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83 Cards in this Set
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- Back
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S/Sx of small vessel vasculitis
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palpable purpura
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General S/Sx of vasculitis include
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Myositis
Arthritis Mononeuritis multiplex Multisystem dz |
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Labs related to vasculitis include
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FUO
high ESR high Acute phase reactants |
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Large-vessel vasculitis dzs are classified as
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Giant Cell
Takayasu's |
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Medium and small vessel vasculitises
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PAN
Churg-Strauss Wegner's |
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In general, giant cell arteritis is ...
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Large vessel vasculitis in which MULTINUCLEATED GIANT CELLS infiltrate vessels ARISING FROM THE AORTIC ARCH
Typically involves the TEMPORAL ARTERY |
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Giant cell arteritis typically involves which specific artery?
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TEMPORAL a
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The ESR in giant-cell arteritis is
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ESR > 60
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There is a 15% associated of _____ with giant cell arteritis
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Polymyalgia rheumatica
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Specific SXS of giant cell arteritis include
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Jaw claudication
Anaurosis fugax Temporal headache Diplopia |
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_____ is indicated in suspected giant cell arteritis, especially given that 40-50% of pts will _____ if untreated
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Temporal a bx
Go blind |
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A large vessel vasculitis affected the aorta and its tributaries, but typically in young asian women
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Takayasu Arteritis (TA)
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TA classically affects the ____, causing ____ in them and ____
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Arms
Claudication Raynaud's phenomenon |
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PAN is a small vessel vasculitis that can affected _____, but has what exception?
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Can affect any organ system, but typically SPARES THE LUNGS
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PAN on PE reveals ____ and is associated with what other dz processes?
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palpable purpura
Hep B, leukemia, HIV |
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Churg-Strauss is a variant of _____ and mainly differs how?
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PAN
AFFECTS THE LUNGS! |
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Pts with Churg-Strauss typically present with _____ because of?
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Asthma and peripheral eosinophilia
Involvement of the lungs, contrary to normal PAN |
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Wegner's Granulomatosis in general is ...
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A small vessel vasculitis with necrotizing granulomas of the SINUSES, LUNGS, and KIDNEYS; can affect joints
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Unlike the other vasculitis dzs, Wegner's often presents with
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ULCERATIVE PURPURA
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______ is positive in the other vasculitis dzs except for ____, which is positive for what?
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P-ANCA
Wegner's C-ANCA |
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Wegner's is dx by ...
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Positive C-ANCA with upper and lower respiratory involvement and glomerulonephritis (+ RBC casts in UA)
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Wegner's is tx by
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high-dose steroids
immunomodulators |
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Seronegative Spon. are generally classified as ...
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Multisystem inflammation with HLA-b27 ab (+) and RF(-)
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Patterns of involvement in Seronegative spon are ..
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Asymmetric polyarticular or oglioarticular arthritis
Spine involvement Dactylitis (Sausage fingers) |
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Ankylosing Spondylitis (AS) is characterized as
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Onset in late adolescence/early adulthood of "bent spine" starting in SI joint that is more common in men
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Systemic associations with AS include ..
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Sacroillitis
Uveitis Aortitis |
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Pts with AS eventually progress to
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"Bamboo Spine"
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Treatment of AS includes
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Exercise (reduces pain)
Postural training NSAIDs Surgery for mobility |
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Reiter's Syndrome (Reactive Arthritis) is associated with which bacteria?
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Shigella
Salmonella Campylobacter Yersinia Chlamydia Klebsiella |
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Extra articular manifestations of Reiter's include
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Keratoderma blennorrhagicum
Circinate balanitis Oral ulcers on tongue and palate |
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Keratoderma blennorrhagicum is
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papulosuqamous rash often on soles of feet
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Circinate balanitis is
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lesions on glans penis
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Lab findings related to Reiter's include
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RA, ANA neg
Leukocytosis Thrombocytosis Acute phase reactants high IgA Reiter's cells |
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Reiter's cells found in Reiter's syndrome are ...
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Large monocytes with ingested PMNs with inclusion bodies
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Tx of Reiter's syndrome is
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Symptomatic
NSAIDs |
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Duration of Reiter's is ..
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self limited to 3-12 mos
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A few pts of Reiter's syndrome may progress to
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15% to chronic symptoms
10% to AS |
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5-7% of pts with psoriasis may progress to
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psoriatic arthritis
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the age of onset of psoriasis is ____, and psoriatic arthritis is _____
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5-15
30-55 |
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The worst-case scenario related to psoriatic arthritis is
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arthritis mutilans
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Classic x-ray finding in psoriatic arthritis
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pencil-in-cup deformity
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Tx of psoriatic arthritis includes
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NSAIDs
DMARDs PUVA therapy anti TNFa |
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Rheumatoid Factor (RF) is actually ..
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antibody to the Fc portion of IgG
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___ is associated with severe RA dz
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HLA-DR4
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The joint aspirate in a pt with RA would demonstrate
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low viscoscity
high WBC (5-50k PMN) |
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In the late stages of RA, the hand would demonstrate what deformities?
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Boutonniere deformity of thumb
Ulnar deviation of MCP joints Swan-neck deformity of fingers |
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Extra articular manifestations of RA include
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Rheumatoid nodules (on extensor surfaces typically)
Anemia of chronic dz Vasculitis (mimics PAN) Mononeuritis multiplex (foot or wrist drop) Felty Syndrome (RA, splenomegaly, neutropenia) Sjogren's |
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Treating RA with ___ only treats the PAIN
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Tylenol
Tramadol Narcotics |
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Treating RA with ___ only treats pain and inflammation, but does not slow joint destruction
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NSAIDs/COX-2
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Treating RA with __ helps pain, inflammation, and slows joint destruction but is not for ____
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Steroids
long-term use |
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RA, besides NSAID-type rx, can also be treated with
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DMARDs
Surgery |
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____ is the most common form of chronic childhood arthritis
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juvenile RA
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Juvenile RA is dx by the presence of ____ for at least 6 weeks, and other causes excluded
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Two or more of loss of motion, tenderness, pain on movement, joint warmthy
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Systemic onset juvenile RA (jRA) characterized by
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1-2 times per day temp is > 101
Rash on trunk (transient, nonpuritic, pink, blanching, macular rash) |
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Polyarticular jRA is characterized as
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> 4 joints involved, usually in girls
RF+, HLA-DR4+ is bad RF- is mild |
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Pauciarticular jRA (pajRA) is characterized as
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involvement of 4 or less joints
Early is mainly girls and has EYE INVOLVEMENT Late is mainly boys and has LARGE JOINT involvement and is BAD |
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OA is the most common disease of the joint. Risk factors include
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Age
Heredity Repetitive use and trauma Female sex Obesity |
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OA features in the hand include
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Heberden's nodes on the DIP
Bouchard's nodes on the PIP |
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COmmon joints involved in OA include
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Hands
Knee Hip Spine |
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Gross changes seen in OA include
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Cartilage irregularity
Ebernation and ulceration of cartilage cartilage loss bone on bone |
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The OAritic hand
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Has fusiform swelling of the joints, Heberden's nodes on the DIP, Bouchard's nodes on the PIP
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uScopic changes seen in OA include
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Decreased glycosaminoglycans
(Chondroitin sulfate, keratin sulfate, hyalaronic acid) Increased water content Increased MMP activity |
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MMP is normally inhibited by
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TIMP
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S/Sx of oA include
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Intermittent pain
Pain increased with use Morning Stiffness < 30 min Worse with weather changes Common joint pattern Crepitus Local warmth and effusion |
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Synovitis is NOT seen in which type of arthritis?
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osteoarthritis
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The classic radiographic feature of OA is ..
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bone proliferation
(osteophyte and spur formation) |
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General radiographic findings in OA include
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Asymmetric joint space narrowing
Subchondral cysts NO MARGINAL EROSIONS |
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Marginal erosions are seen in which type of arthritis?
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Rheumatoid
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non-Rx tx of OA includes
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Reduce joint loading (wt loss, improved posture, splinting, canes)
Streghten supporting structures (PT) Pt education |
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Rx tx of OA includes
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Glucosamine/costochondrointin
Acetomenophin Capsasin NSAIDs/COX2 Tramadol Narcs Intra articular injections of steroids or hyalaronic acid |
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The labs in a pt with OA would demosntrate
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Normalcy
BUT up to 20% of healthy people will have positive RF Sed rate increases with age |
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Prolonged use of NSAIDs may lead to
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GI bleeding
HTN REnal failure Liver failure |
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Surgical tx of OA includes
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CLosed tidal joint lavage
Arthroscopic debridement and lavage osteotomy total joint arthroplasty |
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Most common presentation of septic arthritis
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Monoarticular
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Pts with polyarticular septic arthritis typically have a preexisting ____ or ____
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RA
immunosuppressive dz |
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Most common septic arthritis microbes in drug users and HIV pts
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S. aureus
gram neg |
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Most common microbes in SepA in pts with Colon CA or debilitating dz
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bacteroides fragilis
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Most common bacterial arthritis is
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N. gonorrhoeae
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Presentation of septic arthritis with N. gonorrhea infection is
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5-7 day hx of chills
migratory polyarthralgia tenosynovitis of fingers and toes Skin lesions but NOT in oral mucosa |
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N. gonorrhea septic arthritis should be tx with
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Ceftriaxone 1g/d for 7 days
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Viral arthritis is typically d/t
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Parvo B-19 ("Fifth dz")
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PResentation of viral arthritis d/t Parvo B19
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"Slapped cheeks"
fever Arthralgia in adults (not common in kids) "Boxing glove" effect |
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Parvo B19 septic arthritis is dx by
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Anti B19 IgM
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