Arthritis Review
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| The hallmark of rheumatology is | inflammation (fibromyalgia and OA are not inflammatory)
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| 4 Types of arthritis | Crystal-induced (gout, CPPD), Degenerative (OA), Infectious, Autoimmune (RA, SLE, Spondyloarthropathies, Scleroderms, Inflammatory Myopathies, Vasculitidies)
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| ___ skeleton most commonly affected in non-inflammatory disease (ie, mechanical) | axial
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| The hallmark of the spondyloarthropathies | Enthesitis - inflammation of ligaments or tendons. (ie, achilles)
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| Four features of OA | Decreased joint space, osteophytes, subchondral sclerosis, and subchondral cysts
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| The hallmark of RA | synovitis - inflammation of the synovial membrane
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| Important questions to be answered in the assessment: | articular vs nonarticular, acute vs chronic, localized vs systemic. Inflammatory vs non-inflammatory
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| 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.
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| DIP involvement suggests | OA, psoriatic arthritis
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| MCPs and Wrist involvement suggests | RA, SLE
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| 1st MCPs involvement suggests | Gout, OA
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| 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"
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| RF (autoantibodies: Rheumatoid Factor) | Titers>/= 1:80 clinically sign. RA, TB, syphilis, sarcoid, SBE, other rheumatologic conditions
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| Anti- CCP (cyclic citrullinated peptide) | Equal in sensitivity to RF but much greater specificity. anti-CCP often positive before RF is.
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| ANA | antinuclear antibodies. Used most often to dx SLE but may also be positive in RA, scleroderma, Sjogren's syndrome, polymyositis, vasculitis.
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| 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.
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| Anti-Smith | highly diagnostic of SLE
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| Anti-RNP | highly diagnostic of mixed connective tissue dz
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| Anti-SS-A (aka Ro)SS=sjogren's syndrome | found in 50% of pts with Sjogren's, 30% of SLE
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| Anti-SS-B (aka LA)SS=sjogren's syndrome | Found in pts with SLE or Sjogren's
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| c-ANCA (antineutrophil cytoplasmic antibodies) are useful in diagnosing | vasculitis syndromes, ex: wegener's granulomatosis
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| Anti-DNA is diagnostic for | SLE. Howevever, up to 40% of pts with SLE may lack anti-DNA
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| X-ray findings in advanced RA | erosions "rat bites", diffuse osteopenia, loss of joint space, subluxation of MCPs and IP joint of thumb.
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| 5 recognized diffuse connective tissue diseases | scleroderma, polymyositis, dermatomyositis, SLE, RA
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| Sx of OA | am stiffness <30min, worsens with activity, mechanical pain, bony enlargement
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ltm12