Studydroid is shutting down on January 1st, 2019

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?
OA
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?
OA
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?
OA
Which arthritis is symmetrical and affects shoulders, elbows, wrists, hips, knees and ankles?
RA
How can you differentiate RA arthritis from SLE arthritis?
  • SLE does not have erosions
  • Antibody testing 
Which arthritis has dactylitis (sausage digits)?
Psoriatic
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?
Renal
  • 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
    -osteopenia
    -erosions
  • OA: Addition
    -subchondral sclerosis
    -osteophytes
Where do erosions occur in RA?
Double reflection of the synovial membrane
Patient is newly diagnosed with RA. What next?
PATIENT NEEDS DMARDS

Even if it a sero-negative RA
Patient presents with a new monoarthritis. What do you need to rule out?
Infection
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)
Hydroxychloroquine
Explain SOAP BRAIN MD for SLE
  • 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
Gout
  • What sort of crystal?
  • What birefringence?
  • How do you treat? (3)
  • Describe yellow/blue
  • Monosodium urate crystals
  • Negative birefringence
  • Treatments:
    -NSAIDS
    -Steroids
    -Allopurinol (not until after 3 acute attacks; use along with NSAID or steroid)
  • Yellow parallel, blue perpendicular
Pseudogout
  • 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?
HLA-DR1
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?
TNF-alpha
What signaling pathway is involved in RA pathogenesis?
JAK-STAT
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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