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47 Cards in this Set

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Monoarticular arthritis?
one joint
Oligoarticular arthritis?
2-4 joints
Polyarthritis
more than four joints
differential for acute monoarticular arthritis?
Septic arthritis(most urgent), Crystal induced disease(most common), Trauma, hemorrhage,
Extra articular symptoms and signs for septic arthritis?
Shaking chills, cutaneous or other primary sites of infection
Tophi?
Suggest chronic gout(urate crystals), does not rule out sepsis
Acute monoarticular arthritis without any extra-articular signs or symptoms?
Trauma, hemorrhage, pseudogout, hydroxyappatite
Tests for acute monoarticular arthritis?
Synovial fluid most important analysis(Fluid cell count, Crystal analysis, Gram stain, culture), X-ray(not that helpful), Blood test
Crystal analyses of synovial fluid for acute monoarticular arthritis?
Urate: strongly negative birefringent, gout
Calcium Pyrophosphate: Weak positive birefringent, pseudogout
Synovial fluid cell count for Acute monoarticular arthritis?
(non-inflammatory: WBC=200-2000, PMN's 25%, Inflammatory: 2000-100000 WBC, PMN's 50-75%)
Blood test for Acute monoarticular arthritis?
ESR AND CRP is inflammation
Uric acid levels not diagnostic
Blood cultures could be positive, Coagulation profile (hemarthrois)
Pathophysiology of Crystal induced joint disease?
Uric acid(from damged cells) crystalizes in synovium, activates IL-1R and NF-kB, IL-1, IL-8, PMNs, Crystal phagocytosis(need PMN's for gout), get more IL-1, IL-8 and TNF-alpha
Treatment of gout?
Colchicine: suppresses inflamatory molecules, many SE
Indomethacin: NSAID with many SE
Corticosteroids: TOC
Allopurinol: inhibit xanthine oxidase and decrease uric acid, not for acute
Differential for Chronic Monoarticular Arthritis?
DJD/OA, Mechanical internal derangement, Infection(TB, fungus), Neoplasm, Pigmented villonodular synovitis, idiopathic
Lab tests for Chronic Monoarticular Arthritis?
Synovial Fluid(infection), Blood work(not that heltful), Synovial biopsy(neoplasm, infection, Pigmented villonodular synovitis, Sarcoidosis, plant thorn synovitis
Acute Polyarthritis?
More than four joints ,less than 2 months
Only cause for true migrating polyarthritis?
Rhuematic fever
causes for quasi-migrating polyarthritis?
gonococcal arthritis, Lyme(august and september), Parvovirus B19
Erythema Migrans?
lyme disease
erythema Marginatum?
Rheumatic fever
Vesiculopustular lesions on erythematous base
Gonococcal arthritis
ASO Titer?
Acute rheumatic fever
Culture of cervix, urethra, anus, pharynx, synovial fluid
Test for Gonococcal arthritis, terminal C deficiency
Test for Borrelia serologies?
Elisa and western blot
Clinical picture for Gonococcal Arthritis
Migratory polyarthritis, Tenosynovitis, no purulent effusions, Culture negative synovial effusions, pregnant of perimensus
Virulence Factors of gonococcus?
Bacteria morphology: pilli
Cell wall lipopolysaccharides resists serum killing ability
Most common cause of inflammatory chronic polyarthritis? and noninflammatory?
Rheumatoid Arthritis, Osteoarthritis(Degenerative joint disease)
Epidemiology if Rheumatoid arthritis?
World wide, All races, F>M, 1% prevalence, recent decline in severity and incidence
Rheumatoid arthritis is characterized by?
Symetrical involvement of large and small joints of upper and lower extremities, lubro-sacral spine almost never involved, lots of morrning stiffness
Durration and severity of Morning sickness?
Directly proportionate to the severity of the inflammation, more prominant in RA than OA
Rheumatoid arthritis vs. Osteosrthritis
Soft tissue swelling?
RA: 1-4+
OA: 0-1+
Rheumatoid arthritis vs. Osteosrthritis
SYSTEMIC ANIFESTATIONS?
RA: Rhumatoid nodules, Anemia, Episcleritis, Vasculitis, Serositis, splenomegally, synovitis(lose of knuckles)
OA: none
Rheumatoid arthritis vs. Osteosrthritis
Joint involvement?
RA: elbow and MCP are common, Never DIP or lumbar spine
OA: Lumbar spine and DIP are common, rarely elbows or MCP joints
Most specific test for Rheumatoid arthritis?
Cyclic Citrullinated Peptide antibodies(CCP), RF not not diagnostic
X-rays of rheumatoid arthritis Shows?
Soft tissue swelling, periarticular osteoporosis, symetrical joint space narrowing, erosions, deformities
Rheumatoid Arthritis and MHC?
Linked to MHC DR1 and DR4
Pathogenesis of Rheumatoid Arthritis?
PMN's phagocytose Immune complexes, PMN's release damaging stuff, CD4 cells activate B-cells and RF forms more complexes, dominant expression of TNF-alpha
Treatment of Rheumatoid Arthritis?
Corticosteroids early, DMARDS, Anti-TNF-alpha, IL-1 receptor antagonists
Primary Osteoarthritis?
No antecedent cause
Secondary Osteoarthritis?
Response to clearly recognizable antecedent cause: Trauma(repeated microtrauma), Prior inflammatory joint disease, congenital(dysplasia of hip), Metabolic disorders (hemochromotosis), avascular necrosis of the bone(steroids), joint hypermobility
Low incidence of hip Osteoarthritis?
Asians
High incidence of knee Osteoarthritis?
American blacks
Symptoms of osteoarthritis?
Pain: insidious on onset, present on weight bearing and motion and better with rest
Stiffness: after immobility(<30 min)
Lose of motion
Charecteristic joints in Osteoarthritis?
Cervical spine, lumbar spine, hands(1st CMC, PIP, DIP), Hips, knees, Feet(1st MTP), atypical joints
Lab data for Osteoarthritis?
None useful
Pathogenesis of Osteoarthritis?
Progressive dereterioration and loss of articular cartillage
Cartillage composition?
Water, proteoglycans, collagen, chondrocytes