Jeopardy Template

OA or RA?

100

Associated with HLA-DR4

What is RA

also HLA-DRB1

200

Pain in the morning lasting OVER 1 hour

RA

300

Chronic mechanical stress destroying of articular cartilage --> inflammation with inadequate repair

OA

Contrast to AUTOIMMUNE inflammation in RA --> formation of proliferative granulation tissue

400

Symmetric involvement

RA 

500

Systemic Symptoms

RA (fever, fatigue, weight loss)

OA or RA pt2

100

Joint space narrowing

BOTH

RA (symmetric)w/ Erosions, juxta-articular osteopenia, soft tissue swelling

in OA osteophytes, ASYMMETRIC joint space narrowing

200

Treatment options include NSAIDs and glucocorticoids

BOTH

in OA mainly lifestyle modifications, in RA DMARDS like methotrexate, sulfasalazine, TNF inhibitors

300

Heberden & Bouchard nodes

OA

Heberden (DIP), Bouchard (PIP)

400

MCP, PIP impacted

RA 

NO DIP INVOLVEMENT

500

Occurs more in females

BOTH

in OA obese, old females

in RA smoking females

Arthritis in general

100

Daily spiking fevers, salmon-pink macular rash, anterior uveitis in children

Systemic juvenile idiopathic arthritis

200

Purulent arthritis, tenosynovitis, dermatitis, polyarthralgia

Disseminated gonococcal infection (systemic gonorrhea)

300

Swollen joint, synovial fluid purulent (WBC >50000)

septic arthritis

s aureus, strep, neisseria

400

chronic bone infection, hematogenous spread in children, exogenous spread in adults

osteomyelitis

s aureus most common, salmonella, pseudomonas (puncture wounds). 

Diagnose X-ray, MRI, bone biopsy

Treat?

500

conjunctivitis, urethritis, arthritis triad

reactive arthritis

hyperkeratotic skin lesions in palms and soles

Arthritis pt2

100

HLA-B27 association

Ankylosing spondylitis

NO rheumatoid factor. 

200

Rheumatoid PLUS splenomegaly, anemia, neutropenia, thrombocytopenia

Felty syndrome

300

arthritis with serositis, renal disease, photosensitivity, rash (face), Libman-Sacks Endocarditis

Lupus

Antibodies?

400

Bamboo spine, uveitis, aortic regurg, restrictive lung disease

ankylosing spondylitis

more common in males 20-40 yrs

500

pencil-in-cup deformity of DIP

psoriatic arthritis

skin and nail lesions, asymmetric patchy involvements

Muscle weakness/pain

100

+ Anti-Jo-1, anti-SRP, anti-Mi-2, ANA

Polymyositis/dermatomyositis

increase in Creatine Kinase

200

chronic msk pain associated with "tender points" in females. normal inflammatory markers

fibromyalgia

300

progressive symmetric proximal muscle weakness, inflammation with CD8+ T cells. Most often involves shoulders

Polymyositis

400

Gottron papules on fingers, heliotrope edema of eyelids, "shawl and face" rash in addition to progressive proximal muscle weakness with CD8+ T cell inflammation

dermatomyositis

Antibodies?

500

Autoantibodies to presynaptic Ca2+ channel, improves with muscle use

Lambert-Eaton myasthenic syndrome

Proximal muscle weakness, hyporeflexia, association with small cell lung cancer

Contrast w/ myasthenia gravis (autoantibodies to POSTsynaptic Ach receptor, WORSENS with muscle use, thymic hyperplasia)

Treatment?