Rheumatology

Front 1

Rheumatoid Arthritis
- diagnosis

Back 1

5/7:
1. morning stiffness >1 hour
2. 3+ joint groups with soft tissue swelling/fluid
3. includes: wrist, PIP, MCP
4. symmetrical swelling
5. subcutaneous nodules
6. positive RF
7. radiographic changes

Front 2

Rheumatoid Arthritis
- signs and symptoms (intra-articular)

Back 2

Joints = pain, swelling, tenderness, warmth
- AM stiffness, limited ROM, improve with exercise
- PIPs, MCPs, MTPs, wrist, elbow, knee, forefoot, ankle, subtaalar, upper cervical spine
- hands: ulnar deviation, radial deviation of wrist, palmar subluxation, Z deformity, swan-neck/ boutonniere/ mallet deform
- feet: hindfoot eversion, plantar sublux, midened forefoot, hallux valgus, lateral dev and dorsal sublux of toes

Front 3

Rheumatoid Arthritis
- extra-articular manifestations

Back 3

MSK: atrophy, contractures; rheumatoid nodules: olecranon, prox ulna, achilles, occiput (20-30%)
Resp: pleural disease, interstitial fibr, pleuro pulm nodules, pneumonitis, arteritis
Lympadenopathy, Splenomegaly
Vasculitis: can occur anywhere (neuro, MI, cut ulcers)
rare Heart disease
Eye (<1%): episcleritis, scleritis

Front 4

Rheumatoid Arthritis
- labs

Back 4

CBC: normochromic, normocytic anemia; leukopenia, eosinophilia
ESR↑, ceruloplasmin & CRP↑
RF↑ (66% of patients) >1:80
anti-CCP
synovial fluid: yellow, turbid, ↓visc, ↑WBC, ↑protein

Front 5

Rheumatoid Arthritis
- radiography

Back 5

usually on posteroanterior hand and wrist, knee, feet, etc
* erosions --> fusion
* periarticular osteopenia
* deviations, subluxation
* joint space narrowing

Front 6

Osteoarthritis
- risk factors

Back 6

age >50
obesity
prologed occupational or sports stress
injury - trauma, prev. inflam/infect arth

Front 7

Osteoarthritis
- signs and symptoms

Back 7

- DIP, PIP, knee, cerv/lumb spine, feet, glenohumoral, acromioclavicular, tibiotalar, sacroiliac, TMJ
- mono or asymm oligo/polyarthritis
- joint pain: deep ache, worse by use/better @rest; stiffness/gelling with inactivity <20min, tenderness; can have swelling/bony enlargement, ↓ROM
- periarticular muscle wasting/varus/vagus deform
-Hands: Heberden's/Bouchard's, squared thumb base
-Knee: palpable osteophytes, crepitus, shrug sign (pat fem)
-Feet: hallux valgus/rigidus; hammer/mallet/claw toes

Front 8

Osteoarthritis
- radiography

Back 8

Joint space narrowing
Subchondral bone sclerosis
Subchondral cysts (dark circles on bone near joint)
Osteophytes
- can have erosions in erosive OA

Front 9

Rheumatoid Arthritis
- risk factors

Back 9

HLA-DR4
family hx
Native American
age 20-50 years

Front 10

Rheumatoid Arthritis
- associated conditions

Back 10

Sjogren syndrome
Felty syndrome
↑incidence: infections, lymphomas, renal +CVD
renal disorders from therapy
amyloidosis from chronic inflamm