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59 Cards in this Set
- Front
- Back
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why does neuropathic arthropathy contribute to arthritis?
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due to the loss of feeling which will lead to more mechanical problems
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what are some examples of noninflammatory disorders?
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hemophilia, PVNS, synovial sarcoma, neurpathic arthropathy, osteroarthritis, avascular necrosis, and mechanical problems.
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what are the two major categories of arthritis?
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noninflammatory and inflammatory
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what three categories are under the inflammatory heading?
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infectious, crystalline, autoimmune
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a pt presents with a true infection in his kneecap and a true infection in his elbow, what should you be worried about?
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a 50% mortality. 2 or more true infections in joints leads to a 50% mortality rate
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T/F
infections usually limit themselves to 2 joints. |
false
they are monoarticular so they usually only attack one |
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what is generally the cause of a polyarticular?
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direct infection or immune complex mediated deposition within joints - ie rheumatic fever
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what are the crystalline forms of inflammatory arthritis?
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gout (uric acid), pseudogout (calcium pyrophosphate), basic calcium deposition
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T/F
Crystalline forms of inflammatory arthritis usually infect anywhere from 1 to many joints. |
TRUE
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what are the two types of autoimmune disorders?
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erosive and nonerosive
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what are the three erosive types of autoimmune disorders?
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RA, spondyloarthropathy and IBD
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what are the four nonerosive autoimmune disorders?
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lupus, MCTD, vasculitis, myopathy
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pt presents with chronic back pain localized to his lumbar spine that started about a month and a half ago. What autoimmune disorder can you officially rule out
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RA- even though the time frame is correct, RA does not involve the lumbar spine.
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pt presents with chronic back pain, what autoimmune disorder can you immediately rule out?
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lupus- does not involve the back
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what are the things that you always consider when trying to determine what type of arthritis your pt is suffering from?
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onset
distribution stiffness swelling back pain/ spinal involvement systemic manifestations |
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what anatomical part of the joint is usually not the problem in an arthritic pt?
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the capsule
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how does cartilage get its nutrients?
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via diffusion
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what is tenosynovitis?
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is inflammation of the lining of the sheath that surrounds a tendon (the cord that joins muscle to bone).
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T/F
Backpain is always just a mechanical problem. |
FALSE
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pt comes in complaining of joint pain, you notice an effusion of sorts around the joint. You drain some from the joint area and notice that it is clear, yellow and viscous, and send off for tests. Here are the results:
leukocytes: 1500 are they normal, noninflammatory, inflammatory, or septic? |
noninflammatory
200-2000 clear, yellow, viscous |
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pt comes in complaining of some elbow pain. you notice that it is a little puffy and draw some fluid from around the joint. You note that it is clear, colorless and viscous and send it off for tests. Results:
180 Leukocytes are they normal, noninflammatory, inflammatory, or septic? |
normal
<200 clear, colorless, and viscous |
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pt comes in complaining of some elbow pain. you notice that it is a little puffy and draw some fluid from around the joint. You note that it is purulent with markedly decreased viscosity and send it off for tests. Results:
55,000 Leukocytes- 97% PMNs are they normal, noninflammatory, inflammatory, or septic? |
septic
>50,000 >95% PMNs Purulent, markedly decreased viscosity |
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pt comes in complaining of some elbow pain. you notice that it is a little puffy and draw some fluid from around the joint. You note that it is cloudy, yellow with decreased viscosity and send it off for tests. Results:
Leukocytes: 4000 are they normal, noninflammatory, inflammatory, or septic? |
inflammatroy
2000-100,000 cloudy, yellow, decreased viscosity |
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over what percentage of adults older than 65 will have evidence of OA of the hands?
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80%
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in what demographics is OA more common?
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women (esp over 50 and african american)
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what percentage of persons over age of 70 will have symptomatic OA?
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75%
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what are the risk factors for OA?
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age, female sex, obesity, hereditary, trauma, neuromuscular dysfunction, metabolic disorders
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what is the earliest finding of degenerative joint disease?
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fibrillation of superficial layer articular cartilage
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what is the matrix of the cartilage replaced with in degenerative joint disease? what is released to cause further degradation?
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water and loss of proteoglycans; cytokines and metalloproteinases
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pt presents to you with morning stiffness, joint pain that worsens over the course of the day, bony swelling,functional impairment and diminished range of motion. DX
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osteoarthritis
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pt presents to your office for joint pain and you notice that her fingers where bent at funny angles. what should be on your differential?
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osteoarthritis
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what are some radiographic features that you can see of osteoarthritis?
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osteophytes, joint space narrowing, subchondral, cysts and sclerosis and malalignment.
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what are some causes of secondary osteoarthritis?
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dysplastic (leg-length inequality, epiphyseal dysplasias)
posttraumatic (acute, repetitive, postoperative) skeletal failure (osteochondritis) postinflammatory (infection, RA) endocrine and metabolic (acromegaly, hemochromatosis) Connective Tissue (hypermobility) Misc (frostbite) |
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bony protuberances of the DIP are called what?
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Heberden's nodes
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bony protuberances of the MIP are called what?
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Bouchard's
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what makes the diagnosis of OA?
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history and PE
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what are the most common distribution spots of primary OA? why these points?
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hips, knees, spine, and 1st MTP due to gravity and overuse
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pt presents with morning stiffness and bony swellings. what can you immediately rule out?
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primary OA- NEVER EVER PRIMARY ALWAYS SECONDARY
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what are the radiographic features of secondary OA?
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joint space narrowing, amrginal osteophytes, subchondral cysts, bony sclerosis, malalignment, gull wing
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midfoot and MTPs 2-5 are common in what disorder?
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secondary OA
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how do you manage OA?
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1) decrease pain= increase fxn
2) prescribe progressive exercise to: increase function, endurance and strength, and reduce fall risk 3) pt education: self help course |
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what are the five pharmacologic agents that are used in the management of OA?
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nonopioid analgesics, topical agents, intra-articular agents, opioid analgesics, NSAIDs
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what are the risk factors for peptic ulcer disease?
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prior hx, age> 65, smoking and ETOH, steroids and anticoagulants, H. pylori
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T/F
H2 blockers are ineffective and increase the risk of PUD |
TRUE
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what is the #1 Drug of Choice to treat OA?
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acetaminophen
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what must a general program for muscle strengthening always include?
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warm up with ROM stretching and a Cool-down with ROM stretching
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what are some low-impact reconditioning exercise programs for OA?
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fitness walking, aquatic exercise programs, exercycle and treadmill.
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what is the maximum safe dose of acetaminophen?
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4 grams/ day
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what is drug holiday?
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when the pt stops responding to a particular drug, have them stop taking the drug and then have them try something else for a little while and then put them back on the original drug.
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T/F
NSAIDs retard the disease progression. |
FALSE
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T/F
all NSAIDS increase CV risk |
true
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what is pathways are affected by tramadol?
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opiod and serotonin pathways
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what are morphine and fentanyl patches for?
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severe pain interfering with daily activity and sleep
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what do local cold or hot packs do?
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stop substance P
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what are the three different types of intra-articular therapies? which one provides no evidence of long-term benefit?
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intra-articular steroids, joint lavage, hyaluronate injections;
hyaluronate injections= no long-term benefits |
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T/F
glucosamine has not been proven to be beneficial long term |
True
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why would tetracyclines be useful in OA?
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because they have metalloproteinase affects
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what are two indications for a total joint replacement?
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1. pain unresponsive to medical tx
2. loss of function that prevents activities of daily living |
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second-line approach in managing OA includes?
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NSAIDS (if acetaminophen fails) intra-articular agents or lavage, opioids.
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