Bone & Joint Midterm 2 Material

eden

Inflammatory means there will be:

symmetrical joint space loss, swelling, marginal erosions

What is the most common type of inflammatory arthritis?

rheumatoid arthritis

Juvenile rheumatoid arthritis affects which age group?

16 and younger

What percentage of JRA are seropositive?

10-15%

What percentage of JRA are seropositive? What does that mean?

85-90%, the prognosis is worse and chronic

True or false, JRA is mostly seropositive?

False (mostly seronegative)

What are the different types of seronegative juvenile arthritis?

classic systemic form, polyarticular, pauciarticular (monoarticular)

What is the aka for classic systemic arthritis?

Still's Disease

What is the aka for Still's Disease?

classic systemic form

What is the lab finding for classic systemic arthritis?

Rf- (seronegative)

1 multiple choice option

What are the symptoms of classic system form arthritis?

intermittent fever, lymphadenopathy, and hepatosplenomegaly (also fleeting migratory rash)

Which form of seronegative juvenile arthritis is the least common?

classic systemic form

3 multiple choice options

True or false, there will be x-ray changes seen in classic systemic form of JRA?

False

What other lab findings will you typically find in the classic systemic form of JRA?

carditis, leukocytosis, and anemia

What percentage of patients with Still's Disease develop severe, chronic arthritis after the systemic manifestations are gone?

25%

How many joints must be affected to diagnose polyarticular JRA?

more than 4

What gender is most affected by polyarticular JRA, and how much more often?

girls, 2x as much

Polyarticular JRA presents unilaterally or bilaterally? What about the other forms of JRA?

bilaterally (the others present unilaterally)

What gender is most affected by pauciarticular JRA, and how much more often?

girls, 3x as much

How many joints must be affected to diagnose pauciarticular JRA?

2-4

How many joints must be affected to diagnose monoarticular JRA?

1

Which joint(s) are most commonly affected by pauciarticular and monoarticular JRA?

the knee

Which form of JRA may be complicated by inflammation of the eye? What percentage of patients are affected?

pauciarticular/monoarticular JRA, 5-10%

True or false, pauciarticular and monoarticular JRA are rarely systemic, whereas classic systemic form and polyarticular JRA are usually systemic?

True

In what percentage of JRA, with an Rf+ lab finding, is the prognosis worse?

10-15% of patients will have a worse prognosis than if they were Rf-

If a patient has JRA and is in the active, acute stages, what might show up in their labs?

elevated ESR and c-reactive proteins

In JRA, what percentage of patients experience complete remission?

75% (good prognosis)

Lab findings for JRA are considered what?

non-diagnostic

What are some x-ray indications of JRA?

smaller vertebral bodies, joint fusion of the facet joints (ankylosis), small and eroded epiphysis, and bone erosions

Injury due to systemic lupus erythematosus is primarily due to what?

vasculitis

What demographic is most affected by SLE?

women of childbearing age (90%)

How many people are diagnosed with SLE?

1:2000

SLE is characterized by what?

remissions and exacerbations (chronic)

What disease involves generalized inflammation of connective tissue and involves multiple organ systems?

systemic lupus erythematosus (SLE)

What is the primary lab finding for patients with SLE?

antinuclear antibody (ANA)

What is the most common cause of death for patients with SLE?

kidney failure

The onset of systemic lupus erythematosus is unknown, but there are what kinds of theories?

non-genetic and environmental factor theories

What is the classic sign of SLE?

butterfly rash, aka macular rash

What are the effects on the skin due to systemic lupus erythematosus?

degeneration of the basal layer of the skin causing a rash

What are the effects on the joints due to systemic lupus erythematosus?

up to 90% experience non-erosive arthritis, leading to non-rigid and reversible deformities

What are the effects on the CNS due to systemic lupus erythematosus?

infarcts (tissue death) and hemorrhages

What are the effects on the heart due to systemic lupus erythematosus?

non-bacterial endocarditis

What are the effects on the lungs due to systemic lupus erythematosus?

pleuritis and pleural effusion

What percentage of SLE patients experience joint pain?

40%

What are the initial signs and symptoms of SLE?

fever, malaise, anorexia, weight loss, and rash

What exacerbates or initiates macular rash?

sun exposure

What are the x-ray findings of a patient with SLE?

normal joint space,

reversible deformities (non-rigid),

generalized osteoporosis,

soft tissue atrophy creating calcium deposits

Reversible deformities in patients with SLE can include what?

ulnar deviation and node growths

What lab findings are commonly associated with SLE?

FANA+ (99%) and +LE cells (70%)

What is the most common treatment for SLE and what can it lead to?

corticosteroids, leading to osteoporosis and spinal compression fractures, avascular necrosis (bone death), and gastric or duodenal ulcers

Scleroderma is a disorder that affects what?

connective tissue

What is the AKA for scleroderma?

progressive systemic sclerosis

What demographic is most commonly affected by scleroderma?

women 30-50 years old

Women are affected by scleroderma at what rate compared to men?

3x

What is scleroderma?

a CT disorder characterized by excessive fibrosis throughout the body and generalized inflammation of CT

In addition to the skin, what parts of the body are commonly affected by scleroderma?

lungs, heart, GI, musculoskeletal, kidneys

What is diffuse scleroderma?

the more rapid form, with early skin and visceral involvement

What is the CREST phenomenon?

the slower form of scleroderma, with later visceral and limited skin involvement

What does CREST stand for?

calcinosis, Raynaud's, esophageal dysfunction (dysphagia), sclerodactyly, and telangiectasis

What is calcinosis, as seen in CREST?

calcium deposits which can be seen on x-ray (affects 20% of patients)

What is Raynaud's, as seen in CREST?

skin turns white, then blue, then red (from stress or cold)

What is esophageal disfunction, as seen in CREST?

dysphagia (difficulty swallowing)

What is sclerodactyly, as seen in CREST?

tightening of the skin on the fingers

What is telangiectasis, as seen in CREST?

spider veins

True or false, scleroderma typically present bilaterally symmetrical?

True

What is the most common cause of death in scleroderma patients?

lung fibrosis

True or false, scleroderma begins proximally in the upper extremities, neck, and face and progresses distally

False

What percentage of patients with scleroderma experience pulmonary involvement?

70%

Similarly to SLE, scleroderma is considered a what phenomenon?

non-erosive phenomenon

What joints are most commonly affected in scleroderma patients?

fingers and knees

Distal tuft resorption can be caused by what disorder?

scleroderma

What are the most common x-ray findings for patients with scleroderma?

resorption of the fingers with retraction of the tips, resorption of distal tufts, normal joint space (usually), calcinosis of soft tissue (20%), possible disuse osteopenia

What are the lab findings associated with scleroderma?

elevated IgG (50%),

Rf+ (20-30%),

ANA+ (40-50%),

The two antinuclear antibodies (ANA) that are unique to scleroderma (PSS) are?

Scl-70 and Anti-centromere Ab

What percentage of patients with scleroderma have 10 year survival rate?

65%

PEAR refers to what kind of arthropathies?

seronegative

What does PEAR stand for?

psoriatic arthritis, enteropathic arthritis, ankylosing spondylitis, reactive arthritis/Reiter's syndrome

What are the AKAs for Ankylosing Spondylitis?

Bechterew disease and Marie Strumpell disease

What are the AKAs for Bechterew disease?

Ankylosing Spondylitis and Marie Strumpell disease

What are the AKAs for Marie Strumpell disease?

Ankylosing Spondylitis and Bechterew disease

What demographic is most commonly affected by AS?

young caucasian men 10-30

What lab finding is AS highly associated with?

HLA B27+

What lab findings do we usually see in patient's with AS?

HLA-B27+ (90-95%),

Rf-,

increased ESR

What is HLA B27?

A gene which increases the incidence of inflammatory arthritides and is associated overall with PEAR but mostly AS

AS is a chronic inflammatory disease that results in ankylosis (fusion) of the spine and SI joints due to what?

ossification and fibrosis

True or false, AS can be primary or secondary?

True (patient can have other seronegative arthropathies)

What is the primary indication of AS?

bilateral sacroiliitis

What are signs of bilateral sacroiliitis commonly found on x-ray?

pseudo widening before fusion, rosary bead erosions, bilaterally symmetrical marginal syndesmophytes, ghost joint

What is a bilaterally symmetrical marginal syndesmophyte?

vertical bridging of the vertebrae due to ligament ossification

What is a ghost joint?

fused SI joint caused by AS due to bilateral sacroiliitis

True or false, AS starts at the top of the spine and gradually spreads downward?

False

True or false, AS commonly affects the upper extremities more than the lower?

False

Clinical features of AS

postural abnormalities, fatigue, weight loss, low-grade fever, hypochromic anemia

True or false, in patients with AS, musculoskeletal pain improves with exercise?

True

In patient's with AS, there is an increased risk of what?

atlanto-axial instability/subluxation

What are the extraarticular (outside of the spine) manifestations of AS?

bowel disease, uveitis, conjunctivitis, cardiovascular disease, psoriasis, upper lobe pulmonary fibrosis, aortic regurgitation, cord compression, and amyloid deposition

What are the name signs for AS?

carrot stick fracture,

railroad track sign,

dagger sign,

trolley track sign,

rosary bead erosion,

ghost joint,

romanus lesion,

shiny corner sign.

anderson lesion

What is carrot stick fracture and where are you most likely to find it?

a break through the ankylosed segments in AS, most common at the lower cervical and T/L junction

What is railroad track sign?

ossification of the articular process ligament in AS

What is dagger sign?

ossification of the interspinous ligament in AS