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33 Cards in this Set

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  • Back
Inflammatory Arthritis cardinal signs
swelling
warmth
erythema
tenderness
loss of function
what physical exam suggests pain is referred?
full, painless ROM
when is synovial fluid analysis recommended
monoarticular swelling
when should ana, anca be sent?
when something suspected, not to screen
what wbc counts are important in synovial fluid?
> 2000 = inflammatory
> 50000 = infection
What PEX differs in inflammatory vs. noninflammatory?
Inflam: joint inflammation- warmth, erythema, soft tissue swelling, effusion

Noninflam: bony prolif
Morning stiffness differences in inflam vs. noninflam
inflam > 1 hr
systemic symptoms in inflam vs. noninflam?
inflam: low grade fever, fatigue, rash
what are XR findings in inflam vs. noninflam arthritis?
inflam: erosions, periostitis, joint-space narrowing

non inflam: osteophytes, subchondral sclerosis
Bacterial Joint Infection Patter
asymmetric, monoarticular
Gout joint pattern
asymmetric, monoarticular
diseases associated with AVNs
coticosteroids, alcoholsims, vasculitis, sickle cell disease, trauma
Reiter Syndrome
arthritis, conjunctivitis, urethritis
arthritis and sarcoid
rare, but can present as monoarticular ankle arthritis.
Lofgren syndrome- arthrisis, erythema nodosum, hilar lad
what is indicated if synovial fluid is not inflammatory
structural abnormality, avn, internal derangement, osteoarthritis
infectious causes of polyarticular arthritis
heb b, c, lyme disease, endocarditis, acute rheumatic fever, parvo, hiv, ebv, rubella
Noninfectious causes of polyarticular arthritis
RA, SLE, MCTD, gout,
seronegative spondyloarthropathies
sarcoid, serum sickness, wegener, polyarteritis nodosa, microscopic polyangitis

uncommon: Still disease, Behcet disease, pelapsing polychondritis, whipple
what presents as symmetric arthritis?
RA, SLE, viral infections
what area does RA not affect?
spine, DIPs
What Dermatologic Lesions are in Arthritis?
Photosensitiviy, malar, discoid rashes are seen in SLE

Gottron papules over the metacarpophalangeal region, shwl sign over upper back and shoulders, v-neck on chest are seen in dermatomyositis

Cracked skin over the radial surfaces of the fingers and thenar eminency suggests antisynthetase syndrome assoc with polymyositis

Psoriasis is associated with arthritis in 30%, can see nail pitting

RF- erythema marginatum
Lyme Disease- Erythema Chronicum migrans

Erythema Nodosum- sarcoid, enteropathic arthritis, Behcets

Pyoderma gangrenosum- enteropathic arthritis

Palpable purpura adn livedo reticularis- vasculitis
leukoocytoclastic vasculitis may manifest as palpable purpura and may be associated with RA, SL, Sjogrens or relapsing polychondritis.

Keratoderma Blennorrhagicum and Circinate Balanitis are seen in reactive arthritis. Evanescent Salmon-colored rashes are seen in adult-onset still disease
fever and arthritis
polyarticular crystalline arthropathies, sle, vasculitis, infectious arthritis, and adult-onset still disease. fever is not a common feature of RA and should trigger a serach for infection.
eye disease and arthritis
photophobia and a painful eye are associated with sclertitis and anterior uveitis but not conjunctivitis

conjunctivitis can occur in reactive arthritis

wegener granulomatosis, ra, relapsing polychondritis is associated with scleritis

uveitis is seen with lyme disease, SLE, sarcoid, and Behcet disease
lung disease and arthritis
ILD in RA, Sclerosis, polymyositis/dermatomyositis. Ankylosing spondylitis associated with upper lobe pulm fibrosis. Cavitary lung disease is a feature of wegener granulomatosis.

Microscopic polyangiitis and SLE are seen to have PAH

Sarcoid can affect anything
diarrhea and arthritis
IBD is the only uniform diagnsosi

whipple, celiac sometimes can have reactive arthritis
SEs of MTX
stomatitis, nausea, diarrhea
give folic acid with it
can cause Hepatotox
contraindications: liver disease
Hydroxychloroquine in rheumatoid disease
used in RA, SLE,
take s3-6 months
don't use with renal/hepatic insufficiency
macular toxicity is a severe side effect, but unlikely.
cat c
Sulfasalazine in Rheumatic disease
monitor for neutropenia and liver disase
can have nausea or abd pain
contraindicated i G6PD, sulfa allergy. Can use in pregnancy
Leflunomide
can be used w/ MTX, as effective in RA
SEs: Diarrhea, Nausea, hair loss.
Teratogentic. Must undergo cholestyramine elimination.
measure LFTs monthly
azathioprine in rheumatoid
aza is good for sle, systemic vasculitis
CBCs, LFTs to monitor
pts w/ genitc deficiency of thiopurine mt can get toxicity
can cause hypersensitivity
cyclophosphamide
treats lupus nephritis, systemic vasculitis, and wegener's
Daily oral is more potent but causes toxicity
SEs: Hemorrhagic cystitis, cytopenias, bladder cancer, leukemia

need cbcs, u/as
mycophenolate mofetil
treats lupus nephritis
teratogenic
cyclosporine
used in RA
can cause renal toxicity