by mtoom

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Which types of arthritis have DIP involvement?
  • OA
  • Psoriatic
Which types of arthritis are symmetrical?
  • (sometimes OA)
  • RA
  • SLE
Which types of arthritis are worse in the evening?
Which types of arthritis are worse in the morning?
  • RA
  • SLE
  • Psoriatic
Which types of arthritis have stiffness in the morning (at least 30 minutes)?
  • RA
  • SLE
  • Psoriatic
Which types of arthritis are worse with inactivity?
Which types of arthritis show sclerosis and new bone on X-Ray?
  • OA
  • Psoriatic
Which types of arthritis have inflammatory fluid?
  • RA
  • SLE
  • Psoriatic
Which types of arthritis have erosions?
  • RA
  • Psoriatic
Which arthritis preferentially affects weight-bearing joints and hands?
Which arthritis is symmetrical and affects shoulders, elbows, wrists, hips, knees and ankles?
How can you differentiate RA arthritis from SLE arthritis?
  • SLE does not have erosions
  • Antibody testing 
Which arthritis has dactylitis (sausage digits)?
What are the 4 seronegative spondyloarthropathies?
  • Ankylosing spondylitis
  • Reactive arthritis
  • Psoriatic spondylitis
  • IBD-related spondylitis
Describe symptoms/criteria of ankylosing spondylitis? (5)
  • Chronic back pain
  • Onset before age 40
  • Prolonged morning/AM stiffness
  • Night pain
  • Better with exercise
Describe the 3 key features of ankylosing spondylitis?
  • Syndesmophytes: Bony growth from ligament causing briding of vertebral bodies
  • Sacroiliitis: Ankylosis (fusion) of SI joint
  • Enthesopathy: Heel spurs, wiskering of ischium
What are the 4 characteristic features of reactive arthritis?
  • Arthritis: Asymmetric lower limb
  • Conjunctivitis
  • Urethritis
  • Dysentery

May have sacroiliac involvement as well
What is the pathogenesis of reactive arthritis?
Epitopes for pathogen are similar to self-HLA B27 molecules. Cross reaction leads to autoimmune.
What is an important body system to monitor in patients with SLE and/or vasculitis?
  • Creatinine
  • Urinalysis 
Unlike RA, SLE never has what?
Bone erosions
What is Rheumatoid Factor (RF), specifically?
IgM antibody against Fc receptor of an IgG antibody
In RA, which 2 antibodies are important?
  • RF:
    - (+) in 50% of early RA
    - (+) in 85% of patients after 1-2 years
    - 87% specific
    - Correlates with disease state
  • Anti-CCP:
    - 99% specific
    - Low sensitivity
    - Present in early disease 
In SLE, which 3 immune tests are important?
  • ANA:
    -Very non-specific
    -99% NPV (negative predictive value)
    -Titre: 1/160 significant
  • ENA:
    -AntiSM: SLE, (highly specific, rare)
    -SSA, SSB: SLE/Sjogren
    -RNP: SLE
  • DNA Ab:
    -99% specific SLE 
RA has which deformities? (3)
  • Ulnar deviation
  • Swan neck deformity
  • Boutienniere deformity
Contrast loss of cartilage in RA versus OA?
  • RA: Generalized, diffuse
  • OA: Over weight-bearing area
Which is subtraction and which is addition?
  • RA
  • OA 
  • RA: Subtraction
  • OA: Addition
    -subchondral sclerosis
Where do erosions occur in RA?
Double reflection of the synovial membrane
Patient is newly diagnosed with RA. What next?

Even if it a sero-negative RA
Patient presents with a new monoarthritis. What do you need to rule out?
What are the key features of Sjogren's syndrome? (4)
  • Dry eyes
  • Dry mouth
  • Risk of dental caries (cavities)
  • Parotid gland enlargement
For patients with suspected RA/SLE, what should you do? (3)
  • Rheumatoid Hx.
  • Ask about psoriasis in any patient with arthritis
  • C1/C2 subluxation X-ray
How do you treat SLE? (1)
  • Serositis
  • Oral ulcers
  • Arthritis
  • Photosensitivity
  • Blood tests
  • Renal
  • ANA
  • Immune tests
  • Neurologic Tests
  • Malar Rash
  • Discoid Rash
Psoriatic arthritis is a subset of which patient population?
People with psoriasis
What is common in psoriatic arthritis?
Fusion of peripheral joints
  •  Ankylosis
Ankylosing spondylitis requires what to diagnose?
X-ray evidence of sacroilitis
What 2 diseases are linked to Sjogren syndrome (may cause it)?
  • SLE
  • RA
  • What sort of crystal?
  • What birefringence?
  • How do you treat? (3)
  • Describe yellow/blue
  • Monosodium urate crystals
  • Negative birefringence
  • Treatments:
    -Allopurinol (not until after 3 acute attacks; use along with NSAID or steroid)
  • Yellow parallel, blue perpendicular
  • What sort of crystal?
  • What birefringence?
  • CPPD (calcium pyrophosphate)
  • Positive birefringence

Often asymptomatic and has chondrocalcinosis on x-ray
Workup for inflammatory arthritis (4)
  • Creatinine
  • Urinalysis
  • Liver enzymes
  • CK (if muscle)
Describe giant cell arteritis
Type of large vessel vasculitis
Occurs in older patients
  • New onset of headaches
  • May have jaw claudication
  • Very high ESR
Emergency! Patient can go blind. Start steroids.
Describe polymyalgia rheumatica (PMR)
Occurs with Giant Cell Arteritis
  • Achiness in shoulder or hip girdle
  • High ESR
Rapid response to low-dose prednisoen
Describe fibromyalgia syndrome
  • Pain all over
  • Sleep disorder
  • 11/18 painful fibromyalgia tender points, distributed in at least 4 quadrants in body
  • Normal labs
Which HLA leads to predisposition to RA?
What are environmental triggers for RA?
  • Smoking
  • Gingivitis
  • Other bacteria??
How do citrulinated proteins contribute to RA?
Seem to be recognized more easily by certain HLA types
Main cytokine involved in proliferation in pathogenesis of RA?
What signaling pathway is involved in RA pathogenesis?
Pathogenesis summary (lots of detail)
Shared epitope and/or molecular mimicry between inciting antigen and HLA receptors on macrophage (eg. type A synovial cell) lead to:
  • Macrophage becoming a dendritic cell or APC, presenting of antigen to T-lymphocyte
  • Lymphocytes recruited into synovial membrane
  • Release of cytokines from T-lymphocytes (TNA alpha, IL1, IL6) recruits more T-cells, releases adhesion molecules, activates osteoclast factor, proteolytic enzymes (MMPs)
  • Costimulatory molecules upregulate activation of T-cells and release of cytokines
What happens due to increased metabolic requirements of lymphocytes?
  • Neovascularization
  • Angiogenesis

RA is angiogenesis dependent
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