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36 Cards in this Set
- Front
- Back
Sites of nonarticular rheumatism
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Joint capsule
Tendon Muscle |
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Site of inflammatory arthritis
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Synovium
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Site of degenerative arthritis
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Articular cartilage
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Classification of arthritis
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Inflammatory: seropositive, seronegative, crystal, infectious
Degenerative: primary (old age), secondary (trauma, disease, etc) Non-articular: localized, generalized |
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Types of seropositive arthropathies
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RA
SLE Scleroderma Dermatomyositis/polymyositis Sjogren's syndrome |
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Characteristics of Seropositive arthropathies (3)
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Symmetrical (esp. mcp and mtp joints)
Morning stiffness >1hr Autoantibodies (ANA, RF, ACCP) |
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Classification of seronegative arthropathies
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Symmetrical: ankylosing spondylitis, IBD
Asymmetrical: psoriatic arthritis, reactive arthritis |
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Characteristics of seronegative arthropathies
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Spondylitis (back pain in am >1hr)
HLA B27 positive No autoantibodies Sacroiliitis (bilateral or unilateral) Symmetric: large joints, oligoarticular Asymmetric: DIP, dacylitis |
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Characteristics of ankylosing spondylitis
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Symmetrical spine and large joint involvement
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Characterisitcs of psoriatic arthritis
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Asymmetrical spine and smaller joint involvement
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Classification of crystal arthropathies
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Gout: uric acid
Pseudogout: calcium pyrophosphate Calcific periarthritis: hydroxyapatite |
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Characteristics of crystal induced arthropathes
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Monoarticular
Abrupt onset (pain at rest) Complete remissions Urate, calcium crystals and WBC in synovial fluid |
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Classification of infectious arthritis
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Gonoccocal
Non-gonoccal (bacterial, fungal, TB) |
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Characteristics of infectious arthritis
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Monoarticular
Abrupt or insidious onset Predisposed host or joint Pain at rest, severe with movement Purulent synovial fluid |
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Classificaion of degenerative arthritis
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Primary (OA, familial Heberden's nodes, regional hip or knee)
Secondary (Traumatic (most), metabolic, hemophiliac, neropathic, etc) |
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Characteristics of degenerative arthritis
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Distribution: DIP, PIP, Thumb, 1st MTP, knee, hip, spine
No inflammation: morning stiffness <30min, bland effusions Structural changes: crepitus, enlargement, malalignment, decreased ROM |
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Classification of non-articular rheumatism
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Localized: bursitis, tendonitis, capsulitis
Generalized: fibromyalgia, polymyalgia rheumatica |
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Signs/symptoms of inflammatory arthritis
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am stiffness >1hr
worse after rest/better with activity night time pain that wakes +/- warmth +/- erythema |
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Patterns of joint involvement in arthritis
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Symmetrical small joint polyarthritis: wrists, hands, knees, ankles feet (RA)
Asymmetrical oligoarthropathy: finger, knee (psoriatic, reactive) Symmetrical large joint polyarthritis: shoulders, hips, knees (ankylosing spondylitis, enteric arthritis) Monoarthritis: knee (infectious, crystal) Degenerative:fingers, thumb, hips, knees, spine (C4-T1, L3-S1) |
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Things to evaluate on history and physical
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Onset (acute, subacute, insidious)
Characteristics Pattern Course Therapy (drug, dose, duration, response, reason for discontinuation) Extra-articular features Effect on activities of daily living |
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Signs/symptoms of degenerative arthritis
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am stiffness<30min
better with rest/worse with activity evening pain that wakes +/- crepitus |
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Classification based on onset
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Insidious: inflammatory or degenerative
Subacute: CPPD, infection Acute: Gout, infection |
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Classification based on course
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Gout - acute flares with complete remission in between
RA - flares with incomplete and decreasing remission Osteoarthritis - steady worsening with slight flares CPPD - steady worsening with spikes of flares |
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Classification based on extra-articular manifestations
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Seropositive: multisystemic
Seronegative: psoriasis, iritis, urethritis, mucosal ulcers Crystal: tophi Infectious: primary source, skin pustules/lesions, tenosynovitis Non-articular rheumatism: tender points, dermatographism |
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Classification of funcional capacity
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Class I: able to perform usual activities
Class II: limitation of vocational activities Clas III: limitation of vocational and avocational activities (ex-work) Class IV: limited self-care |
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Role of xray in diagnosis of arthropathies
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Confirm suspected diagnosis
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Blood tests for Seropositive arthritis
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RF, anti-ccp, ANA, CBC, urinalysis
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Blood tests for Seronegative arthritis
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HLA B27
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Blood tests for crystal arthritis
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serum urate, calcium, 24hr urine urate
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Blood tests for infectious arthritis
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Tissue cultures
CBC |
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Blood tests for degenerative and non-articular rheumatism
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ESR
CRP |
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Approach to evaluation of arthritis
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1. Articular vs. non-articular
2. Degenerative or inflammatory 3. Extra-articular features guide diagnosis 4. Lab tests confirm diagnosis |
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Synovial fluid characteristics: inflammatory arthritis
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Appearance: turbid
String Sign: poor WBC: >2000 Crystal: positive in gout, CPPD Gram stain: positive in septic Glucose: decreased in septic and RA |
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Synovial fluid characteristics: degenerative arthritis
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Appearance: clear
String Sign: good WBC: <2000 Crystal: negative Gram stain: negative Glucose: normal |
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Xray findings: inflammatory arthritis
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Diffuse cartilage loss (symmetric joint space narrowing)
Erosions Periarticular osteopenia |
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Xray findings: degenerative arthritis
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Local cartilage loss (assymetric joint space narrowing)
Bone overgrowth (osteophytes) Eburnation (sclerosis) |