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257 Cards in this Set
- Front
- Back
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What type of cartilage is in diarthodial joints?
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Type II hyaline cartilage
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Where is the initial injury in RA?
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synovial microvasculature
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What is the most important destructive element in RA?
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pannus formation
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What is pannus?
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granulation tissue
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What is the main component of vascular granulation tissue?
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proliferating fibroblasts
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What type of inflammatory cells are present in pannus?
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T lymphocytes
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On what chromosome is the Major Histocompatability Complex?
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Chromosome 6
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How many criteria must be present over what time frame to diagnose RA?
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4/6weeks
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What aer the 7 ACR criteria?
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1. morning stiffness
2. arthritis of at least 3 joints 3. arthritis of hand joints 4. symmetric arthritis 5 rheumatoid nodules 6. RF positive 7.radiographic changes in hands and wrists |
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How long does hand/wrist morning stiffness last in RA? OA?
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>1-2 hours for RA
<30 minutes for OA |
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What are 4 characteristics of synovial fluid in RA?
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1. Low viscosity
2. WBC1,000-75,000 3. >70% PMNs 4. Transparent - cloudy |
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Antibodies to what peptides are specific to RA and indicate aggressive disease?
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cyclic citrullinated peptides
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What percentage of RA patients are RA +?
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85%
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RF+ can be seen in what 3 other major rheumatoid diseases?
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SLE
scleroderma Sjogren's |
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What hand joint is spared in RA?
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DIP
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Name 5 characteristic radiographic hand/wrist/foot findings in RA.
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1. Erosion of ulna styloid
2. Erosion of metatarsal head of MTP 3. Ulnar deviation 4. Radial deviation of radiocarpal joint 5. Hallux Valgus |
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What cervical area is affected by RA?
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atlantoaxial joint subluxation >2.5mm
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What are the two characteristic RA finger deformities?
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Boutonniere deformity
Swan Neck deformity |
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What is main defect in boutonniere's deformity?
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Rupture of central slip causing PIP to protrude
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What is the treatment for Boutonniere's?
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Ring split
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What joint is affected in Boutonniere's?
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PIP
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What finger joints are affected in Swan Neck?
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MCP or PIP
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Describe 3 finger joint positions of Swan Neck
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1. flexion contracture of MCP
2. Hyperextension of PIP 3. Flexion of DIP |
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Describe 3 finger joint positions of Boutonniere's.
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1. Hyperextension of MCP
2. Flexion of PIP 3. Hyperextension of DIP |
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Where is the main defect resulting in ulnar deviation of fingers?
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weakening of ECU
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In what direction does the wrist deviate in ulanar deviation of fingers?
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radially
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What two tendons are involved with de Quervain's Tenosynovitis?
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extensor pollicis brevis (EPB) and abductor pollicis longus (APL)
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What ligaments are involved with the Pseudobenediction sign?
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radioulnar ligaments
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In what direction are the most common atlantoaxial subluxations?
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anterior
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What is protrusio acetabuli?
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inward bulging of the acetabulum into the pelvic cavity
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What is the position of the toes in hallux valgus?
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lateral deviation of toes
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What drug can accelerate the development of rheumatoid nodules?
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methotrexate
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Name two conditions with rheumatoid nodules
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RA
Gout |
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Name 4 features of Caplan's Syndrome.
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1. Intrapulmonary nodules
2. RF+ 3. Associated with RA and pneumoconiosis 4. Granulomatous response to silica dust |
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Name a cardiac manifestation of RA?
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pericarditits
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What is the primary EKG abnormality in pericarditis?
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diffuse ST elevations
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Name a hematologic manifestation of RA.
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Felty's syndrome
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What is the classic triad of Felty's?
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RA
splenomegaly leukopenia |
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What type of weight program is indicated for RA/
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isometric
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Why is heat not used in acutely inflamed joints in RA?
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heat increases activity of collagenase that causes increased joint destruction
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What therapy is used in acutely inflamed RA joints?
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cryotherapy
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What is the major goal of wrist splinting in RA?
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to prevent MCP flexion
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Name six indicators of a poor prognosis in RA.
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1. Rheumatoid nodules
2. RF+ 3. xray shows erosion 4. synovitis 5. insidious onset 6. antiboidies to CCp |
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What is the nature of adalimumab?
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It is a human monoclonal antibody
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What is the nature of etanercept
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It is a soluble receptor
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What is the nature of infliximab?
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It is a chimeric antibody
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What is the MOA of all anti-TNF agents?
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They reduce levels of TNF-alpha
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Name 4 main toxicities of anit-TNF agents.
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1. reactivation of TB
2. demyelinating disease 3. CHF 4. Autoimmunity |
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Name a co-stimulating modulator
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abatacept
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What is the MOA of abatacept?
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prevent T-cell activation
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What is a main toxicity of abatacept?
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COPD
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Name a anti-b-cell antibody medication
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rituximab
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What is the MOA of rituximab?
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depletes B-cells
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What is the main toxicity of rituximab?
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infection
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What is the main toxicity of hydroxychloroquine?
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macular damage
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What is the main toxicity of sulfasalazine?
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myelosuppression
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What are 3 main toxicities of methotrexate?
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stomatitis
hepatic fibrosis cirrhosis |
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What are 4 main toxicities of cyclosporine?
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renal dysfunction
tremor hirsutism gum dysplasia |
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What are 3 main toxicities of gold?
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myelosuppressio
proteinuria diarrhea |
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What are 3 main toxicities of azothioprine?
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myelosuppression
hepatotoxicity lymphoproliferative disorders |
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What are 3 main toxicities of d-penacillamine?
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oral ulcers
bone marrow suppression proteinuria |
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What are 5 main toxicities of chlorambucil?
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bone marrow suppression
GI seizures pulmonary fibrosis infertility` |
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What is the MOA of interleukin?
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antagonizes Il-1 by binding to interleukin receptor
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What is the therapeutic blood level for ASA in RA?
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15-25mg/dL
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What is the toxic level for ASA?
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>30mg/dL
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What is hallmark blood test for gout?
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hyperurecemia
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What unique medicine is used for acute gout and what is its MOA?
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cochicine - inhibits phagocytosis of urate crystals
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What is the hallmark of ankylosing spondylitis?
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bilateral sacroiliitis
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What is the genetic marker in >90% of patients with ankylosing spondylitis?
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HLA-B27 +
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Name 5 HLA-B27 + diseases,
|
Ankylosing spondylitis
Enteropathic arthropathy Pauciarticular JRA Psoriatic arthritis Reiter's syndrome |
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What joint finding is common to AS and RA?
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synovial inflammation
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What are the top 4 sites of AS in order of descending incidence?
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sacroiliac
lumbar thoracic cervical |
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Does morning lumbar stiffness in AS worsen with exercise?
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No, exercise improves stiffness
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What is the most common extraskeletal symptom of AS?
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iritis/iridocyclitis
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What are some other extraskeletal conditions associated with AS?
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aortitis leading to conduction defects
Pulmonary fibrosis amyloidosis cauda equina syndrome |
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What are two common xray findings in AS?
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SI joint narrowing and bamboo spine
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Where is the pathology in bamboo spine?
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ossification of the anterior spinal ligament
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What is syndesmophyte formation?
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squaring of lumbar vertabrae's anterior concavity
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What clinical test is used for AS and what does it detect?
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Schober's test- limitation of forward flexion
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What is the triad of reiter's syndrome (reactive arthritis)?
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conjunctivitis
arthritis nongonococcal urethritis |
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What percentage of patients with reactive arthris progress to AS?
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3-10%
|
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Reactive arthritis typically follows what two kinds of infections?
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GU - chlamydia
GI - campylobacter,yersinia, shigella, salmonella |
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Is reactive arthritis symmetric or asymmetric>
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asymmetric
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What aer the 3 most common locations for reactive arthritis?
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knees, ankles, small joint of the feet
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With what condition can reactive arthritis be confused?
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plantar fasciitis
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Name 4 finding of synovial fluid analysis in reactive arthritis.
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turbid
poor viscosity WBC 5,000-50,000 PMN increased protein, normal glucose |
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Name 3 xray findings in reactive arthritis.
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"lover's heel" - erosions at insertions of plantar fascia and achillies tendon
syndesmophytes pencil in cup deformities |
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What areas are most commonly involved in psoriatic arthritis due to HIV?
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foot and ankle
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What two agents are never used in psoriatic arthritis due to HIV?
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oral steroids
methotrexate |
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On what leg and arm surfaces is psoriatic arthritis located?
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extensor surfaces
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What is auspitz's sign?
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gentle scraping of psoriatic lesions results in pinpoint bleeding
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What finger joint is affected in psoriatic arthritis?
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DIP
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Is psoriatic arthritis symmetric or asymmetric?
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asymmetric
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"Telescoping of the finger" is called what in psoriatic arthritis?
|
arthritis mutilans
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What is a cardiac manifestation of psoriatic arthritis?
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aortic insufficienty
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Name 5 xray findings in psoriatic arthritis.
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pencil in cup of DIP
asymmetric sacroiliitis fluffy periostitis syndesmophytes bone erosion |
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What type of UV light is used to treat psoriatic arthritis?
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long wave UV A light
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What two anti-TNFs work best against psoriatic arthritis?
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adalimumab
infliximab |
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Enteropathic arthritis is secondary to bacterial etiology in what two type of IBD?
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Crohn's and UC
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What 3 joints are most commonly involved with enteropathic arthritis?
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knees, ankles, and feet
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Is synovitis present in enteropathic arthritis?
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Yes
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Is enteropathic arthritis symmetric or asymmetric?
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asymmetric
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Can sacroiliitis occur in enteropathic arthritis?
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yes
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What is an extra-articular manifestation of Crohn's
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erythema nodosa
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What is an extra-articular manifestation of UC?
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pyoderma gangrenosa
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What oral manifestations are apparent with enteropathic arthropathies?
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deep oral ulcers
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SI joint involvement can occur with what 4 types of arthropathies?
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AS, reactive arthritis, PA, and enteropathic arthropathies
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What is the mnemonic to remember the 11 diagnostic criteria for SLE"
|
DOPAMINE RASH
D - discoid rash O- oral ulcers P - photosensativity A - arthritis M - malar (butterfly rash) I- immunologic disorder NE - neurologic disorder R- renal disorder A- abnormal ANA S - serositis (pleuritis or pericarditis H - hematological disorder |
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How many of the 11 SLE criteria must be present?
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4
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What are 2 primary features of Jaccoud's arthritis?
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non-erosive
ulnar deviations of fingers |
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What two lab tests are specific for SLE?
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Ds-DNA
Anti-SM |
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What type of arthritis is specific for SLE?
|
Jaccoud's
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How is scleroderma classified?
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by the degree of skin thickening
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Scleroderma often develops rapidly after what condition?
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Raynaud's phenomenon
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What is CREST?
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C - calcinosis
R - raynaud's phenomenon E - esophageal dysmotility S - sclerodactaly T - Telangectasias |
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What are two trigger of Raynaud's?
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cold
stress |
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What medication is used to prevent Raynaud's
|
calcium channel blockers - nifedipine
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What condition is precipitated by strenuous exercise?
|
Eosinophilic faciitis
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What is the hallmark of polymyositis/dermatomyositis (P/D)?
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profound symmetrical weakness of proximal muscles
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What neck muscles are affected in P/D?
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anterior neck flexors
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What type of P/D is associated with malignancy?
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Type III
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The hallmark of type IV P/D is what?
|
severe joint contractures
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Name 4 pathological features of muscle cells in P/D.
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perifascicular atrophy
Type I and II fibers necrosis fiber size variation large nuclei |
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What are 5 EMG findings in P/D?
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PSW, fibs, CRDs, decreased amplitude, decreased duration
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What are 2 dermatologic features of dermatomyositis?
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lilac heliotrope rash with periorbital edema
gottron's papules-scaly dermatitis over MCP and PIP |
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What type of exercise is recommended in P/D?
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isometric
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What type of gammaglobulin treatment is recommended in P/D?
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IVIg
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What 4 blood labs are elevated in P/D?
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CK, aldolase, LDH, transaminases
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What muscles are affected first in P/D?
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hips, then shoulders and dysphagia
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What are 4 findings in juvenile dermatomyositis?
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heliotrope rash
clumsiness vasculitis responds well to steroids |
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Name 5 conditions with postive HLA-B27.
|
AS
Reiter's Psoriatic Arthritis Enteropathic arthritis Pauciarticular JRA |
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Name 3 conditions that a ANA+ and RF-.
|
SLE
Scleroderma Polymyositis |
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What condition affects Asian females who have erytherma nodosum on legs and pulselessness ?
|
Takayasu arteritis
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Abrupt visual loss is found in 15% of what condition?
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Temporal arteritis
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With what condition is temporal arteritis associated?
|
polymyalgia rheumatica
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What is the treatment for visual loss in temporal arteritis?
|
high dose steroids and ASA
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What is the treatement for Polymyalgia rheumatica?
|
steroids
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What percent of PMR patients develop temporal arteritis?
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15%
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What is the primary cause of death in polyarteritis nodosa?
|
glomerulonephritis
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Polyarteritis nodosa is also seen in what 3 conditions?
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RA
SLE Sjogren's |
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What is polyarteritis nodosa?
|
necrotizing vasculitis of small and medium vessels
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What is Wegener's granulomatosis?
|
necrotizing vasculitis on upper/lower respiratory tract and gloumerulonephritis
|
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What is Behcet's syndrome?
|
oral and genital skin ulcers
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What is Goodpasture's syndrome?
|
pulmonary and kidney involvement
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What are 4 clinical hallmarks of Sjogren's?
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dry eyes
dry mouth skin lesions parotid involvement |
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What are two extraglandular manifestations of Sjogren's?
|
arthralgia
raynauds |
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What is primary Sjogren's?
|
Dry eyes and mouth with ANA + and RF+
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What is the most common joint in infections arthritis?
|
knee
|
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What is most common bug in adults/children in infectious arthritis?
|
Adults: n. gonorrhea
Children: staph aureus |
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Wha tis the most common bug causing septic arthritis in RA in adults?
|
Staph aurues
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What is the most common bug in infants causing infectious arthritis?
|
H. influenza
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What is the most common bug causing infectious arthritis in neonates?
|
Group B Strep
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|
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TB arthritis most commonly affects which 2 joints?
|
hips and knees
|
|
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Where is Pott's disease found?
|
thoracic spine
|
|
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What is the rash in Lyme's disease called?
|
bull's eye rash
|
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What is the bug causing lyme's disease?
|
borrelia burgdorferi
|
|
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What is the presentation of synovial fluid analysis in lyme's disease?
|
inflammatory
|
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What are the two diagnostic tools used to dx lyme's disease?
|
ELISA, Western Blot
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What joint is most commonly affected in Lyme's disease arthritis?
|
knee
|
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What antibiotics are used in adults/children with Lyme's disease?
|
doxycycline/amoxicillin
|
|
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In what 2 joints does the arthritis of hemochromotosis most commonly occur?
|
2nd and 3rd MCP and PIP joints
|
|
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What is the treatment for hemochromatosis?
|
phlebotomy, NSAIDs
|
|
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Darkening of tissue parts is called what?
|
ochronosis (alkaptonuria)
|
|
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Alkaptonuria turns tissues and urine what color?
|
blue
|
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What area is affected by arthritis of alkaptonuria?
|
spine
|
|
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What is the inheritance pattern of alkaptonuria?
|
autosomal recessive
|
|
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What is the inheritance pattern of Wilson's disease?
|
autosomal recessive
|
|
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What metal is deposited in Wilson's disease?
|
copper
|
|
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What 3 joints are affected in the OA of Wilson's disease?
|
MCP, knees, spine
|
|
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What is the treatment for Wilson's disease?
|
copper chelation with penacillamine
|
|
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What joints are affected in the arthritis of Gaucher's disease?
|
hip and knee
|
|
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What is the inheritance pattern in Gaucher's disease?
|
autosomal recessive
|
|
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What is the defect in Gaucher's disease?
|
glucocerebroside accumulation in reticuloendothelial cells of spleen, liver, and bone marrow
|
|
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What joints are most commonly affected in arthritis of sarcoidosis?
|
Knees, PIP, MCP, wrists
|
|
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What are the microscope findings in amyloidosis?
|
homogenous eosinophilic material seen with Congo red dye
|
|
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What is a clinical feature of amyloidosis?
|
median neuropathy
|
|
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Effusions are common in amyloidosis in what joint?
|
shoulders
|
|
|
What is the inheritance pattern of hemophilia?
|
x-linked recessive
|
|
|
What factor is deficient in classic hemophilia?
|
Factor VIII
|
|
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What factor is deficient in Christmas disease?
|
Facter IX
|
|
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What joints are commonly affected in hemophilia?
|
elbow, knee, and wrist
|
|
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What is the etiology of pannus formation in the arthritis of hemophilia?
|
hemosiderin deposition in the joint causes synovial proliferation and pannus formation
|
|
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What treatment is considered last resort in hemophilia arthritis?
|
joint aspiration
|
|
|
Osteomyelitis of Sickle Cell is most commonly caused by what bug?
|
salmonella
|
|
|
Sicke Cell causes what percentage of femeral/humeral heads to go onto osteonecrosis?
|
33%/25%
|
|
|
Painful pitting of hands and feet in sickle cell is called?
|
dactylitis
|
|
|
What are the 3 main causes and affected joint in Charcot joint?
|
STD
Syrigomyelia - shoulder Tabes Dorsalis - syphilis knee Diabetic neuropathy - ankle |
|
|
What is the most common cause of charcot joint and where?
|
Diabetic neuropathy - ankle
|
|
|
What 3 x-ray findings of Charcot distinguishes it from OA?
|
bony fragments
subluxation periarticular debris |
|
|
What is the treatment of charcot joint?
|
immobilization
restriction of weight bearing |
|
|
What is SCFE?
|
Slippeed capital femoral epiphysis
|
|
|
What is the age range for SCFE for boys/girls
|
Boys - 13-16
Girls 11-13 |
|
|
What is the most common cause of SCFE?
|
hypothyroidism
|
|
|
What is a less common cause of SCFE?
|
Down's syndrome
|
|
|
What ROM is decreased in SCFE?
|
loss of internal rotation
|
|
|
Where is pain in SCFE?
|
groin and medial thigh
|
|
|
What causes pain in acute SCFE?
|
weight bearing
|
|
|
What is the most common slip in SCFE acute or chronic?
|
chronic
|
|
|
What 2 x-ray views are required in SCFE?
|
AP and Frog Leg
|
|
|
What type of pinning is done in SCFE?
|
Knowles
|
|
|
What are two maternal etiologic factors in congenital hip dislocation?
|
tight uterus
tight abdominal musculature |
|
|
What hip is more commonly dislocated in congenital hip dislocation?
|
Left
|
|
|
What test is done at birth to test for congenital hip dislocation?
|
Barlow - dislocation
Ortolani - relocation |
|
|
At what age are xray findings useful?
|
6 weeks
|
|
|
What is a complication of congenital hip dislocation?
|
AVN
|
|
|
What are 3 complications of SCFE?
|
chondrolysis
AVN OA |
|
|
What is LCPD?
|
Legg-Calve-Perthes Disease
|
|
|
What is the age of onset of LCPD?
|
2-12
|
|
|
What gender is affected most commonly by LCPD?
|
Boys
|
|
|
Is LCPD primarily unilateral or bilateral?
|
unilateral
|
|
|
What is an etiologic factor for LCPD related to stature?
|
Short stature
|
|
|
What endocrine disease is linked to LCPD?
|
hypothyroid
|
|
|
What are 4 findings in LCPD?
|
no pain
painless limp Hip flexure contracture - Thomas test short stature |
|
|
What xray view is required in LCPD?
|
frog leg
|
|
|
What xray sign is present in LCPD?
|
crescent sign
|
|
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What is the crescent sign in LCPD?
|
subchondral fracture
|
|
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What is a complication of LCPD?
|
AVN
|
|
|
What brace/cast are used in LCPD?
|
Toronto/Petrie
|
|
|
What 2 surgical treatments are used in LCPD?
|
epiphysiodesis/valugus osteotomy
|
|
|
What is the most common cause of hip pain in children? Treatment?
|
Acute transient synovitis. Self limiting
|
|
|
What is the mnemonic for AVN etiology?
|
PLASTIC RAGS
Pancreatitis Lupus Alcohol Steroids Trauma Idopathic infection Caisson disease Radiation Amyloid Gaucher's Disease Sickle Cell |
|
|
Name 4 trigger of Fibromyalgia
|
Physical activity
Inactivity Sleep Disturbance Emotional stress |
|
|
What is the primary diagnostic criteria of fibromyalgia?
|
11 of 18 tender points
both sides of body; upper and lower body |
|
|
Where are the fibromyalgia tender points?
|
occipital
lower cervical traps suprapinatus second rib lateral epicondyle gluteal greater trochanter knee |
|
|
What are the two meds approved for use in fibromyalgia?
|
Pregabalin - Lyrica
Duloxetine - Cymbalta |
|
|
What are the primary differences among myofascial pain syndrome, fibromyalgia, and chronic fatigue?
|
Chronic fatigue- disabling fatigue
Myofascial: local pain and tenderpoints that resolve. |
|
|
For how long must symptoms persist to characterized as Fibromyalgia?
|
3 months
|
|
|
Type 1 CRPS is also known as what 4 syndromes?
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RSD
Sudecks Algodystrophy Shoulder-hand |
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Type 2 CRPS is also known as what?
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Causalgia
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What type of CRPS is seen after a specific nerve injury?
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Type 2
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What are 3 hallmark symptoms of CRPS?
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allodynia
hyperalgesia hyperpathia |
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What is allodynia
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Pain induced by non-noxious stimulus
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What is hyperalgesia?
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lowered pain threshold and enhanced pain perception
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What is the time frame for dystrophic changes in CRPS?
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3-6 months
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What is the xray appearance of CRPS?
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ground-glass appearance and osteopenia
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What phase of a 3-phase bone scan is abnormal in CRPS?
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3rd phase with enhanced uptake in peri-articular structures
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What is the female:male ratio of CRPS in children?
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4:1
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What 6 clinical responses are necessary to confirm a properly performed stellate ganglion block?
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ipsilateral Horner's syndrome, anhidrosis
conjuctival injection nasal congestion vasodilation increased skin temperature |
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What is the guanethidine test?
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injection of guanethidine distal to a suprasystolic cuff causes pain and when the cuff is released there is pain relief
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What is the pentolamine test?
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IV pentolamine reproduces the pain
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What is the ischemia test?
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inflation of the suprsystolic cuff decreases the pain
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What is the pathological process in Dupuytren's contracture?
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fibrous hyperplasia and contrature of the palmar fascia causes flexion contracture at MCP and PIP joints
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What joints are affected in Dupuytren's contracture?
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MCP and PIP
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With what systemic diseases is Dupuytren's contracture associated?
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Epilepsy
pulmonary TB alcoholism DM |
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What is the demographic for Dupuytren's contracture?
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white males 50-70
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The palmar fascia is a continuation of what tendon?
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palmaris longus tendon
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What digits are most commonly affected by Dupuytren's contracture?
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4 and 5th digits
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Name 3 chemical treatement for Dupuytren's contracture
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trypsin
chymotrypsin lidocaine |
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What is trigger finger?
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With the finger in extension the nodule is distal to the pulley; when finger is flexed, the tendon locks proximal to the pulley
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What is the pathology of trigger finger?
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thickening of flexor tendon sheath
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At what pulley does the tendon catch?
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A1 pulley
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What is the most common extensor tendon injury?
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mallet finger
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What is the pathology of mallet finger?
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rupture of the extensor tendon into distal phalanx secondary to forceful flexion
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What is the treatment for mallet finger?
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splint the distal phalanx in hyperextension
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What is the surgical indication for mallet finger?
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avulsion of >1/3 bone
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List 4 conditions that may RF+?
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dermatomyositis/polymyositis
scleroderma Lupus Sjogrens |
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In what demographic group may RF+ be a normal finding?
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healthy elderly
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