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DU PA Intro to Rheum

DU PA Introduction into Rheumatology

degenerative arthritis is the same thing as __ osteoarthritis
the common theme of all rheumatological diseases is __ inflammation
strictly refers to inflammation of a joint
rheumatism refers to inflammation of joints, bones, muscles, tendons, and ligaments, multiple organ involvement
more than __% of US adults were found to have arthritis 21
__% of those with arthritis are women 60
arthritis is now the leading cause of __ in the US disability
some forms of degenerative disease have __ component an inflammatory
the majority of rheumatologic diseases are __ in origin immune-mediated
__ most commonly affected in non-inflammatory disease (mechanical disease) axial skeleton
__ are most often affected in inflammatory disease mobile joints of the extremities
the __ is most often involved in ankylosing spondylitis enthesis
the point at which a tendon or ligament or muscle inserts into bone, where the collagen fibers are mineralized and integrated into bone tissue enthesis
muscle inflammation myosis
microcrystalline arthritis gout
hallmark of rheumatoid arthritis synovitis
__ involves the bony endplate of a joint osteonecrosis
__ involves cartilage degeneration osteoarthritis
__ involves cartilage degeneration degenerative arthritis
inflammation at ligamentous insertion into bone enthesitis
hallmark of autoimmune disease failure of self tolerance
Theory of autoimmunity in which microbes have what looks like host antigens → release of self-reactive T-cell clones molecular mimicry
compare frequency of a mutation or polymorphism in affected population to that in matched control population, attempts to associate particular gene with particular disease association studies
based on observation that genes closely arranged on the chromosome are inherited together, these studies look for polymorphisms that may be linked to complex diseases linkage analysis
Most of the rheumatic diseases are __ and thus genetic susceptibility plays an important but variable role in pathogenesis autoimmune diseases
Genes involved in rheumatic disease have low __ predictive power
A cluster of genes on chromosome 6 that control immune function and regulate transplant rejection major histocompatibility complex
the __ plays a critical role in immune function and antigen presentation major histocompatibility complex
Genetic susceptibility plays an important, __, role in development of rheumatic diseases but not exclusive
most common symptom of rheumatologic musculoskeletal disorder stiffness with immobility (gel)especially in the morning
__ is improved with rest and worsened by activity non-inflammatory
__ is worsened by inactivity inflammatory pain (and stiffness)
rheumatoid arthritiis usually presents as symmetric small bone involvement
__ is not usually a feature of rheumatoid disease (outside of inflammatory myopathy) weakness
cardinal signs of inflammation on PE warmth, effusion, decreased ROM in all planes
plasma proteins synthesized by the liver, cytokine-mediated systemic response to tissue injury, non-specific acute phase reactants
2 most commonly used acute phase reactants are the __ and the __ erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)
normal ranges for ESR 0-15mm/hr for men, 0-20mm/hr for women
normal range for CRP <0.2 mg/dL
ESR is increased in anemia, inflammation, female sex, pregnancy, elevated cholesterol, advanced age
ESR is decreased in sickle cell disease, abnormalities of RBC size and shape
ESR is uneffected by body temperature, recent meal, aspirin/NSAIDs, cachexia, steroid therapy
antibodies to a variety of nucleoproteins antinuclear antibodies (ANA)
the higher the titer of ANA the more likely the patient has a rheumatologic disease
diseases in which ANA testing is helpful SLE, scleroderma, polymyositis, dermatomyosits, Sjogren’s syndrome, antiphospholipid syndrome, mixed connective tissue disease
diseases in which ANA testing not likely to be helpful rheumatoid arthritis (RA), gout, spondyloarthropathies, osteoarthritis, fibromyalgia
Previously considered the gold standard in the evaluation of rheumatic disease but not widely used synovial fluid analysis
Essential in infectious and crystal-induced arthropathies synovial fluid analysis
Four categories of joint fluid non-inflammatory, inflammatory, septic, hemorrhagic
noninflammatory joint fluid usually indicates osteoarthritis
inflammatory joint fluid can indicate gout, RA, SLE, AS, PsA, septic arthritis
hemorrhagic joint fluid can indicate tumor, TB, trauma
useful in detecting infection, stress injuries and osteonecrosis bone scan
__ any symptomatic joint x-ray
__ are used for early changes in SI joints, axial disease CT and MRI
Created by: bwyche