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263 Cards in this Set
- Front
- Back
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Most common form of arthritis
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Osteoarthritis
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From repetitive stress (mechanical or compressional)/trauma/impact
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Osteoarthritis
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Obesity increases risk
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Osteoarthritis
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Cartilage splitting and irregularities (fibrillation) = cartilage ulceration and cartilage loss
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Osteoarthritis
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Bone on bone contact then eburnation (polished bone)
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Osteoarthritis
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Dc'd glycosaminoglycan
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Osteoarthritis
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Dc'd chondrotin sulfate
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Osteoarthritis
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Dc'd keratin sulfate
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Osteoarthritis
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Dc'd hyalouronic acid
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Osteoarthritis
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In'd Matrix Metalloproteinase (MMP) activity
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Osteoarthritis
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Disease of hyaline cartilage of joints
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Osteoarthritis
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Joint tenderness and enlargement (PIP and DIP most visibly)
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Osteoarthritis
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Pain and crepitus
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Osteoarthritis
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Subchondral microfractures and periostitis
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Osteoarthritis
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Osteophytes
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Osteoarthritis
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Subchondral boney sclerosis and cysts
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Osteoarthritis
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Joint space narrowing (loss of cartilage)
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Osteoarthritis
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Morning stiffness less than 30 min
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Osteoarthritis
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Gelling, possible locking
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Osteoarthritis
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Bouchard's nodes
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Osteoarthritis (DIP)
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Heberden's nodes
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Osteoarthritis (PIP)
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Varus deformity
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Osteoarthritis
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Diagnose by H&P and plain x-ray film
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Osteoarthritis
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APAP, NSAIDS
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Osteoarthritis
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Zostrix
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Osteoarthritis
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Intra-articular steroid or hyalgan injection
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Osteoarthritis
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Joint replacement (arthroplasty)
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Osteoarthritis
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Hyperuricemia (from breakdown or purines) > 7 mg/dl
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Gout
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mostly men in 40's
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Gout
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Risk increased by alcohol, obesity, or renal dysfunction
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Gout
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Overproduction or underexcretion of uric acid or combo of both
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Gout
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Monosodium urate crystals in cooler peripheral joints
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Gout
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Podagra
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Gout
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1st MTP joint = red, hot, swollen, exquisitely painful
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Gout
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Gout
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Attack caused by starting uric acid lowering therapy, surgery/trauma, stroke, acute MI, alcohol
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Gout
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Needle-shaped, negatively birefringent monosodium urate crystals in joint fluid
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Gout
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Aspirin is contraindicated
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Gout
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Colchicine
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Gout, pseudogout, sarcoidosis
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Benecid and Zyloprim
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Gout
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Arthritic joint like gout
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Pseudogout
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Attack from trauma, surgery, stroke, acute MI
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Pseudogout
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Often due to aging (older than 60)
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Pseudogout
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hot, red, swollen, tender joint (wrist or knee = most common)
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Pseudogout
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Rhomboid-shaped positively birefringent calcium pyrophosphate crystals in joint fluid
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Pseudogout
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NL serum urate level
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Pseudogout
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Vector = Ixodes
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Lyme Disease
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Borrelia burgdorferi = pathogen
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Lyme Disease
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Hx of bug bite or outdoors activity
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Lyme Disease
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Erythema migrans
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Lyme Disease
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Bulls-eye rash
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Lyme Disease
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Fatigue, fever, headache
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Lyme Disease
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Arthritis problems (1 knee most common)
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Lyme Disease
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Neurologic problems (meningeal signs like nuchal rigidity)
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Lyme Disease
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Bilateral Bells' palsy
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Lyme Disease
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Cardiac problems (AV block)
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Lyme Disease
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IgM then IgG response
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Lyme Disease
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Use ELISA and Western Blot test
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Lyme Disease
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Slight increase in WBCs, NL sed rate
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Lyme Disease
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Pleocytosis (increased WBC in CSF)
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Lyme Disease
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Doxycycline
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Lyme Disease (for rash)
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Rocephin (2)
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Lyme Disease (for carditis/meningitis), Septic arthritis (if gonococcal)
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After GU, GU, or resp. infection
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Reiter's Syndrome (Reactive Arthritis)
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Often after have Chlamydia
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Reiter's Syndrome (Reactive Arthritis)
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Triad = arthritis, conjuctivities, and nongonococcal urethritis
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Reiter's Syndrome (Reactive Arthritis)
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From gastroenteritis (ex. Clostridium dificile) or venereal (ex. Chlamydia)
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Reiter's Syndrome (Reactive Arthritis)
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Sausage digits/dactylitis (2)
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Reiter's Syndrome (Reactive Arthritis), Psoriatic Arthritis
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Enthesopathy (esp. achilles tendon) (2)
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Reiter's Syndrome (Reactive Arthritis), Psoriatic Arthritis
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Circinate balanitis
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Reiter's Syndrome (Reactive Arthritis)
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Kertodermal blennorrhagica (on palms or soles)
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Reiter's Syndrome (Reactive Arthritis)
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Inc'd ESR and C reactive protein (2)
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Reiter's Syndrome (Reactive Arthritis), Rheumatoid Arthritis
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DMARDS (5)
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Reiter's Syndrome (Reactive Arthritis), Psoriatic Arthritis, Rheumatoid Arthritis, SLE, Sjogren's syndrome
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Red, hot, swollen, painful joint
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Septic Arthritis
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Could destroy joint completely
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Septic Arthritis
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Bacterial joint infection
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Septic Arthritis
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Sepsis and death possible
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Septic Arthritis
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Hx of joint-penetrating injury, drug use or sexual activity
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Septic Arthritis
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Gonorrhea
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Septic Arthritis
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Inc'd WBC, >10K/uL
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Septic Arthritis
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Dec'd glucose, Inc'd protein
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Septic Arthritis
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Treat empirically with antibiotic, Rocephin
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Septic Arthritis
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Gram stain and C&S = may need to switch Abx
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Septic Arthritis
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Well-demarcated pink-to-salmon colored plaques covered with sliver/white scales (on scalp or extensor surface)
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Psoriatic Arthritis
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Inc'd epidermal cell turnover = acanthosis
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Psoriatic Arthritis
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Pitting of nails
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Psoriatic Arthritis
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Onchylosis and discoloration of nails
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Psoriatic Arthritis
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Auspitz sign
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Psoriatic Arthritis
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Koebner phenomenon
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Psoriatic Arthritis
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May be a form of reactive arthritis
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Psoriatic Arthritis
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Oligoarthritis = scattered small joints (PIP, DIP, MCP)
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Psoriatic Arthritis
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Arthritis mutilans (only DIP)
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Psoriatic Arthritis
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Telescoping of distal phalanx
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Psoriatic Arthritis
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Pencil-in-cup deformity
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Psoriatic Arthritis
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Acro-osteolysis = resorption of distal bone tuft of distal phalanx
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Psoriatic Arthritis
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Joint space loss (mostly in interphalangeal joints)
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Psoriatic Arthritis
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Enebrel
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Psoriatic Arthritis
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Topical steriod and Vit. A and D derivatives
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Psoriatic Arthritis
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Chronic inflammatory systemic disease
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Rheumatoid Arthritis
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Dominated by joint destruction (from inflammation)
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Rheumatoid Arthritis
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Progressive inflammatory synovitis
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Rheumatoid Arthritis
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Symmetric arthritis (MCP. PIP, carpal, Knees, MTP joints)
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Rheumatoid Arthritis
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Injury to synovial microvasculature = hyperplasia of synoviocytes
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Rheumatoid Arthritis
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Early T-cell emigration leads to hypertrophic synovium
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Rheumatoid Arthritis
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Pannus formed
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Rheumatoid Arthritis
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Type 3 Hypersensitivity (immune complex) (3)
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Rheumatoid Arthritis, SLE, Scleroderma
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RF binds to Fc part of IgG
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Rheumatoid Arthritis
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>2000 cells/mm3 (mostly lymphos)
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Rheumatoid Arthritis
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Morning stiffness greater than 30 min (often greater than 2 hours)
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Rheumatoid Arthritis
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Adhesive capsulitis
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Rheumatoid Arthritis
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Ulnar nerve entrapment
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Rheumatoid Arthritis
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MCP and PIP involvment/enlargement (spare DIP)
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Rheumatoid Arthritis
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Swan neck, boutonniere deformity, hammer
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Rheumatoid Arthritis
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Opera glass hands (radial deviation of wrist and ulnar deviation of MCP)
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Rheumatoid Arthritis
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Carpal tunnel syn (median nerve)
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Rheumatoid Arthritis
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Guyon's canal syn. (ulnar nerve) - at wrist
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Rheumatoid Arthritis
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Cubital tunnel syn. (ulnar nerve) - at elbow
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Rheumatoid Arthritis
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Baker's cyst = posterior herniation of joint capsule
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Rheumatoid Arthritis
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Tarsal tunnel syn.
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Rheumatoid Arthritis
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MCP, PIP, MTP subluxations
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Rheumatoid Arthritis
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Rheumatoid nodules (granuolmatous inflammation) on extensor surfaces
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Rheumatoid Arthritis
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Keratoconjuntivitis sicca
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Rheumatoid Arthritis
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Interstital fibrosis
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Rheumatoid Arthritis
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Restrictive pericarditis or pericardial effusion
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Rheumatoid Arthritis
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Rheumatrex (2)
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Rheumatoid Arthritis, Sarcoidosis
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Joint erosion, osteopenia, joint space narrowing
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Rheumatoid Arthritis
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Valgus deformity
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Rheumatoid Arthritis
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WBC > 2000 (mostly lymphos)
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Rheumatoid Arthritis
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Mod inc'd protein, mod dec'd glucse
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Rheumatoid Arthritis
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Great imitator of other diseases
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SLE
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Malar (butterfly) rash
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SLE
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Photosensitivity
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SLE
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Raynaud's phenomenon (2)
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SLE, Limited Scleroderma
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anti-dsDNA +
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SLE
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anti-SM +
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SLE
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Prototype of autoimmune diseases
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SLE
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Fatigue, arthralgia, vasculitis
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SLE
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Hyperglobulinemia, more Ab making cells, heightened response to antigens
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SLE
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Ics deposited throughout the body
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SLE
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Discoid lesion
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SLE
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Alopecia
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SLE
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Mucus mem lesion, myalgias, fibromyalgias
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SLE
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Renal dysfunction (proteinuria, hematuria, pyuria, urinary cases, azotemia)
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SLE
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Neuropsych problems (headache, seizures, chorea, CVA's)
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SLE
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Cranial and peripheral neuropathies
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SLE
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Organic Brain Syndrome
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SLE
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Pleurisy and Pericarditis
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SLE
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Abdominal pain
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SLE
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Pnuemonitis, pulmonary hemorrhage, pulmonary HTN
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SLE
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Pericarditis, myocarditis, endocarditis, cor. Vasculitis, atherosclerosis
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SLE
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Acute necrotizing vasculitis
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SLE
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*D'cd C-reactive protein*
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SLE
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Fibrotic and degenerative skin changes
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Scleroderma
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Very nasty skin changes
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Scleroderma
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Calcinosis
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Limited Scleroderma
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Esophageal dysmotility
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Limited Scleroderma
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Sclerodactyl
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Limited Scleroderma
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Telangectasias
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Limited Scleroderma
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dysphagia
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Limited Scleroderma
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LES dysfunction
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Limited Scleroderma
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GERD
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Limited Scleroderma
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Barrett's esophagus
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Limited Scleroderma
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Diffuse edema of fingers and hands, then become claw-like, eventually affects face
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Limited Scleroderma
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Anticentromere Abs +
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Limited Scleroderma
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SCL-70 Abs +
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Diffuse Scleroderma
(Systemic Sclerosis) |
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Salt and pepper appearance
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Diffuse Scleroderma
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Finger mobility impaired
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Diffuse Scleroderma
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Skin ulcers on fingers = necrosis = finger loss
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Diffuse Scleroderma
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GI tract = saccular diverticuli
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Diffuse Scleroderma
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Heart = pericardial effusion, cor vasospasm, sys HTN, pul HTN
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Diffuse Scleroderma
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Lungs = pul fibrosis, restrictive lung disease, RV failure, decreased alveolar O2 uptake
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Diffuse Scleroderma
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Kidneys = decreased GFR = azotemia
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Diffuse Scleroderma
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Flexion contractures of fingers, wrist, elbows
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Diffuse Scleroderma
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Treatment is symptomatic
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Diffuse Scleroderma
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Ca channel blockers and ang II receptor blockers
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Diffuse Scleroderma
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H2 blockers and proton pump inhibitors
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Diffuse Scleroderma
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ACE inhibitors
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Diffuse Scleroderma
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Inflam disease of exocrine glands
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Sjogren's Syndrome
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Salivary and lacrimal gland dysfunction
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Sjogren's Syndrome
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Chronic dryness of eyes and/or mouth plus mild joint pain
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Sjogren's Syndrome
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Xerostomia and keratoconjunctivitis sicca
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Sjogren's Syndrome
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Other mucus mem dysfunction (vagina, pancreas, tracheobronchial)
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Sjogren's Syndrome
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emigration of CD4 T-lymphocytes = destroy cells
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Sjogren's Syndrome
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Anti-SS-A Ab +
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Sjogren's Syndrome
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Anti-SS-B Ab +
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Sjogren's Syndrome
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Schirmer's test
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Sjogren's Syndrome
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Rose Bengal
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Sjogren's Syndrome
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Corneal abrasions
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Sjogren's Syndrome
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Whole saliva sialometry
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Sjogren's Syndrome
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Avoid meds with anticholinergic effects
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Sjogren's Syndrome
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Proximal muscle weakness
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Polymyositis/Dermatomyositis, Polymyalgia Rheumatica
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Difficulty with stairs and chairs and lifting head from pillow (2)
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Polymyositis/Dermatomyositis, Polymyalgia Rheumatica
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Biopsy or chemical evidence of muscle degeneration/inflammation
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Polymyositis/Dermatomyositis
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Elevated CPK-MM, aldolase, LDH, ALT/AST
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Polymyositis/Dermatomyositis
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Anti-Jo-1 Ab +
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Polymyositis/Dermatomyositis
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Electromyographic evidence of myopathy
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Polymyositis/Dermatomyositis
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Slow onset = 3 to 6 months
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Polymyositis/Dermatomyositis
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Dysphonia
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Polymyositis/Dermatomyositis
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Urine dip pos for myoglobin (rhabdomyolysis)
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Polymyositis/Dermatomyositis
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Gottron's sign
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Dermatomyositis
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Heliotrope rash
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Dermatomyositis
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Shawl sign
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Dermatomyositis
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V sign
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Dermatomyositis
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Mechanics hands
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Dermatomyositis
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Periungual telanectasias
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Dermatomyositis
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Methotrexate or azathioprine
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Dermatomyositis
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Fever, weight loss, malaise
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Sarcoidosis
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Lymphadenopathy
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Sarcoidosis
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Dyspnea, dry cough, vague chest pain
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Sarcoidosis
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Myalgia or arthritis (often ankles)
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Sarcoidosis
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Bilateral hilar adenopathy on chest x-ray
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Sarcoidosis
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Non-caseating granuloma in lungs, lymph nodes, liver
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Sarcoidosis
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Hypercalcemia, hypercalciuria
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Sarcoidosis
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High serum ACE level
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Sarcoidosis
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Kveim-Siltzbach test +
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Sarcoidosis
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Granulomatous disease
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Sarcoidosis
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Erythema nodosum
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Sarcoidosis
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Lupus pernio
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Sarcoidosis
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Depressed cell immunity, heighted humoral immunity
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Sarcoidosis
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Pt is over 50
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Polymyalgia Rheumatica
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Very high sed rate
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Polymyalgia Rheumatica
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No biopsy or chemical evidence of muscle degeneration
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Polymyalgia Rheumatica
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*Associated with termporal arteritis* = can cause permanent blindness
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Polymyalgia Rheumatica
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Good response to steriods (high or low dose)
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Polymyalgia Rheumatica
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Not autoimmune, but dominated by myalgia of proximal muscle groups
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Polymyalgia Rheumatica
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Muscle pain and stiffness but no evidence of muscle degeneration
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Polymyalgia Rheumatica
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Inc'd ESR
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Polymyalgia Rheumatica
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Chronic fatigue and widely distributed pain in muscles and tendons
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Fibromyalgia Syndrome
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H/O of anxiety, depression, panic disorder, poor sleep
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Fibromyalgia Syndrome
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Pain response to at least 11 out of 18 known trigger points
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Fibromyalgia Syndrome
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Dx depends on ruling out other possibilities
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Fibromyalgia Syndrome
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Pain usually of neck, trapezius, lower back/upper buttocks
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Fibromyalgia Syndrome
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CNS mechanism possibly
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Fibromyalgia Syndrome
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No objective findings, Dx is clinical
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Fibromyalgia Syndrome
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Increased substance P
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Fibromyalgia Syndrome
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Dec'd blood flow to thalmus and caudate nucleus
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Fibromyalgia Syndrome
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Stage 3-4 sleep often interrupted = alpha wave intrusion
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Fibromyalgia Syndrome
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Asymptomatic, early
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Osteoporosis
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Pathologic fractures (esp. pelvis, femur, verterbrae)
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Osteoporosis
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Radiculopathy
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Osteoporosis
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X-ray = osteopenia, vert crush fx (dec'd bone mass)
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Osteoporosis
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DEXA scan
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Osteoporosis
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Tx = stay active, get calcium, HRT
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Osteoporosis
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Evista, Bisphosphates (Fosamax)
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Osteoporosis
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Miacalcin nasal spray
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Osteoporosis
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Metabolic demineralizing bone disease
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Osteoporosis
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Secondary = from endocrine, neoplasia, GI, drugs, misc.
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Osteoporosis
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Primary = from postmenopause or senile
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Osteoporosis
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Bone loss = mostly from trabecular bone (not cortical bone)
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Osteoporosis
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Low estrogen = risk factor
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Osteoporosis
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Reduced phys activity = risk factor
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Osteoporosis
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Immobilization could lead to pneumonia and DVT/pul embolism
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Osteoporosis
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Bone pain
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Paget's Disease
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Enlarged and/or deformed soft bones (hat doesn't fit)
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Paget's Disease
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Pathologic fx = chalkstick fx
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Paget's Disease
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Inc'd urine calcium and hydroxyproline (osteolytic phase)
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Paget's Disease
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Inc'd alk phos (osteoblastic phase)
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Paget's Disease
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X-ray = thicker, white, more radiopaque bone, less white in other bone areas
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Paget's Disease
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Bone shows mosaic pattern (woven)
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Paget's Disease
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Bone hypervascularity = inc'd CO = highoutput CHF and vascular steal phenomena (TIA)
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Paget's Disease
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Vert crush fx = back pain and radiculopathy
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Paget's Disease
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Skull growth = cranial neuropathy
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Paget's Disease
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Bisphosphate (Fosamax)
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Paget's Disease
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3 phases = primary osteolytic phase, mixed phase, osteosclerotic phase
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Paget's Disease
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