Term
| List 4 degenerative, infectious and crystal induced arthopathies? |
|
Definition
1)Osteoarthritis
2)Gouty Arthritis (gout)
3)Pseudogout
4)Septic arthritis |
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Term
|
Definition
1)Fibromyalgia
2)Carpal Tunnel Syndrome
3)Complex Regional Pain Syndrome (CRPS)
4)Bursitis |
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Term
| List 4 autoimmune rheumatic disease? |
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Definition
1)Rheumatoid arthritis
2)Systemic Lupus Erythematosus (SLE)
3)Scleroderma
4)Sjogren Syndrome |
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Term
| List 4 vasculitis syndromes? |
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Definition
1)Polyarteritis nodosa
2)Polymyalgia Rheumatica (PMR) and Giant Cell Arteritis
3)Wegener Granulomatosis
4)Bechet Syndrome |
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Term
| List 3 seronegative arthropathies? |
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Definition
1)Ankylosing spondylitis
2)Psoriatic arthritis
3)Reactive arthritis (formerly Reiter Syndrome) |
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Term
| What are the 3 main things to note when you approach a patient w/ joint pain? |
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Definition
1)Inflammation
2)Number of joints involved
3)Site of joint involvement |
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Term
| What are some symptoms that are usually associated with inflammation? |
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Definition
| Redness, swelling, reduced range of motion, pain |
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Term
| Where is the location of 1st presentation for gout? |
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Definition
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Term
| What 3 initial clinical characterizations are considered with presenting arthritis? |
|
Definition
1)Duration: acute or chronic
2)Associated extraarticular disease
3)Lab and imaging findings (inflammatory markers, autoimmune markers, plain film/CT/MRI |
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Term
|
Definition
| A disease of joint use or overuse. |
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Term
| What are some common causes of osteoarthritis? |
|
Definition
-Aging
-Occurs prematurely due to trauma
-Trauma: competitive sports, job related activities, or 2ndary to acute joint injury |
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Term
Epidemiology & demographics of osteoarthritis:
1)Prevalence
2)Gender dominance
3)Age |
|
Definition
1)2 to 6% of general population
2)Females more commonly involved: 2:1 ratio
3)Over 50 yrs (post menopausal women) |
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Term
| List 5 modifable risk factors or things that can be controled? |
|
Definition
1)Obesity: contributes joint trauma
2)Nutritional deficiencies: Vitamin D and presence of crystal arthropathies
3)Trauma
4)Involvement in competitive sports
5)Job related: lifting, repetative impact motion |
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Term
| List some of the common signs and symptoms of osteroarthritis? |
|
Definition
-Stiffness, pain, crepitus
-Joint tenderness
-Swelling (occasional inflammation)
-Bouchard nodes: bony enlargement of PIP joints of hand
-Heberden nodes: bony enlargement of DIP joints in hand
-Pain through range of motion |
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Term
|
Definition
|
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Term
|
Definition
| bony enlargements of the PIP joints of the hand |
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Term
|
Definition
| bony enlargements of the DIP joints of the hand |
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Term
| How do you diagnose osteoarthritis? |
|
Definition
-Image studies: joint space narrowing, new bone formation, subchondral sclerosis
-MRI: detect source of pain
-Inflammation may occur intermittently
-No specific test exists & labs are normal |
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Term
| How is MRI used in the diagnosis of osteoarthritis? examples |
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Definition
Helpful in detecting sources of pain such as:
-synovial thickening
-effusions
-bone marrow edema
-bony attrition
-periarticular lesion
-osteophytes may occur at margins of bones |
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Term
| When looking at an image of a potential osteoarthritic joint, what must you look for and compare? |
|
Definition
-Presense of cartilage loss, deviations, spurs proximal and distal to joints
-Need to note size of joint space
-Compare joint space to lower space |
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Term
| How would you treat a osteoarthritis? (5) |
|
Definition
1)NSAIDs (not inflammatory doses)
2)Opioids (safer than NSAIDs)
3)Acetaminophen (risk: liver problems)
4)PT/OT
5)Surgical: joint replacement |
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Term
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Definition
| Result of precipitation of monosodium urate w/in the joint space. Can be do to overproduction or underexcretion (most) of urate |
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Term
| In gout, monosodium urate crystals commonly deposit in tissues with limited blood flow (colder, distal), give some examples? |
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Definition
-Tendons
-Cartilage
-Ligamints
-Bursa
-Surrounding soft tissue |
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Term
| Describe primary affected joints in gout? |
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Definition
-Distal joints which are lower in temp
-#1: big toe |
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Term
What is the end product of purine metabolism?
Where is it excreted? |
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Definition
Uric acid
-predominantly excreted in urine and, to lesser extent, in GI tract |
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Term
| What % of patients with hyperuricemia and gout is a result of underexcretion? overproduction |
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Definition
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Term
| List some of the physiologic factors that affect uric acid excretion? |
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Definition
-Genetics
-Drugs
-Hormones
-Renal function
-Concomitant diseases |
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Term
| For hyperuricemia in gout, what urate plasma level is a risk factor? |
|
Definition
>6.8 mg/dL
*higher level and long duration of increased levels, increase risk of monosodium urate crystal formation |
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Term
| What are some risk factors for secondary gout in genetically predisposed patients? (12) |
|
Definition
1)Low-dose aspirin
2)Cyclosporine
3)Niacin
4)Chronic renal insufficiency= hyperuricemia
5)Alcohol ingestion
6)Myeloproliferative disorders
7)Multiple myeloma
8)Hemoglobinopathies
9)Hypothyroidism
10)Psoriasis
11)Sarcoidosis
12)Lead poisoning |
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Term
| 1st gouty attack tends to follow what event? |
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Definition
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|
Term
Epidemiology & Demographics for Gouty arthritis:
1)Prevalance
2)Gender dominance
3)Onset |
|
Definition
1)1-2% of adult population
2)Men to women is 9:1
*common cause of inflammatory arthritis in men
3)Men: 30 and older
Women: postmenopausal, increases with age, ratio equal to men by age 75 |
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Term
| True/False. Gouty arthritis has atypical presentation in joints other than the great toe in woman |
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Definition
| True. Men it is primarily great toe |
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Term
| Describe the typical clinical presentation of the first gouty attack? |
|
Definition
-Redness
-Painful
-Inflamed single joint (monoarticular)
-Generally involves great toe
-Tophi may be present
-Frequently begins at night w/ dramatic pain and swelling |
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Term
What is tophi?
1)shape
2)location
3)occurance stage |
|
Definition
Large deposits of monosodium urate that develop w/in the joint and surrounding soft tissue
1)firm, irregular subcutaneous deposits
2)Often form along tendinous tissue on extensor surfaces of joints and tendons, & outer helix of ear
3)Occur more in chronic state |
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Term
| What % of men who have experienced 1 gouty arthritis attack, never experience a second attack? |
|
Definition
20%
one attack does not predict future attacks |
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Term
| After a 2nd gout attack, __% do not progress to chronic, recurrent gout. |
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Definition
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Term
| How long do gout attack last, both early and later attacks? |
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Definition
Early: Subside spontaneously w/in 3-10 days
-intervals vary in length w/ no residual symptoms until the next episode
Later: Intervals between attacks shrink and symptoms occur all the time |
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Term
| With chronic gouty arthritis, patients may develop what other condition, which can cause confusion w/ RA? |
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Definition
| Chronic nosymmetrical synovitis |
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Term
| What outcomes can be seen in rare cases of chronic gouty arthritis? |
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Definition
-In some cases chronic GA is only manifestation
-In some cases only periarticular tophaceous deposits are found in the absence of synovitis |
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Term
| List some physical findings of gouty arthritis? |
|
Definition
-Involved joint is tender and swollen
-May involve more than one joint during same attack & involvement is asymmetrical
-Pain becomes more intense w/ progression of attack
-Fever common
-Tophi may be present |
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Term
| What lab evidence is needed along with clinical appearance to diagnose gout? |
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Definition
| Presence of needle crystals in the aspirate of acutely or chronically involved joints or tophaceous deposits. |
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Term
| Why are serum urate levels a misleading lab test for diagnosing gout? |
|
Definition
-Serum levels will be high in 1st attack in 95% of patients
-levels can be normal or low at time of acute attack, as inflammatory cytokines can be uricosuric
-ESR and WBC elevated in acute attack
-Serum level unreliable as disease becomes more chronic |
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Term
| How do you diagnose gouty arthritis when there are underlying risk factors present? |
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Definition
| Based on clinical presentation |
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Term
| Presence of what 2 things confirm a presumptive diagnosis of gout? |
|
Definition
1)Monosodium urate crystals in synovial aspirate
2)Tophi |
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Term
| How would you treat an acute gout attack? (3) |
|
Definition
1)NSAIDs (used most)
2)Colchicine (old, problems)
3)Corticosteroids |
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Term
| What prophylatic therapy would you use to treat more frequent gouty attacks? (3) |
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Definition
1)Allopurinol
2)Probenecid
3)Colchicine (rarely used) |
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Term
| What disease can mimic gout, rheumatoid arthritis, or osteoarthritis? |
|
Definition
| Calcium pyrophosphate dihydrate crystal deposition disease (CPPD) |
|
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Term
|
Definition
-Crystal formation in the joint, systematic
-Intermittent monoarticular arthritis
-Often in knee or wrist
-Occurs more w/age |
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Term
| CPPD crystal deposition disease is commonly associated w/ what other diseases? |
|
Definition
| hemochromatosis and hyperparathyroidism |
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Term
| Who is most often affected by pseudogout? |
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Definition
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Term
| If pseudogout were to occur in a young patient, it is likely secondary to what diseases or conditions? (4) |
|
Definition
1)Hyperparathyroidism
2)Hypothyroidism
3)Wilson Disease
4)Hemochromatosis |
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Term
| What is the etiology for pseudogout? |
|
Definition
-Initiating cause of CPPD crystal deposition in unknown
-Several risk factors are known: important one is aging |
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Term
| What % of patients w/ CPPD deposition disease exhibit the pseudogout pattern of disease? |
|
Definition
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Term
| Describe the duration and severity of pseudogout attacks? |
|
Definition
-Acute signs & symptoms are monoarticular inflammatory arthritis lasting several days to 2 wks
-Self-limited attacks vary in intensity, but occur abruptly like acute gout attacks |
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Term
| What % of patients w/ CPPD deposition manifest symptoms that mimic rheumatoid arthritis? |
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Definition
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Term
| Describe symptoms of a patient with CPPD deposition that manifests RA symptoms? |
|
Definition
-low-grade inflammation in multiple, symmetric joints
-morning stiffness, fatigue, synovial thickening, joint contractures, and elevated erythrocyte sedimentation rate |
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Term
| What is a key lab finding that helps with the diagnosis of pseudogout? |
|
Definition
-Presence of rhomboid crystals of sodium pyrophosphate in joint aspirate
-Positive x-ray of chondrocalcinosis |
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Term
| If joint fluid looks purulent upon aspiration, what type of arthritis needs to be excluded? |
|
Definition
septic arthritis
**from the rhomboid crystals of sodium pyrophosphate found w/ pseudogout |
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Term
| How do you treat pseudogout? (3) |
|
Definition
Similar to gout:
1)Antiinflammatory doses of NSAIDs
2)Colchicine
3)Corticosteroid joint injection (removal of infection 1st) |
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Term
| What is septic arthritis? |
|
Definition
| Arthritis due to joint infection, most commonly Staphylococcus aureus bacteria. |
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Term
| Septic arthritis presents with what symptoms? |
|
Definition
-Acute with painful, swollen, warm joint
-Obvious joint effusion
-Moderate to severe joint tenderness to papation
-Restriction of both passive and active motion
-Commonly monoarticular, involving large weight bearing joints (knee or hip) |
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Term
| What are some potential causes for septic arthritis? |
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Definition
-Bacteria in blood
-Infection in area of joint moved by movement of the joint
-Trauma (surgery)
-Compromising barriers in immunocompromised pts (AIDS, HIV, kidney surgery) |
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Term
| What % of pts typically have monoarticular septic arthritis? % with polyarticular? |
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Definition
1)80-90% of all cases
2)10-20% of cases and these are associated w/ a higher rate of mortality |
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Term
| Septic arthritis has what type of onset? |
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Definition
| very quick or acute onset |
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Term
| Bursitis of which two joints may be the 1st manifestation of septic arthritis in patients with RA? |
|
Definition
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Term
| List some risk factors associated with septic arthritis? (8) |
|
Definition
1)Chronic systemic disease (RA, crystal induced arthropathies, DM, SLE)
2)Recent surgery (orthopedic w/ prosthetic joint replacement)
3)Recent trauma
4)Indwelling catheters
5)IV drug abuse
6)Use of immunosuppressant drugs
7)Advanced age
8)Sexual activity (gonococcal infection- most common) |
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Term
| What is the incidence of septic arthritis in the general population? |
|
Definition
|
|
Term
| What is the incidence of septic arthritis in the RA population or in those w/ prosthetic joints? |
|
Definition
|
|
Term
| True/False. Septic arthritis occurs more frequently in adults than children. |
|
Definition
| False. More frequent in children |
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|
Term
| What is the mortality % for septic artritis? |
|
Definition
|
|
Term
| What are the 3 most common causes of septic arthritis? |
|
Definition
1)Hematogenous spread
2)Direct inoculation (including surgery & trauma)
3)Spread from adjacent bony or soft tissue |
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Term
| Septic arthritis: W/in hours of entering joint space, the synovium becomes infected, leading to what? (2) |
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Definition
1)synovial membrane proliferation
2)infiltration by polymorphonuclear and other inflammatory cells |
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Term
| The local inflammatory response that occurs with septic arthritis leads to what 3 things? |
|
Definition
1)enzymatic and cytokine-mediated degradation of articular cartilage
2)neovascularization
3)development of granulation tissue |
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Term
| Why is it important that patients suffering from septic arthritis recieve the appropriate treatment? |
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Definition
| Could result in irreversible subchondral bone loss and cartilage destruction w/in a few days of the intial infection |
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Term
| What factor could help contribute to the diagnosis of septic arthritis? |
|
Definition
-Acute onset of inflammatory monoarticular arthritis in large weight-bearing joints and wrists
-Previous joint damage, trauma, or surgery
-infection w/ causative organism found elsewhere in body
-Joint effusions: large & WBC counts >50,000 /mcL
-CT or MRI images |
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Term
| How do you treat septic arthritis? |
|
Definition
-Drainage
-Intravenous antibiotic therapy
-Early progressive joint mobilization |
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