Infectious Arthritis; Misc Rheum Syndromes

Front 1

How are most infectious arthritis cases diagnosed?

Back 1

most require culture from synovial fluid or tissue.

Front 2

Non-GC bacterial arthritis presents with acute (mono, poly) arthritis while viral arthritis presents with acute acute (mono, poly) arthritis.

Back 2

mono; poly

Front 3

(Men, women) much more commonly affected by GC arthritis

Back 3

Women, probably because they're often asymptomatic.

Front 4

Which is more severe: GC or non-GC bacterial arthritis

Back 4

non-GC bacterial arthritis

Front 5

GC arthritis: clinical features

Back 5

Dermatitis - pustular skin lesions

Migratory arthralgias

Later mono- or oligoarthritis

Often asymptomatic at sites of infection.

Synovial fluid leukocytosis not as striking.

Front 6

Typical skin lesion for GC arthritis

Back 6

Pustular

Front 7

non-GC bacterial arthritis: what organisms?

Back 7

Mostly gram-positive (straph, strep) but may be seen with others.
S. aureus - 50%
Strep - 25%
Gm neg - 20%
Others - 5%

Front 8

GC arthritis: tx and outcome

Back 8

Not a devastating disease for most. IV abx followed by oral course.

Response often rapid and complete.

Front 9

GC arthritis vs. non GC arthritis: difference in patient populations

Back 9

GC arthritis: usually younger and healthier

non GC arthritis: older, often compromised with underlying joint disease.

Front 10

Non-GC arthritis: clinical features

Back 10

1) Usually monoarticular
2) Fever, leukocytosis in most
3) VERY elevated synovial fluid leukocytosis
4) synovial fluid culture almost always positive.

Front 11

Non-GC arthritis: tx

Back 11

IV antibiotics for 4-6 weeks

Surgical debridement usually required.

Front 12

Non-GC arthritis: outcome

Back 12

Can be very poor with destructive arthritis

Front 13

Infection involving medullary cavity of bone

Back 13

osteomyelitis

Front 14

Viral arthritis: patient population

Back 14

usually younger

Front 15

Viral arthritis: initial presentation

Back 15

Normally with viral prodrome then a rash

Front 16

Viral arthritis: prognosis

Back 16

almost always good, but a few have persistent symptoms for months.

Front 17

What viruses are often associated with viral arthritis?

Back 17

Parvovirus B-19
Rubella virus or vaccine
Mumps
Hepatitis B and C
Acute HIV infection
Epstein-Barr virus

Front 18

Lyme disease: causative agent

Back 18

Borrelia burgdorferi

Front 19

Lyme disease: tick vector

Back 19

ixodes dammini

Front 20

Lyme disease: geographic distribution

Back 20

Endemic areas in US - Coastal NE, upper midwest, N Cal

Front 21

Lyme Disease: what are the 3 phases?

Back 21

Early localized disease
Early disseminated disease
Late disease

Front 22

Early localized Lyme disease characteristics

Back 22

ERYTHEMA MIGRANS in 50-80% - red, central clearing, bullseye

Viral-like syndrome with fatigue, myalgias, etc.

Front 23

Early disseminated Lyme disease characteristics

Back 23

Occurs days to months after tick bite

Cardiac manifestations - 8% - myocarditis, pericarditis, heart block
Neurologic disease in 10% - meningitis, CN palsy (eg Bells)

Front 24

Late Lyme disease characteristics

Back 24

Months to years after bite

Occurs in the majority of untreated patients

Intermittent, migratory polyarthritis in 50%

Chronic monoarticular arthritis in 10% (usually knee)

Late neurologic features

Front 25

Lyme disease: dx

Back 25

Erythema migrans bullseye rash

Definite neuro findings

Definite inflammatory synovitis (not just arthralgias)

<b>Positive ELISA test</b>

Front 26

Fungal arthritis: general principles

Back 26

Most have insidious onset, indolent course, mild inflammation.

Most are spread hematogenously with pulmonary or skin lesions.

Front 27

Tuberculous Arthritis: how is it spread

Back 27

Usually hematogenously from pulmonary source.

Front 28

Pott's disease: defn

Back 28

tuberculosis of spine

Front 29

Two types of Tuberculous Arthritis

Back 29

1) Spinal (Pott's)
2) Peripheral - hips and knees. Monoarticular, insidious.

Front 30

Fibromyalgia: dx

Back 30

It's a dx of exclusion, so chronic widespread pain with
-normal joints exam
-multiple periarticular tender points
-normal radiographic and lab studies.

Front 31

Fibromyalgia: age of onset and other demographics

Back 31

Mostly female (80-85%), typical onset age 30-50

Front 32

Fibromyalgia: how is it currently conceptualized?

Back 32

as a centrally mediated chronic pain syndrome.

Front 33

Fibromyalgia: sx

Back 33

Diffuse aching in muscles and joints
Axial more than peripheral pain
Swelling mild or none
Morning stiffness usually < 1 hour
Sleep disorder
“Nonrestorative” pattern
Fatigue- often overwhelming
Non-musculoskeletal symptoms
Irritable bowel, headaches

Front 34

Fibromyalgia: tx

Back 34

1) tricyclic and other antidepressants
2) New antidepressants and neuro pain relief
3) Aerobic exercise
4) multidisciplinary approach

Front 35

Reflex sympathetic dystrophy: defn

Back 35

Diffuse pain syndrome usually involving an entire extremity associated with hyperalgesia, vasomotor instability, and dystrophic changes.

Front 36

Fibromyalgia: suspected Pathogenetic factors

Back 36

1) Sleep disturbance
2) CNS-Neurotransmitter and hypothalamic-pituitary abnormality
3) Deconditioning
4) Psychopathology - ie depression

Front 37

Prognosis in Fibromyalgia

Back 37

Tends to be chronic

Approx 20% of time spent in remission


No major change in status over 3 year period
Possibly slightly improved over 10 years

Front 38

Complex regional pain syndrome, type I is aka

Back 38

Reflex sympathetic dystrophy

Front 39

3 stages of Reflex sympathetic dystrophy

Back 39

1) Edematous phase: change in skin temp, severe pain, increasing sweat, vasoreactivity

2) Worsening pain, nail cracking, slowed hair growth

3) Atrophy and contracture: muscle wasting, limited movement, stiff joints and muscles.

Front 40

Reflex Sympathetic Dystrophy:Diagnosis

Back 40

Vasomotor instability symptoms on PE.

1) Plain films - may see patchy osteopenia

2) Bone scan showing diffuse uptake in extremity

3) Sympathetic blockade

Front 41

Reflex Sympathetic Dystrophy: treatment

Back 41

Local therapy, mobilization
Sympathetic nerve blockade
Sympathectomy
Oral corticosteroid
Other meds (antidepressants, neurontin, gabapentin etc)

Front 42

Behçet’s Disease: defn

Back 42

rare immune-mediated systemic vasculitis that often presents with mucous membrane ulceration and ocular involvements.

Front 43

Behçet’s Disease: geographic distribution

Back 43

most common Turkey, the "Silk Road", and Japan

Front 44

Behçet’s Disease: common clinical features

Back 44

1) Oral ulcers (aphthae): frequent, painful

2) Genital ulcers

3) Skin lesions - usually show pathologic neutrophilic inflammation.

4) Ocular inflammation - uveitis, may be severe with hypopyon

Front 45

Behçet’s Disease: less common clinical features (but more severe)

Back 45

pulmonary
cardiac
renal
myositis

Front 46

Usually first sign of Behçet’s Disease

Back 46

Oral apthae (ulcers).

painful.

Front 47

hypopyon: defn

Back 47

pus in the eye

Front 48

Behçet’s Disease: dx

Back 48

Recurrent oral ulcerations + two of the following:

1) Recurrent genital ulcers
2) Eye lesion - uveitis
3) Skin lesion - erythema nodosum or acneiform lesions

Front 49

Behçet’s Disease: tx

Back 49

Cutaneous lesions: colchicine, dapsone, corticosteroids (also for vascular lesions)

Severe manifestations: azathioprine, methotrexate.

Front 50

Behçet’s Disease-Ocular characteristics

Back 50

Pain, photophobia, blurred vision, floaters, lacrimation or redness

Front 51

Relapsing Polychondritis: defn

Back 51

Rare AI d/o characterized by inflammation of cartilage and sometimes vasculitis or other systemic features

Front 52

Relapsing Polychondritis: clinical manifestations

Back 52

Auricular inflammation (red ears)
Nasal cartilage inflammation (red nose)
Tracheal inflammation (throat pain, stridor)
Arthritis- inflammatory, non-erosive
Ocular inflammation- scleritis, uveitis
Cardiac valve lesions
Skin, renal, CNS in rare cases

Front 53

Sarcoidosis is best known for _______ involvement.

Back 53

Pulmonary.

Front 54

Sarcoid arthritis: characteristics

Back 54

Acute sudden arthritis and periarthritis in ankles and feet

If occurs with hilar adenopathy and E.nodusum it's called Lofgren's syndrome.

Front 55

Lofgren's syndrome: defn

Back 55

Hilar lymphadenopathy

Erythema nodosum

Arthritis

Front 56

Amyloidosis: defn

Back 56

Multisystem disease caused by protein deposition

Categories based on type of protein deposition

Front 57

Amyloidosis: histological characteristics

Back 57

Homogenous, hyaline, eosinophilis material on H&E which binds Congo Red.

Very pink.

Front 58

Amyloidosis: what does it show on Congo red staining?

Back 58

Apple green birefringence.

Front 59

AL amyloid (primary or myeloma associated): clinical characteristics

Back 59

Very poor prognosis.

Associated with nephropathy, cardiomyopathy, neuropathy, purpura.

Front 60

Beta-2 microglobulin (dialysis related) amyloidosis: clinical characteristics

Back 60

Carpal tunnel, neuropathy, tendinopathy, arthropathy

Front 61

AA amyloidosis (secondary- chronic infection, inflam. dis.-eg RA, Familial Med. Fever): clinical characteristics

Back 61

Renal, GI, hepatic disease

Front 62

Shoulder-Pad Sign: defn

Back 62

enlargement of the anterior shoulder due to fluid in the joint and/or amyloid infiltration of the synovial membrane - arthropathy in shoulder joints due to primary amyloidosis