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146 Cards in this Set

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Type II Collagen
Articular Cartillage (Osteoarthritis; aneural, avascular)
Type III Collagen
Tendons (also type I collagen)
Tendon Sheaths
Diabetics; Dupuytren’s contractures = thickening of tendon sheaths
High Elastin
Ligaments (Type I Collagen)
Avascular
Articular Caritllage and CENTRAL part of Menisci
Baker’s Cyst
Popliteal cyst; bursa; rheumatoid arthritis
Inflammatory Joint Fluid
Low viscosity (low hyaluronic acid from fibroblasts; high synovial fluid), turbid color, high WBCs and high polys
Synovial Effusions
Reactive arthritis, lyme disease
Ragocytes
WBCs with debris; indicative of active synovium; rheumatoid arthritis
Low hyaluonic acid
Either (1) high volume or (2) hyaluronic acid breakdown (bacterial infection)
DIP involvement
NOT RA; could be Gout, post-infectious (reactive arthritis), osteoarthritis
HLA B27
Spondylarthropathies = 1) Alkylosing spondyltis 2) Reactive arthritis 3) psoriatic arthritis 4) IBD
Enthesopathy
Spondylarthropathies (inflammation at insertion of tendons/ligaments into bone), Lyme Chronic Arthritis
Ro
Neonatal SLE; associated with photosensitivity; in 60% patients with Schogrens
Anti-centromere
CREST
Anti-mitochondrial
Proimary biliary cirrhosis
C Anca
AKA antiserine proteinase 3; Wegener’s (Granulomatous Polyangitiis)
P Anca
AKA MPO; Churg-Strauss and Microscopic Polyangiitis
Hep B
Polyarteritis Nodosa (renal; patchy)
Hep C
Cryoglobulinemia; Schogrens
SS(a)
Ro
SS(b)
La; Schogrens (= Ro + La)
T-cell mediated (Th1)
Schogrens + Rheumatoid + Scleroderma
Type III Hypersensitivity
Rhematoid Arthritis, SLE
HLA-DR4
Rheumatoid Arthritis
Osteophytes
Osteoarthritis (bone spurs)
Degeneration of articular cartillage
Osteoarthritis (Non-inflammatory!)
Syndesmophytes
Spondyloarthropathies  alkylosing spondylitis; bamboo spine (no path of discs!); acute angle
Extra-articular manifestations of spondyloarthropathies
Iritis, urethritis, IBD
Lover’s heal; “fluffiness”
Spondyloarthrpoathies: post-infectious!
Sensitivie antibodies for SLE
ANA
SLE
Small vessel vasculiitis; Type III hypersensitivity; deficiency early complement and abnormal apoptosis; EBV
EBV
SLE (anti-SM antibodies AND anti-Ro; molecular mimicry), Schogrens
Specific antibodies for SLE
DNA, Smith (SM)
Pulmonary hypertension
Scleroderma (progressive systemic sclerosis = PSS)
Increased risk of B cell lymphoma
Schogrens
Red Joints
Infectious arthritis / Gout
Bilateral Joint Involvement
Rheumatoid Arthritis
Fibrinoid necrosis with histiocytes
Rheumatoid Nodules (Rheumatoid arthritis); granulomas outside joint space
Parvovirus B19
Rheumatoid arthritis
Alcohol negatively associated
Rheumatoid arthritis
Type A synovial membrane cells
Macrophages
Type B synovial membrane cells
Fibroblasts (secrete hyaluronic acid and lubrican); become malignant in rheumatoid arthritis
Pannus
Rheumatoid arthritis; proliferating synovium; granulation tissue
Rheumatoid Factor
IgM that targets Fc portion of IgG
TNF-alpha
Required for rheumatoid nodules; anti-TNF-alpha therapy predisposes to TB + lupus-like syndrome
Impaired opsonization
Rheumatoid Arthritis
Anti-CCP
Rheumatoid Arthritis; more destructive; high specificity
Extra-articular feature of RA
Anemia of chronic disease= most common
Secondary Schogrens
Rheumatoid Arthritis; Scleroderma
Methotrexate
Treatment for RA (gold standard)
Rituximab
Tx for RA, SLE, Schogrens
Cyclosporine
RA
Drugs with SLE-like syndromes
Phenytoin, Hydralazine; INH, D-penicillamide), Anti-TNF inhibitors
Crithidian Test
Test for DS DNA in SLE; prevent false positives
Double Stranded DNA
Associated with renal disease in SLE
Pathopneuomonic for SLE
Anti-SM antibodies
Peripheral Rim pattern for ANA anti bodies
Most specific for SLE; anti-DS DNA
Subacute lupus rash
1)
2)
Annjular rash with central clearning IF HAVE anti-RO
Chronic lupus rash
Chronic discoid rash = SCARRING
Bimodal pattern (young and old)
SLE
Leibman-Sachs Endocarditis
SLE; fibrinous vegetations on valve leaflets due to IC deposition
Corticosteroid Tx
Tx for SLE, Schogrens
Anti-malarial drugs (hydroxchloroquine)
Tx for SLE, Schogrens, Osteoarthritis (supplementary)
Sicca
Schogrens with no arthritis
Diagnosis of Schogrens
Lip biopsy; rho/la antibody
Deficiency of androgens
Schogren’s syndrome (androgen effect on epithelial cells, NOT lymphocytes)
Treatment DHEA
In SLE helpful for Women
False + lip biopsy for Schogrens
HIV, Chronic Hep C
Perivascular + CD8+
Hepatitis C
Periductal + CD4
Schogrens
Anti-muscarinic antibodies
Schogrens (not in SLE/RA!!!!!!!)
Anti-TNF-alpha Tx
Schogrens, Psoriatic Arthritis
No rheumatoid factor
Spondylarthropathies
No rheumatoid nodules
Spondyloarthropathies
Mouth ulcer
Spondyloarthropathies (painless); Essential Cryoglobulinemic Vasculitis
Spondyloarthropathies signs
Conjunctivitis, arthritis, tendonitis, urethritis, aortitis (aortic regurgitation)
ARTS-1
Spondyloarthropathies; ER-associated aminopeptidase; function = cleaves cytokine receptors and processes peptides for MHC-I
CCSSY Bacteria
Spondyloarthropathies; Chlamydia, Campylobacter, Shigella flexneri (NOT SONALI), Salmonella, Yersinia + HIV
Romanus lesions
Spondyloarthropathies; erosion of bone
Marginal Syndesmophytes
Ankylosing spondylitis at margins of intervertebral discs
Nonmarginal Syndesmophytes
Psoriatic and Reactive Arthritis
Heat-shock proteins
Rheumatoid Arthritis, Spondyloarthropathies
Post-infectious reactive arthritis
Can’t pee, can’t see, can’t climb a tree
Bypass arthritis
Spondylarthropathies; corrected w/ reversal; also have vasculitis, oral/genital ulceration/ iritis
Sausage Fingers = Dactylitis
Psoriatic arthritis
Nail pitting
Psoriatic arthritis
Telescoping of fingers
Psoriatic arthritis
Asymmetric Arthritis
Osteoarthritis
Gel phenomenon
Osteoarthritis
Weather sensitivity
Osteoarthritis
Bland joint effusions with Calcium Pyrophosphate Dehydrogens (CPPD)
Osteoarthritis
Effusions of the knee, narrow joint space, bone spurs
Osteoarthritis
Acromegaly as secondary cause
Osteoarthritis
Hemochromatosis
Osteoarthritis
Cartillage swelling followed by aggregan decrease and inc MMP
Osteoarthritis
CPPD
Pseudogout, Osteoarthritis (also can be seen in hyperparathyroidism)
Edema of basement membrane on MRI
Osteoarthritis
Ebernation
Osteoarthritis; polished bone
AmidoPRT
Initial and rate limiting step of de novo purine synthesis (adenine and guanine)
“Purine disease”
Gout
Primary Gout
Protein, Alcohol, Thiazides
Secondary Gout
Genetic (PRPP EXCESS, HGPRT deficiency = Lesch-Nyhan), Leukmia, Von Gierke’s (glycogen storage disease)
PMNs required
Acute gout
Podagra
Inflammation of 1st MTP (can also occur with osteoarthritis)
Radiology for gout
Rat bite lesion, tophi, cysts
Acute Gout Tx
NSAIDs (contraindicated if on coumadin); Colchicines, Corticosteroids
Long Term Gout Tx
Allopurinol (for OVERPRODUCTION) and Probenecid (Underexcretor)
XO inhibitor
Allopurinol and Febuxastat
Knee and wrist
Pseudogout (calcium pyrophosphate dehydrogenase)
Chondocalcinosis
Pseudogout; precipitation of Ca within cartilage
Ankle and toe
Gout (monosodium urate)
Short term tx pseudogout
NSAIDs, Corticosteroids
Longer term tx pseudogout
NONE
Basic Calcium Pyrophosphate Disease (BCP)
Hydroxyapetite only on EM! Milwaukee shoulder/knee syndrome (intense arthritis of dominant shoulder; tx w/ corticosteroids)
Dialysis arthritis
Basic Calcium Phosphate Crystal Disease; CAN SEE BCP crystals in and around joints
“Candle dripping”
Diffuse Idiopathic Skeletal Hyperostosis (DISH); osteophytes
Cutaneous luekocytoelastic Angitis
True hypersensitivity vasculitis; postcapillary venules inflammation; palpable patechiae; associated with meds and recent infection
Essential Cryoglobulinemic Vasculitis
Small vessel; Type II cryoglobulin  hep C association; mouth ulcers; old men

Check for high RF!
Wegner’s Granulomatosis
AKA Granulomatosis with polyangitis: Saddle nose deformity, sinusitis/URIs, nephritis, C-ANCA; 3 Cs of Wegner’s = 1) C-anca; 2) Cyclophosphamide; 3) Corticosteroids
Microscopic Polyangitis
Wegener’s WITHOUT granulomas
Churg-Strauss Syndrome
Allergic granulomatosis and angiitis; ASTHMA!
Vasculitis + Eosinophilia
Churg-Strauss Syndrome
Saddle-nose deformity
Wegener’s granulomatosis (AKA granulomatosis with polyangitis); necrotizing vasculitis, lung granulomas, glomerulonephritis; c-anca= antiserine proteinase 3
Tissue deposition of Ig-A in post-capulary venules
Henoch-Schonlein purpura
Conjunctivitis + fever + Strawberry tongue + Coronary Aneurisms
Kawasaki Disease
Mononeuritis Multiplex
Footdrop; seen with Polyarteritis nodosa; can also see with Sjogren's
Granulomatous inflammation of aortic arch; weak/absent pulses in both upper extremities
Takayasu arteritis
Henoch-Schonlein Purpura
Children; IgA complexes; palpable purpura; GI discomfort and renal disease
Polyarteritis Nodosa
Patchy distribution of vasculitis; renal, hep B, mononeuritis multiplex, KIDNEY DISEASE (hematuria)
Unilateral headache, jaw claudication, impaired vision, inc ESR/CRP
Temporal arteritis (tx with glucocorticoids); associated with polymyalgia rheumatica
Acute Septic Arthritis Organisms
Staph, Strep, Gonorrhea
Chronic arthritis infectious agents
Lyme (B. bergdorfi), and TB (myocbacteria)
Mechanism of septic arthritis spread
Most common = hematogenous; direct = injection; contiguous = children
Gonorrhea Arthritis
Monoarticular; migratory, asymmetrical; tx with cephtriaxone
Parvovirus B19 septic arthritis
Multiple joints; Symmetric, self-limiting; IgM positive; no permanent damage!
HIV Associate dArthritis
Associated with Spondyloarthropathies, Sjogren’s; usually hip/knee
Osp-A
Lyme Disease Arthritis; downregulated to move from gut to salivatory glands
Lyme Arthritis
Knee arthritis; large joint effusions!; enthesopathy; persistent is HLA-DR4 / antibodies to OspA; tx with doxycycline or ceftriaxone
Complement Deficiency
SLE; Scleroderma
(note that schogrens is deficiency in androgens!)
Anti-topoisomerase I
Anti-Scl-70 antibody; associated with diffuse cutaneous scleroderma
Anti-centromere
CREST
Treatment for Scleroderma
NOT corticosteroids; alpha-1 blockers early then prostacylcins/PDE inhibitors/ET receptor blockers / cyclophosphamide; give ACE inhibitors for renal crisis
Increase TGF-beta; decrease INF-gamma
Scleroderma: causes fibrosis component (vascular component is IL-1)

TGF-B increase --> inc in collagen and ECM dep and dec in MMP activity!
Chronic GVHD
Scleroderma