arthritis?
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Helps by ruling out other forms of arthritis
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A pt with Psoriatic arthritis will have an elev. ESR, CRP, anemia and ....
-hypouricemia -hyperuricemia -hypocalcemia -hypercalcemia |
hyperurcemia
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What is the tx of non-severe Psoriatic Arthritis?
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Tylenol, NSAIDs, Psoralen UV-A
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What is the tx of severe Psoriatic Arthritis?
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methotrexate; azathioprine; anti-TNF
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Arthritis is more commonly found in pt's with ?
-UC -Crohn's disease -Diverticulosis |
Crohn's disease
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How will a pt. present with arthritis and Irritable Bowel Disease?
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have asymmetric oligoarthritis of peripheral lg jts that parallel IBD flares
Spondylitis similar to AS independent of IBD flares |
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What lab values should be evaluated in a pt. in which u suspect Arthritis and IBD?
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mild anemia; elev ESR; CRP
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what will XR of arthritis of IBD?
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sacroiliac joint sacroilitis
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What is the mgt of a pt with Arthritis and IBD?
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NO NSAID's becuz of concomitant bowel dx; PT for spine, methotrexate, sulfasalazine, infliximabe
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