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Duke PA Arthritis

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Question
Answer
__ is effective in pain relief for those with OA   exercise  
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formerly called degenerative joint disease   osteoarthritis  
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most common cause of long-term disability in U.S.   OA of the knee  
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__ is the most powerful risk factor for developing osteoarthritis   Age  
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female to male ratio for osteoarthritis risk __:1   2  
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african american to caucasian ratio for osteoarthritis risk __:1   2  
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Type __ finger configuration associated with doubled risk of OA knees, hips, hands   3  
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higher __ shows a decreased risk for developing OA   education  
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most affected joints in OA   Knees, hips, base of big toe, base of thumb  
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when OA affects three or more joint groups   generalized OA  
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loss of joint space, subchondral sclerosis, osteophytes, subchondral cysts   characteristics of OA  
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__ can't see chondral erosions   x-rays  
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Knee pain and x-ray osteophyte(s)-- plus --at least one of the following: (age > 50 y.o.morning stiffness(<30 min.), crepitus with motion)   DIAGNOSTIC CRITERIA Knee OA  
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Mechanical pain, Gel phenomenon, Bony enlargement, Decreased ROM, Muscle atrophy   other diagnostic features of knee OA  
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mild signs of __ in osteoarthritis   inflammation  
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most significant way to decrease progression of OA   weight loss  
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__ can improve arthritis symptoms by __%   15-30  
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contralateral to painful joint   proper use of a cane  
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__ have questionable effectiveness in treating osteoarthritis of the knee   unloader braces  
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__ is an effective treatment for patello-femoral pain   patellar taping  
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squatting puts __ times your body weight on your knees   9  
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running puts __ times your body weight on your knees   4-7  
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walking puts __ times your body weight on your knees   3-4  
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kneeling, squatting, prolonged standing   things to avoid when you have OA  
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sit in a __ stool if stationary at work if you have OA   high  
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low toilets, low chairs, low beds, bath tubs   things to avoid when you have OA  
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__ relaxed muscles, stimulates blood flow, good for OA   heat  
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__ eases muscle spasms, blocks pain signals for OA   cold  
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only thermal modality to raise hip joint temperature   ultrasound  
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useless thermal modalities for OA   infrared, diathermy  
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__ better for hip OA   bicycle  
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__ better for knee OA   elliptical  
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__ promotes joint preservation   wt-bearing exercise  
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shock absorbers of the joints   periarticular muscles  
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physiologic retirement plan   muscle mass  
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__ helps combat sarcopenia   weight resistance training  
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best done when muscles are warm   stretching  
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jogging, stair-climbers, rowing machines, running and jumping sports   not recommended for patients with OA  
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the go to OTC for OA   acetaminophen  
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if response to acetaminophen is inadequated try low dose   OTC NSAIDS  
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Start low, go slow, skip doses or eliminate __ as soon as possible   NSAID  
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NSAIDS can cause __   GI bleeds  
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if you must use an NSAID b/c tylenol is inadequate also put the patient on a   proton pump inhibitor  
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acts like a narcotic but is not as addictive   tramadol (Ultram)  
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no real GI advantage after 12-18 months   Clecoxib (Celebrex)  
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no evidence for an increase in cardiovascular events over other NSAIDS   Clecoxib (Celebrex)  
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visco-supplementation   hyaluronic acid  
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shows no slowing of disease progression but does have some pain relieving qualities, and is very safe   Glucosamine, chondroitin  
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no benifit to __ for OA   abrasion chondroplasy  
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autologous chondrocyte implantation   carticel procedure  
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Osteochondral Auto Transplant System   OATS procedure  
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longevity of this surgery is 15-20 years in 90-95%   joint replacement surgery  
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gout is principally a disease of __   men  
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gout is to a lesser extent a disease of __   postmenopausal women  
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the prevalence of gout is directly related to the degree of __   hyperuricemia  
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overall gout occurs in __% of the adult male population   2-3  
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the prevalence of gout is __ dependant   age  
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uric acid is the breakdown products of the purines __   adenine and guanine  
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__ of daily uric acid input comes from dietary sources   1/3  
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2/3 of the excretion of uric acid occurs in the __   kidneys  
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overall __% of patients with primary gout have increased uric acid production   10-20  
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__ of daily uric acid input comes from de-novo purine synthesis   2/3  
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__ can lead to uric acid overproduction, and secondary gout   lymphomas, leukemias, disorders of hematopoiesis, wide spread psoriasis  
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clinically the most important stimulus to uric acid production is __ which can dramatically increase de-novo synthesis   alcohol  
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__ can all lead to decreased urate clearance   diuretics, aspirin, dehydration, and acidosis  
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__ has long been associated with gout   lead nephropathy  
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uric acid accumulations   tophi  
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trauma to the __ joint from weight-bearing activities may underlie its predominant involvement   first metatarsophalangeal  
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__ sometimes leads to breakdown of tophi   rapid lowering of uric acid blood levels  
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acute gouty arthritis is characterized by __   rapid crescendo onset  
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a patient with acute gouty arthritis will go to sleep with no symptoms and __   is awakened by severe pain, erythema, and swelling in the affected joint  
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__ is the most commonly involved joint in gout   first metatarsophalangeal joint  
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gouty involvment of the first metatarsophalangeal joint   podagra  
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the skin overlying a gouty joint is __   erythematous and warm  
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after the big toe the other joints most affected by gout in order   instep, heel, ankle, knee, hands, wrists, elbows  
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the acute onset of inflammatory monoarthritis in a joint of the lower extremity particularly in middle aged and older men is likely to be __   gout  
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__ is common in gout   low grade fever  
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patients with __ usually have a more insidious onset than patients with gout   septic joint disease  
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the joint fluid in gout is __, with more than 10,000 WBC's and >90% PMN's   inflammatory  
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__ are both pathognomonic for and for and essential to the diagnosis of acute gouty arthritis   intracellular, needle shaped, negatively birefringent crystals  
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many patients have __ at the time of acute attack, therefore making serum levels unhelpful   normal blood uric acid levels  
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gout may present as   chronic polyarthritis  
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in contrast to the non-reactive margins in rheumatoid arthritis, x-rays of gout typically show   sclerotic changes at erosive borders  
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RA joint progression in chronological order   wrists, knees, elbows, ankles, hips, shoulders  
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RA joints are usually described as __   boggy  
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morning stiffness   hall mark symptom of RA  
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with RA symptoms are worse in the __   am  
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with RA symptoms are worse after __   prolonged periods of rest  
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to qualify for RA quality morning stiffness, the stiffness has to last at least __   1 hour  
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RA usually shows __ involvement   bilateral  
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for a diagnosis of RA there must be at least one   swollen joint in the hand  
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__% of those with RA will never develop serum rheumatoid factor   30  
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the criteria for RA must be present for __ weeks, to rule out polyarticular manifestations of infection   6  
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ulnar deviation, swan neck deformities, boutonniere deformities   RA articular manifestations  
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feet are affected in __% of patients with longstanding RA   90  
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outside of the cervical spine __ usually does not affect the spine   RA  
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usually involves the MCP's, PIP's, and DIP's   RA  
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__ is rare but can occur in patients with longstanding RA   tendon rupture  
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subluxation of the MTP's in RA can lead to a visible __   callous formation on the ball of the foot  
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no single diagnostic tests confirms __   RA  
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platelet counts are usually increased in patients with   inflammatory diseases  
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patients who are RF negative tend to have __ as compared to those who are RF positive   milder disease course  
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acute phase reactants associated with RA   ESR, CRP, thrombocytosis  
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synovial fluid analysis in joints affected with RA show   increased WBC's with predominant neutrophils  
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__ is common in RA, and is usually not fixable. it is not due to a lack in Iron.   mild anemia of chronic disease  
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radiographic joint damage in RA is sometimes referred to as a __   rat bite  
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on radiograph the joint space narrowing in __ is usually more diffuse   RA  
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Keratoconjunctivitis sicca   dry eyes-extra-articular manifestation of RA  
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Pericarditis, premature atherosclerosis, vasculitis, valve disease, and valve ring nodules   heart-extra-articular manifestation of RA  
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Pleural effusions, interstitial lung disease, bronchiolitis obliterans, rheumatoid nodules, vasculitis   lung-extra-articular manifestation of RA  
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Entrapment neuropathy, cervical myelopathy, mononeuritis multiplex (vasculitis), peripheral neuropathy   neurologic-extra-articular manifestation of RA  
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Anemia, thrombocytosis, lymphadenopathy, Felty's syndrome   hematopoitic-extra-articular manifestation of RA  
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Nodules, fragility, vasculitis, pyoderma gangrenosum   skine-extra-articular manifestation of RA  
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for treatment of RA with evidence of moderate-severe @ diagnosis start with __   DMARDs  
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adjunct treatment for RA   glucocorticoids, NSAIDs, analgesics, physical, and occupational therapy  
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rare manifestation of RA + splenomegaly, leukopenia and recurrent pulmonary infections   Felty's syndrome  
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rupture of synovial fluid from knee into calf; mimics DVT, cellulitis   Baker's cyst  
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patients with RA have an increased risk for __   cardiovascular disease, accelerated atherosclerosis, increased rate of malignancy (lymphoma)  
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patients with RA can undergo __   spontaneous remission  
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estrogen protects against __   gout  
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peak age for gout in men __ years   40-50  
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peak age for gout in women >__ years   65  
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decreased renal clearance leading to gout   underexcretion  
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increased renal production of uric acid leading to gout   overproduction  
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__% of cases of gout are due at lest in part to   decreased renal clearance leading to hyperuricemia  
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hyperuricemia and __ are associated   hypertension  
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risk factors for gout   infection, trauma, weight loss (extreme diets), hospitalization, dyslipidemia  
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__ are the 4 stages of gout, there can be decades in between stages   hyperuricemia, acute gout, intercritical gout, chronic gout  
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uric acid levels increase at __   puberty  
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hyperuricemia is defined as serum uric acid level > __ mg/dL   6.8  
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most people with __ don't develop gout   hyperuricemia  
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asymptomatic __ usually doesn't need to be treated   hyperuricemia  
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dusky red is the color of __   gout  
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usually exquisitely tender (bed sheet sign)   gout  
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may be difficult to distinguish from septic arthritis (similar lab features)   gout  
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Peggy says this is the NSAID of choice for gout   indomethacin  
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Treatment of choice for gout   NSAIDs  
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limit/restrict offending foods, limit ETOH, increase fluid intake, weight loss   lifestyle modifications for gout  
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beef, pork, canned sardines, foods with high yeast content, shellfish, asparagus, cauliflower, mushrooms, spinach   foods high in purines  
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__ should be obtained before initiating therapy for acute gout   24 hour urinary uric acid measurement  
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__ is very allergenic and associated with severe side effects (bone marrow/liver failure, severe skin rashes)   allopurinol  
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__ prophylaxis in a flair   don't stop  
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fenofibrat, and losartan   have mild uricosuric affects  
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aka interval gout   intercritical gout  
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in gout this manifestation can resemble rheumatoid nodules   tophi  
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CPPD Disease   aka pseudogout  
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is a rheumatologic disorder with varied clinical manifestations due to precipitation of calcium pyrophosphate dihydrate crystals in the connective tissues   chondrocalcinosis  
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can mimic RA, OA, or gout when symptomatic   CPPD disease  
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often asymptomatic   CPPD disease  
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may worsen OA when both exist   CPPD disease  
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Calcific tendonititis   frozen shoulder  
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inflammation at sites of attachment of bone to a tendon or ligament   enthesopathies  
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characterized by enthesopathies and involvement of the sacroiliac joints   Spondyloarthropathies  
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Formerly preceded by prefix “seronegative” denoting absence of rheumatoid factor   Spondyloarthropathies  
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association with human leukocyte antigen (HLA) B-27   Spondyloarthropathies  
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if a patient with a spondyloarthropathy is HLA B-27 positive __   they are more likely to have eye symptoms, earlier onset, and more axial involvement  
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if a patient with a spondyloarthropathy is HLA B-27 negative __   they are more likely to have peripheral arthritis, skin and nail manifestations, gut symptoms  
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sites of enthesitis in the spondyloarthropathies   Achilles' tendon, plantar fascia, symphysis pubis, ischium, iliac crest, greater trochanter, finger & toes, anterolateral ribs  
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Ankylosing SpondylitisReactive ArthritisPsoriatic ArthritisEnteropathic ArthritisUndifferentiated Spondyloarthropathy   The Spondyloarthropathies  
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Ankylosing Spondylitis   spondyloarthropathy  
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Reactive Arthritis   spondyloarthropathy  
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Psoriatic Arthritis   spondyloarthropathy  
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Enteropathic Arthritis   spondyloarthropathy  
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insidious onsetworsens with inactivity; improves with exercisepersists greater than 3 monthsam stiffnessoften radiates to buttocks, thighs   inflammatory characteristics of low back pain Enteropathic Arthritis  
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acute onsetworsens with activity; improves with restlast 2-4 weeksno am stiffnessrarely radiates   non-inflammatory characteristics of low back pain Enteropathic Arthritis  
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Bilateral Sacroiliitis makes the diagnosis for   ankylosing spondylitis  
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it can take as long as 10 years for someone with spondylitis to show arthropathy on __   plain film  
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uveitis, conjunctivitis, sicca symptoms   eye manifestations of spondyloarthropathies  
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AI, conduction delays   cardiac manifestations of spondyloarthropathies  
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IgA nephropathy, amyloidosis   renal manifestations of spondyloarthropathies  
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c-spine fractures or dislocations   neurologic manifestations of spondyloarthropathies  
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occult or overt colitis   GI manifestations of spondyloarthropathies  
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manifestations only in psoriatic arthritis and reactive arthritis   skin manifestations of spondyloarthropathies  
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males with Ankylosing Spondylitis tend to have more   lumbar spine involvement  
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females with Ankylosing Spondylitis, tend to have more peripheral involvement, but when they do have spinal involvment it is   in the c-spine  
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Mark at L5 make a mark 10 cm above that, have the patient bend at the hip. This distance should increase to 15 cm or more in the normal patient   Shober maneuver, tests for ankylosing Spondylitis  
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most people with reactive arthritis are   HLA B-27 positive  
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sausage digits   dactylitis  
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enthesopathiesdactylitisinvolvement of skin & mucous membranesrecovery is usually spontaneous with good prognosischronic cases can occur ( SI joint & axial disease associated with chronicity)susceptibilty associated with HLA B-   Clinical Features of Reactive Arthritis  
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Antibiotics if triggering infection is still presentRestNSAIDsConsider intra-articular corticosteroid injectionsChronic disease: consider DMARDs   Treatment of Reactive Arthritis  
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Association with HLA B-27 is weak (<50%)   Psoriatic Arthritis  
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An inflammatory arthritis found in 20-30% of patients with psoriasisUsually (75% of time) psoriasis precedes joint disease on average of 2 decadesPsoriatic findings may be occult (check scalp, nails, flexural areas)Male: female ratio is 1:1   Psoriatic Arthritis  
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Predominant involvement of DIPs, Symmetric polyarthritis clinically indistinguishable from RA (most common), Asymmetric oligoarthritis of small joints ( most characteristic), Arthritis mutilans with sacroilitisAS-type with sacroilitis and spondylitis   5 types of Psoriatic Arthritis  
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pencil in cup deformity is seen in   psoriatic arthritis  
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NSAIDsCombination of NSAIDS + sulfasalazine work wellMethotrexate can be added in refractory casesOligoarthritis form: amenable to corticosteroid injectionsPhysical therap   Treatment of Psoriatic Arthr  
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outside of arthritis patients with a spondyloarthropathie will most often have   gut symptoms  
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patients with gut diseases (Crohn's) are more likely to have   arthritis symptoms  
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male to female ratio with axial enterophathic arthirits __:1   1  
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GI symptoms and __ are usually temporally related   arthritis flares  
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Extra-articular manifestations of enteropathic arthritis = __   Extra-intestinal manifestations of IBD  
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Low back pain: could it be sacroiliitis? Do __ test   FABER  
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microbes reach joint usually via __ in infectious arthritis   hematogenous spread  
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__ is a rare cause of infectious arthritis   intra-articular  
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__ is the most commonly affecte joint in infectious arthritis   knee  
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infectious arthritis is usually   monoarticular  
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__ accounts for 2/3 of infectious arthritis cases in patients <40 years in adults   gonococcal arthritis  
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__ are a greater risk for gonococcal arthritis   women  
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syndrome of rash, fever, chills, migratory tenosynovitis of knees, ankles, wrists, feet and hands (~30-60%)~40% have skin lesions: papulovesicular or hemorrhagic, varying size monoarticular process: kneehip, ankle, wrist or elbow   gonococcal arthritis  
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Treatment:patients should be hospitalizedceftriaxone 1gm (IM or IV) q 24 hours until clinical improvementpo cefixime or cefpodoxime for at least one week   gonococcal arthritis  
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__ accounts for most cases of nongonococcal arthritis   S. aureus  
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__% of nongonococcal arthritis cases are monoarticular   90%  
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order of joints affected by nongonococcal arthritis   knee>hip>shoulder>wrist>elbow  
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moderate to severe pain surrounding jointeffusion, spasm, warmth and erythema commonchills and fever common but may be absent in as many as 20% of affected patients   nongonococcal arthritis  
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Synovial fluid is essential for diagnosis and treatment   nongonococcal arthritis  
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syphilis (rare), lyme disease, M. tuberculosis   other (less common) etiologies of bacterial arthritis  
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usually a chronic monoarticular process, pain and swelling develop in affected joint over months to years   tuberculosis arthritis  
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borrelia burgdorferi carried by Ixodes tick causes   Lyme arthritis  
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reported in nearly all states   lyme arthritis  
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Primarily in northeast from Massachusetts to Maryland and in Wisconsin, Minnesota, California, and Oregon   lyme arthritis  
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__% of patients with Lyme disease who are untreated develop arthritis   70  
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most common etiology of viral arthritis   hep B&C, rubella, and parvovirus  
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__ can be confused with RA   parvovirus  
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Predilection for immunocompromised patients - DM, alcoholism, AIDS, post-transplant, corticosteroid therapy, chemotherapy   fungal arthritis  
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gardeners and those occupationally or recreationally exposed to soil   fungal arthritis  
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less common etiologies of fungal arthritis   Aspergillus, Cryptococcus, Pseudallescheria, dematiaceous fungi  
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infection complicates __% of joint replacements   1-4  
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most common cause of early prosthetic joint infection   S. epidermidis  
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most common cause of late prosthetic joint infection   S. aureus  
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aggressive debridement and prolonged antibiotic therapy   treatment of early prosthetic joint infection  
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removal of prosthesis and prolonged antibiotic therapy   treatment of late prosthetic joint infection  
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