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arthitis
arthitidies
15
Medical
Graduate
01/27/2007

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Term
Osteoarthritis
Definition
degeneration of cartilage, hypertrophy of bone at articular margins.
S/Sx: insidious onset, am stiffness <25 min, pain worse with activity or weight bearing. No systemic sx or deformities.
Labs: no elevated ESR or signs of inflammation. X-ray shows thinkened subchondral bone, ostephyte foration and lipping of marginal bone.
Tx: weight loss, PT, s/p
Rx: NSAID
Term
Rheumatoid arthritis
Definition
S/Sx: insidious onset, prodromal malaise, weight loss, vague periarticular pain/stiffness. Symmetric joint swelling w/ stiffness, warmth, tenderness and pain. Stiffness persists for >30 min in am and subsides later in day, worse with inactivity. PIP and MCP most common. Synovial cysts, subcutaneous nodules occur. Deforomities: swan-neck (flexion of DIP and extension of PIP), ulnar deviation, boutonniere (hyperextension of DIP and flextion of PIP), valgus knees.
Labs: +serum protein, rheumatoid factor (IgM), ANA, increased ESR and immune globulins (IgM and IgG), hypochromic normocytic anemia, increased platelets, synovial fluid shows inflammation. X-rays show narrowed joint space and erosions.
Tx- heat/cold, assistive devices, rest, PT, splints, weight loss.
Rx- NSAIDS, steroids, methotrexate
Term
Gouty arthritis
Definition
Caused by overproduction of uric acid associated w/ EtOH, meds, myeloproliferative dz, hypothyroid, psoriasis, renal; or undersecretion.
S/Sx: acute onset, often at pm. May be precipitated by EtOH, changes in medication. Commonly in MTP of great toe. Joint swollen, tender, with warm, tense, red skin. Low grade fever, tophi may be in ears, hands, feet, elbow and knee. Asymptomatic perods for months or years.
Lab: eleated uric acid (>7.5 mg/dl), ESR and WBC. Aspiration shwos chrystals. X-ray shows no changes early, but erosions late.
Tx-diet
Rx-NSAID, cholchicine, steroids. Tx pain early and uric acid late.
Term
SLE
Definition
S/Sx- fever, anorexia, malaise, weight loss, butterly (malar) rash, conjunctivitis, photophobia, blurred vision, pleurisy, cardiac. Joint sx w/ or w/o synovitis, seldom deforming, no erosion on x-ray.
Labs: anemia, leukopenia, throbocytopenia, proteinuria, hematuria, ANA, hypocomplementemia
Tx-
Term
Scleroderma
Definition
chronic disorder characterized by diffuse fibrosis of skin and internal organs.
S/S,- polyarthralgia, Raynauds, subcutaneous edema, fever, malaise. Thick skin with loss of folds, telegiectasia, pigmentaion and depigmentation; ulceration of fingertips; dysphagia; fibrosis and atrophy of GI tract causes malabsorption; pulm fibrosis and cardiac causes mortality.
Labs: anemia (mild), renal dz causes proteinuria and hemolytic anemia; +ANA, scleroderma antibody.
Tx: supportive
Term
Sjogren's
Definition
Autoimmune disorder causing dysfxn of exocrine glands. Often associated w/ RE, SLE, scleroderma. Most pts are women over 50 y/o.
S/sx: burning, itching eyes with sensation of FB, drymouth, loss of taste/smell, parotid enlargement, dryness includes nose, throat, larynx, bronchi, vagina and skin.
Labs: mild anemia, leukopenia and eosinophilia, +ANA and rheumatoid factor
Tx: symptomatic and supportive
Term
Polymyalgia Rhematica
Definition
S/Sx- pain and stiffness of shoulder and pelvic girdle, fever, malaise, weight loss. May be associated with giant cell arteritis. No muscle weakness. May have joint swelling.
Labs:elevated ESR, anemia, CRP.
Tx: prednisone
Term
Giant cell arteritis
Definition
subacute granulomatous arteritis involving external cartids, esp temporal artery.
S/Sx: age >72y/o, headache, scalp tenderness, jaw claudication, throat pain, blindness, asymmetrical pulses, aortic regurg.
Labs: ESR >50, normochromic, normocytic anemia and thrombocytosis, CRP
Tx: urgent, rapid to prevent blindness. Prednisone 60mg/d immediatly. Temporal artery biopsy.
Term
Psoriatic arthrits
Definition
Pauciarthritis of symmetric joints, usualy DIP, sausage digits, involvement of SI joint.
Elevated ESR, uric acid.
X-ray reveals marginal erosions of bone and irregular destruction of bone and joint.
Term
Reactive arthritis
Definition
"Cant see, can't pee, can't climb a tree".
Conjunctivitis, urethritis, arthritis. Sx develop w/in days or weeks after either a dysenteric infection (shigella, salmonella, yersinia, campylobacter) or STD (chlmydia).
S/sx: asymmetric often large weight bearing joints. 20% have sacroiliitis or ankylosing spondylitis. Systemic sx are fever and weigt loss, balanitis, stomatitis, keratoderma, arditis and aortic regurg.
Rx: NSAIDs. Abx tx of nongonococcal STD reduces chances of reactive arthritis, but cannot help once it has developed.
Term
Nongonococcal arthritis
Definition
S. aureus, GABS, GBBS, G- becoming more common (E coli and P aeruginosa). Usually associated w/ persitant bacteremia, IV drug use, endocarditis.
S/Sx: acute onset pain, swelling and heat in one joint (often knee), fever.
Las: blood culter+ in 50%, leuckocytes 50-100, gram stain, x-ray nml early but show demineralization w/in days.
Tx: abx, s/p draingage, heat and rest.
Term
Gonoccal arthritis
Definition
S/sx: 1-4 days of migratory polyarthralgia involving knee, ankle or elbow followed by tenosynovitis in 60%, fever, asymptomatic skin lesions of necrotic pustules over extremities.
Labs: WBC 10 in blood and 50 in synovial. Gram stain and culture
Tx: hospital admin to exclude endocarditis. Oten PCN resistant- ceftriaxone.
Term
Lyme
Definition
S/sx: chronic recurrant joint and perarticular pain. Tx w/ tetracycline
Term
Viral arthritis
Definition
May be caused by mumps, rubella, parvovirus, HBV or HCV
Term
osteomyelitis
Definition
Staph, E coli and Strep; funguses like candida, coccidiocycosis and histo. Often req prolonged abx and s/p debridement.
TB spreads hematologically from primary lesion. Pain mild at onset worse at night. Commonly knee. Abscesses form, muscle atrophy and deformity.
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