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Arthritis Review
| Question | Answer |
|---|---|
| The hallmark of rheumatology is | inflammation (fibromyalgia and OA are not inflammatory) |
| 4 Types of arthritis | Crystal-induced (gout, CPPD), Degenerative (OA), Infectious, Autoimmune (RA, SLE, Spondyloarthropathies, Scleroderms, Inflammatory Myopathies, Vasculitidies) |
| ___ skeleton most commonly affected in non-inflammatory disease (ie, mechanical) | axial |
| The hallmark of the spondyloarthropathies | Enthesitis - inflammation of ligaments or tendons. (ie, achilles) |
| Four features of OA | Decreased joint space, osteophytes, subchondral sclerosis, and subchondral cysts |
| The hallmark of RA | synovitis - inflammation of the synovial membrane |
| Important questions to be answered in the assessment: | articular vs nonarticular, acute vs chronic, localized vs systemic. Inflammatory vs non-inflammatory |
| Clue to establishing a rheumatologic etiology by history: Identification of distinct rheumatologic patterns: symmetric vs asymmetric, small bones vs large bones, axial vs periperal, "root" joints. AND | Systemic (constitutional Sx): fatigue, fever, weight loss, paresthesias, GI sx, ocular sx, rash. Preceeding infxn: especially GI or GU, Chlamydia, shigella, salmonella. |
| DIP involvement suggests | OA, psoriatic arthritis |
| MCPs and Wrist involvement suggests | RA, SLE |
| 1st MCPs involvement suggests | Gout, OA |
| The physical exam of Musculoskeletal dz | gait assessment, inspection, palpation of involved joints and surrounding soft tissue, ROM (active and passive), muscle strength, sensory, special "tests" |
| RF (autoantibodies: Rheumatoid Factor) | Titers>/= 1:80 clinically sign. RA, TB, syphilis, sarcoid, SBE, other rheumatologic conditions |
| Anti- CCP (cyclic citrullinated peptide) | Equal in sensitivity to RF but much greater specificity. anti-CCP often positive before RF is. |
| ANA | antinuclear antibodies. Used most often to dx SLE but may also be positive in RA, scleroderma, Sjogren's syndrome, polymyositis, vasculitis. |
| Anti-Smith, anti-RNP, anti-Ro, anti-La. When to order these | Only when ANA is positive. Exceptions are pts with strong clinical features of SLE but negative ANA. They come as a panel, so they are ordered together. |
| Anti-Smith | highly diagnostic of SLE |
| Anti-RNP | highly diagnostic of mixed connective tissue dz |
| Anti-SS-A (aka Ro)SS=sjogren's syndrome | found in 50% of pts with Sjogren's, 30% of SLE |
| Anti-SS-B (aka LA)SS=sjogren's syndrome | Found in pts with SLE or Sjogren's |
| c-ANCA (antineutrophil cytoplasmic antibodies) are useful in diagnosing | vasculitis syndromes, ex: wegener's granulomatosis |
| Anti-DNA is diagnostic for | SLE. Howevever, up to 40% of pts with SLE may lack anti-DNA |
| X-ray findings in advanced RA | erosions "rat bites", diffuse osteopenia, loss of joint space, subluxation of MCPs and IP joint of thumb. |
| 5 recognized diffuse connective tissue diseases | scleroderma, polymyositis, dermatomyositis, SLE, RA |
| Sx of OA | am stiffness <30min, worsens with activity, mechanical pain, bony enlargement |
Created by:
ltm12