SS
dry eyes and dry mouth
name 3 deformities seen in RA
swan neck, ulnar deviation, joint erosion
Name 3 different causes of secondary OA
Secondary
-Due to disorders that damage articular cartilage, subchondral bone, or synovium (trauma, genetic disorders like Marfan’s, etc)
-Post-traumatic: Repetitive squatting, stairs
-Congenital/malformation: Developmental hip dysplasia, slipped capital femoral epiphysis
-Malposition (eg. varus/valgus of knee)
-Postoperative
-Postinfectious
- Metabolic: Rickets, hemachromatosis
-Endocrine: Acromegaly, hyperparathyroidism, obesity, gout, pseudogout
-Aseptic osteonecrosis
-Infiltrative: Hemophilia, sarcoidosis, amyloidosis
-Neuromuscular: Muscle weakness, Charcot joint
Starts as a small papule or pustule after trauma; progresses to ulcerative lesion.
- Seen in RA, Crohn's, UC, and IgA myeloma
Pyoderma gangrenosum
what are Hegerden's vs Bouchard's nodes?`
Are these OA nodules or RA nodules?
Heberden: DIP
Bouchard: PIP
OA nodules- bony growths (RA nodules are inflammatory growths)
What are 4 other body systems affected by SS and name specific findings
for extra 100, what is anti-SSA associated with regardless of a diagnosis of sjogrens
- mucous membranes: URT, vulvovaginal area, anorectal area
- GI: dysphagia due to dry pharynx & esophagus; pancreatitis, issues due to achlorhydria
- extra glandular involvement: interstitial nephritis/RTA, liver disease, interstitial lung disease
- cardiac, neuro
Anti-SSA associated with ILD
•External trigger → autoimmune rxn → synovialhypertrophy + chronic joint inflammation insusceptible individuals
•CD4 T cells, mononuclear phagocytes,fibroblasts, osteoclasts, neutrophils, and Bcells play major roles
•Cytokines, chemokines, and otherinflammatory mediators (eg, TNF-α, IL-1, IL-6, TGF-β, FGF, PDGF) are all active
•Ultimately, inflammation & proliferation of thesynovium destroys cartilage, bone, tendons,ligaments, and blood vessels
name 3 joints commonly affected in OA and 3 joints uncommonly involved in OA
Common
Cervical spine
Lumbar spine
1st CMC
PIP
DIP
Hip
Knee
1st MTP
Uncommon: shoulder, thoracic spine, elbow, wrist, MCP, ankle, subtalar
What are the medical terms for medium vessel vasculitis and small vessel vasculitis?
medium: livedo reticularis
small: circular purpura
RF is not isolated to RA, what other rheumatoid and non-rheumatoid conditions often have RF?
rheumatoid: cryoglobulinemia, sjogrens, MCTD
non-rheumatoid: subacute bacterial endocarditis, hep C, leprosy, ILD, primary biliary cirrhosis
- sensitivity is 30%, specificity is 90%
What HLA are 87% of pts with SS positive for?
HLA-DR52
What antibodies are an emerging focus of research, associated with more severe disease and is positive in pts in pre-symptomatic stage?
anti-CarP antibodies
In isolated patellofemoral arthritis, what positions or movements would worsen pain? where is pain?
• anterior knee pain that worsens with climbing stairs or rising from a seated position.
• Exam: compress patella as pt. flexes knee. Pain is elicited if arthritis is present. Resisted knee extension may also reproduce symptoms.
Name 2 abnormalities of the cervical spine in RA
1.Atlantoaxial instability / atlantoaxial subluxation.
2.Superior migration of the odontoid.
3.Subaxial subluxation.
what's the difference between osteophyte and syndesmophyte?
Ankylosing spondylitis has involvement of SI joints & syndesmophytes. Syndesmophytes bridge across the joint as compared to osteophytes which are non-bridging.
Name 2 complications of SS
- lymphoma: (increased 18x above normal) most commonly MALT lymphoma
- parotid infections (staph, strep, pneumococcal)
- parotid tumors
- antiphospholipid antibody syndrome
- neonatal lupus with congenital heart block
Name a genetic association (HLA) and 2 autoantibodies. What pulmonary complication is common in RA?
what antibody has a specificity of >99% for RA?
HLA-DRB1
RF, anti-CCP Ab
- pleuritic common, exudative pleural effusions, rheumatoid nodules
* anti-CCP Ab
Name 3 things that contribute to the pathophysiology of OA
Altered chondrocyte function
Loss/thinning of cartilage
Subchondral bone thickening/sclerosis
Bone remodeling
Osteophytes
Cystic changes in subchondral bone
Mild reactive synovitis
What's the term for rheumatoid pneumoconiosis in pts with both RA and pneumoconiosis related to mining dust?
Caplan syndrome
- symptoms: cough, dyspnea, wheeze, joint pain, swelling
What's DAS28 and how do you calculate?
To calculate the DAS28:
-Number of swollen joints (out of the 28),
-Number of tender joints (out of the 28),
-Measure ESR or CRP,
-Patient makes a ‘global assessment of health' (Pt. marks aline between very good and very bad).
A complex mathematical formula produces an overall score.
A DAS28 > 5.1 implies active disease, < 3.2 low disease activity,and < 2.6 remission.
For a diagnosis of SS, you need to meet 4 of 6 criteria, including either a biopsy or antibodies. can you give me 4 criteria?
Alternatively, explain 3 different diagnostic tests to confirm
•Dry eyes with need for artificial tears (3x daily) for >3 months
•Dry mouth, swollen salivary glands, needing liquids to swallow
•Positive Schirmer test or ocular vital dye staining (Lissamine green)
•Abnormal oral scintigraphy or sialography findings
•+ biopsy of minor salivary gland
+Anti-Ro/SSA or Anti-La/SSB
What is Felty's Syndrome?
Classic Triad: RA, neutropenia, splenomegaly
SANTA: Splenomegaly, Anemia, Neutropenia, Thrombocytopenia, Arthritis
Describe Diffuse Idiopathic Skeletal Hyperostosis (DISH)
for extra 100 pts: what's the zebra 'sign' on XR?
“Flowing osteophytes” in ≥ 4 contiguous vertebrae.
Ossification of anterior longitudinal ligament.
-Posterior longitudinal ligament occasionally involved.
Preservation of joint and disc spaces.
No systemic inflammation.
- associated with type 2 DM, obesity, hyperinsulinemia, hyperuricemia
- candle wax pattern- normal IV discs
what's the term for degenerative thinning of the sclera, seen in RA
Scleromalacia perforans
What characterizes erosive OA from OA and RA?
A subset of hand osteoarthritis: Affects 5-15% of pts. with hand OA
Acute onset of pain
↑ inflammation compared to usual OA
Presence of erosions on x-ray
Subluxations, flexion contractures, ankylosis may also be seen
Most common in postmenopausal women: Typical onset age 50-55
OA of hands--Subchondral erosions in at least 2 IP joints, with 1 a DIP*
- Negative RF, anti-CCP, ESR, CRP
- No psoriasis, gout, or pseudogout