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83 Cards in this Set

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S/Sx of small vessel vasculitis
palpable purpura
General S/Sx of vasculitis include
Myositis
Arthritis
Mononeuritis multiplex
Multisystem dz
Labs related to vasculitis include
FUO
high ESR
high Acute phase reactants
Large-vessel vasculitis dzs are classified as
Giant Cell
Takayasu's
Medium and small vessel vasculitises
PAN
Churg-Strauss
Wegner's
In general, giant cell arteritis is ...
Large vessel vasculitis in which MULTINUCLEATED GIANT CELLS infiltrate vessels ARISING FROM THE AORTIC ARCH

Typically involves the TEMPORAL ARTERY
Giant cell arteritis typically involves which specific artery?
TEMPORAL a
The ESR in giant-cell arteritis is
ESR > 60
There is a 15% associated of _____ with giant cell arteritis
Polymyalgia rheumatica
Specific SXS of giant cell arteritis include
Jaw claudication
Anaurosis fugax
Temporal headache
Diplopia
_____ is indicated in suspected giant cell arteritis, especially given that 40-50% of pts will _____ if untreated
Temporal a bx

Go blind
A large vessel vasculitis affected the aorta and its tributaries, but typically in young asian women
Takayasu Arteritis (TA)
TA classically affects the ____, causing ____ in them and ____
Arms

Claudication

Raynaud's phenomenon
PAN is a small vessel vasculitis that can affected _____, but has what exception?
Can affect any organ system, but typically SPARES THE LUNGS
PAN on PE reveals ____ and is associated with what other dz processes?
palpable purpura

Hep B, leukemia, HIV
Churg-Strauss is a variant of _____ and mainly differs how?
PAN

AFFECTS THE LUNGS!
Pts with Churg-Strauss typically present with _____ because of?
Asthma and peripheral eosinophilia

Involvement of the lungs, contrary to normal PAN
Wegner's Granulomatosis in general is ...
A small vessel vasculitis with necrotizing granulomas of the SINUSES, LUNGS, and KIDNEYS; can affect joints
Unlike the other vasculitis dzs, Wegner's often presents with
ULCERATIVE PURPURA
______ is positive in the other vasculitis dzs except for ____, which is positive for what?
P-ANCA

Wegner's

C-ANCA
Wegner's is dx by ...
Positive C-ANCA with upper and lower respiratory involvement and glomerulonephritis (+ RBC casts in UA)
Wegner's is tx by
high-dose steroids
immunomodulators
Seronegative Spon. are generally classified as ...
Multisystem inflammation with HLA-b27 ab (+) and RF(-)
Patterns of involvement in Seronegative spon are ..
Asymmetric polyarticular or oglioarticular arthritis

Spine involvement

Dactylitis (Sausage fingers)
Ankylosing Spondylitis (AS) is characterized as
Onset in late adolescence/early adulthood of "bent spine" starting in SI joint that is more common in men
Systemic associations with AS include ..
Sacroillitis
Uveitis
Aortitis
Pts with AS eventually progress to
"Bamboo Spine"
Treatment of AS includes
Exercise (reduces pain)
Postural training
NSAIDs
Surgery for mobility
Reiter's Syndrome (Reactive Arthritis) is associated with which bacteria?
Shigella
Salmonella
Campylobacter
Yersinia
Chlamydia
Klebsiella
Extra articular manifestations of Reiter's include
Keratoderma blennorrhagicum
Circinate balanitis
Oral ulcers on tongue and palate
Keratoderma blennorrhagicum is
papulosuqamous rash often on soles of feet
Circinate balanitis is
lesions on glans penis
Lab findings related to Reiter's include
RA, ANA neg
Leukocytosis
Thrombocytosis
Acute phase reactants
high IgA
Reiter's cells
Reiter's cells found in Reiter's syndrome are ...
Large monocytes with ingested PMNs with inclusion bodies
Tx of Reiter's syndrome is
Symptomatic
NSAIDs
Duration of Reiter's is ..
self limited to 3-12 mos
A few pts of Reiter's syndrome may progress to
15% to chronic symptoms
10% to AS
5-7% of pts with psoriasis may progress to
psoriatic arthritis
the age of onset of psoriasis is ____, and psoriatic arthritis is _____
5-15

30-55
The worst-case scenario related to psoriatic arthritis is
arthritis mutilans
Classic x-ray finding in psoriatic arthritis
pencil-in-cup deformity
Tx of psoriatic arthritis includes
NSAIDs
DMARDs
PUVA therapy
anti TNFa
Rheumatoid Factor (RF) is actually ..
antibody to the Fc portion of IgG
___ is associated with severe RA dz
HLA-DR4
The joint aspirate in a pt with RA would demonstrate
low viscoscity
high WBC (5-50k PMN)
In the late stages of RA, the hand would demonstrate what deformities?
Boutonniere deformity of thumb

Ulnar deviation of MCP joints

Swan-neck deformity of fingers
Extra articular manifestations of RA include
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
Treating RA with ___ only treats the PAIN
Tylenol
Tramadol
Narcotics
Treating RA with ___ only treats pain and inflammation, but does not slow joint destruction
NSAIDs/COX-2
Treating RA with __ helps pain, inflammation, and slows joint destruction but is not for ____
Steroids

long-term use
RA, besides NSAID-type rx, can also be treated with
DMARDs
Surgery
____ is the most common form of chronic childhood arthritis
juvenile RA
Juvenile RA is dx by the presence of ____ for at least 6 weeks, and other causes excluded
Two or more of loss of motion, tenderness, pain on movement, joint warmthy
Systemic onset juvenile RA (jRA) characterized by
1-2 times per day temp is > 101
Rash on trunk
(transient, nonpuritic, pink, blanching, macular rash)
Polyarticular jRA is characterized as
> 4 joints involved, usually in girls

RF+, HLA-DR4+ is bad

RF- is mild
Pauciarticular jRA (pajRA) is characterized as
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
OA is the most common disease of the joint. Risk factors include
Age
Heredity
Repetitive use and trauma
Female sex
Obesity
OA features in the hand include
Heberden's nodes on the DIP

Bouchard's nodes on the PIP
COmmon joints involved in OA include
Hands
Knee
Hip
Spine
Gross changes seen in OA include
Cartilage irregularity
Ebernation and ulceration of cartilage
cartilage loss
bone on bone
The OAritic hand
Has fusiform swelling of the joints, Heberden's nodes on the DIP, Bouchard's nodes on the PIP
uScopic changes seen in OA include
Decreased glycosaminoglycans
(Chondroitin sulfate, keratin sulfate, hyalaronic acid)

Increased water content

Increased MMP activity
MMP is normally inhibited by
TIMP
S/Sx of oA include
Intermittent pain
Pain increased with use
Morning Stiffness < 30 min
Worse with weather changes
Common joint pattern
Crepitus
Local warmth and effusion
Synovitis is NOT seen in which type of arthritis?
osteoarthritis
The classic radiographic feature of OA is ..
bone proliferation
(osteophyte and spur formation)
General radiographic findings in OA include
Asymmetric joint space narrowing
Subchondral cysts
NO MARGINAL EROSIONS
Marginal erosions are seen in which type of arthritis?
Rheumatoid
non-Rx tx of OA includes
Reduce joint loading (wt loss, improved posture, splinting, canes)

Streghten supporting structures (PT)

Pt education
Rx tx of OA includes
Glucosamine/costochondrointin
Acetomenophin
Capsasin
NSAIDs/COX2
Tramadol
Narcs
Intra articular injections of steroids or hyalaronic acid
The labs in a pt with OA would demosntrate
Normalcy

BUT up to 20% of healthy people will have positive RF

Sed rate increases with age
Prolonged use of NSAIDs may lead to
GI bleeding
HTN
REnal failure
Liver failure
Surgical tx of OA includes
CLosed tidal joint lavage
Arthroscopic debridement and lavage
osteotomy
total joint arthroplasty
Most common presentation of septic arthritis
Monoarticular
Pts with polyarticular septic arthritis typically have a preexisting ____ or ____
RA
immunosuppressive dz
Most common septic arthritis microbes in drug users and HIV pts
S. aureus
gram neg
Most common microbes in SepA in pts with Colon CA or debilitating dz
bacteroides fragilis
Most common bacterial arthritis is
N. gonorrhoeae
Presentation of septic arthritis with N. gonorrhea infection is
5-7 day hx of chills
migratory polyarthralgia
tenosynovitis of fingers and toes

Skin lesions but NOT in oral mucosa
N. gonorrhea septic arthritis should be tx with
Ceftriaxone 1g/d for 7 days
Viral arthritis is typically d/t
Parvo B-19 ("Fifth dz")
PResentation of viral arthritis d/t Parvo B19
"Slapped cheeks"
fever
Arthralgia in adults
(not common in kids)

"Boxing glove" effect
Parvo B19 septic arthritis is dx by
Anti B19 IgM