Chapter 52: Alterations in Musculoskeletal Function: Rheumatic Disorders (exam 4)

What are the 7 characteristic manifestations of rheumatic disorders?

Joint pain, pain with motion, soreness to touch, stiffness after immobility, improvement with mild exercise, worsening with weather changes, and improvement with warmth.

What distinguishes noninflammatory arthritis from inflammatory arthritis?

Noninflammatory arthritis worsens with use and improves with rest, whereas inflammatory arthritis worsens with rest and improves with movement.

What is ankylosis?

Stiffening of a joint due to abnormal adhesions.

What is osteoarthritis (OA)?

A progressive, noninflammatory, degenerative disease of weight-bearing synovial joints.

What are major risk factors for osteoarthritis?

Obesity, joint trauma, congenital abnormalities, and hormonal factors.

What initiates cartilage breakdown in osteoarthritis?

Release of proteolytic and collagenolytic enzymes from chondrocytes.

What structural changes occur in osteoarthritis?

Cartilage erosion, osteophyte formation, subchondral sclerosis, cyst formation, and joint space narrowing.

What are osteophytes?

Bone spurs that develop at joint margins in osteoarthritis.

What causes crepitus in osteoarthritis?

Roughened articular surfaces rubbing together during movement.

What are common clinical manifestations of osteoarthritis?

Joint pain with movement, crepitus, bony enlargement, and morning stiffness lasting less than 30 minutes.

What are Heberden nodes?

Bony enlargements of the distal interphalangeal (DIP) joints.

What are Bouchard nodes?

Bony enlargements of the proximal interphalangeal (PIP) joints.

What radiographic findings are characteristic of osteoarthritis?

Asymmetric joint space narrowing, osteophytes, subchondral sclerosis, and cyst formation.

What is the primary goal of osteoarthritis treatment?

Improve function and reduce stress on joints.

What medications are commonly used to treat osteoarthritis?

Acetaminophen, NSAIDs, and COX-2 inhibitors such as Celebrex.

What is infectious (septic) arthritis?

Infection of the synovial membrane by bacteria or other pathogens.

What is the most common cause of septic arthritis?

Staphylococcus aureus.

What are other common causes of septic arthritis?

Streptococcus pyogenes and Streptococcus pneumoniae.

What are common clinical manifestations of septic arthritis?

Fever, chills, leukocytosis, severe joint pain, swelling, redness, warmth, and limited ROM.

How many joints are usually involved in septic arthritis?

Typically a single joint.

What synovial fluid finding is common in septic arthritis?

Neutrophils often greater than 50,000 cells/mm³.

How is septic arthritis treated?

IV followed by oral antibiotics for 4–6 weeks and joint drainage.

What organism causes Lyme disease?

Borrelia burgdorferi.

How is Lyme disease transmitted?

By deer tick bites.

Where is Lyme disease most common in the United States?

Northeast, Midwest, and West Coast regions.

What is the characteristic early skin lesion of Lyme disease?

A red macule or papule at the tick bite site.

What systems can Lyme disease affect?

Musculoskeletal, neurologic, and cardiac systems.

What musculoskeletal symptom is common in Lyme disease?

Migratory pain involving joints, tendons, bursae, muscles, or bones.

How is Lyme disease treated?

Oral or parenteral antibiotics.

What is rheumatoid arthritis (RA)?

A systemic autoimmune inflammatory disease affecting synovial joints.

What immune cells play a major role in rheumatoid arthritis?

T lymphocytes, B lymphocytes, and macrophages.

What is rheumatoid factor (RF)?

An autoantibody produced by B cells in rheumatoid arthritis.

What is pannus?

Inflammatory granulation tissue that destroys cartilage and bone in RA.

What joints are commonly affected first in RA?

MCP and PIP joints of the hands.

Which finger joints are usually spared in RA?

DIP joints.

What is the classic pattern of joint involvement in RA?

Bilateral symmetric polyarthritis.

What systemic symptoms commonly occur in RA?

Malaise, fatigue, and diffuse musculoskeletal pain.

What is a swan-neck deformity?

Hyperextension of the PIP joint with flexion of the MCP and DIP joints.

What is a boutonnière deformity?

Flexion of the PIP joint with hyperextension of the DIP joint.

What is ulnar deviation in RA?

Drifting of the fingers toward the ulnar side of the hand.

What medications are used to treat RA?

DMARDs, NSAIDs, COX-2 inhibitors, corticosteroids, and biologic agents.

Why should DMARDs be started early in RA?

To minimize permanent joint damage.

What is systemic lupus erythematosus (SLE)?

A chronic multisystem autoimmune disease with periods of exacerbation and remission.

What immune abnormality characterizes SLE?

B-cell overactivity causing excessive autoantibody production.

What is the classic skin finding in SLE?

Butterfly (malar) rash across the cheeks and nose.

What joint symptoms occur in SLE?

Joint swelling, tenderness, pain with movement, and morning stiffness.

What cardiac complication is common in SLE?

Pericarditis.

What renal complication is common in SLE?

Glomerulonephritis.

What neurologic manifestations can occur in SLE?

Seizures, psychosis, diplopia, ptosis, and ataxia.

How is SLE treated?

Sun protection, corticosteroids, NSAIDs, hydroxychloroquine, and immunosuppressants.

What is ankylosing spondylitis?

A chronic inflammatory arthritis causing fusion of vertebrae and sacroiliac joints.

What genetic marker is strongly associated with ankylosing spondylitis?

HLA-B27.

Who is most commonly affected by ankylosing spondylitis?

Young males in their late teens and early twenties.

What is the hallmark symptom of ankylosing spondylitis?

Low back pain that improves with exercise but not with rest.

What symptom helps distinguish inflammatory back pain from mechanical back pain?

Back pain at night.

What spinal posture develops in advanced ankylosing spondylitis?

Kyphosis with loss of lumbar curvature.

What medications are used to treat ankylosing spondylitis?

NSAIDs, sulfasalazine, methotrexate, and TNF-α inhibitors.

What is Reiter syndrome (reactive arthritis)?

A seronegative arthritis that develops after infection.

What infections commonly trigger reactive arthritis?

Salmonella GI infections and Chlamydia trachomatis STIs.

How long after infection does reactive arthritis usually appear?

2–6 weeks.

What joints are most commonly affected in reactive arthritis?

Knees and ankles.

What pattern of arthritis occurs in reactive arthritis?

Asymmetric oligoarthritis.

What is acute rheumatic fever?

An inflammatory disease following group A β-hemolytic streptococcal pharyngitis.

What is the incubation period for acute rheumatic fever?

2–6 weeks after infection.

What organs may be affected in acute rheumatic fever?

Joints, heart, skin, and nervous system.

What are common manifestations of acute rheumatic fever?

Fever, polyarthritis, and carditis.

How is acute rheumatic fever treated?

NSAIDs, corticosteroids, and antibiotics.

What is psoriatic arthritis (PsA)?

An inflammatory arthritis associated with psoriasis.

What immune mediators are important in PsA?

TNF-α, IL-1, and IL-15.

What pattern of arthritis is common in PsA?

Asymmetric oligoarthritis.

Which joints are predominantly affected in PsA?

DIP joints.

How can PsA be distinguished from RA?

DIP involvement and psoriatic nail changes.

What is onycholysis?

Separation of the nail from the nail bed.

What skin findings occur in psoriasis?

Erythematous plaque-like lesions with scales.

How is psoriatic arthritis treated?

NSAIDs, corticosteroids, methotrexate, and TNF-α antagonists.

What is enteropathic arthritis?

Arthritis associated with inflammatory bowel disease.

Which diseases are associated with enteropathic arthritis?

Crohn disease, ulcerative colitis, and celiac disease.

What pattern of arthritis is common in enteropathic arthritis?

Asymmetric peripheral arthritis.

What laboratory findings often accompany enteropathic arthritis?

Anemia and leukocytosis.

What medications are used to treat enteropathic arthritis?

Celebrex, corticosteroids, sulfasalazine, and infliximab.

What is neuropathic osteoarthropathy (Charcot joint)?

Joint destruction caused by loss of pain sensation and proprioception.

What are common manifestations of neuropathic osteoarthropathy?

Swollen, unstable, deformed joints with severe destruction.

How is neuropathic osteoarthropathy treated?

Joint protection and immobilization.

What causes hemophilic arthropathy?

Repeated bleeding into joints.

Which joints are commonly affected in hemophilic arthropathy?

Knees, hips, and elbows.

What is the primary treatment for hemophilic arthropathy?

Enhancing clotting factor activity.

What is gout?

A disorder of uric acid metabolism resulting in monosodium urate crystal deposition.

What causes hyperuricemia in gout?

Uric acid production exceeds renal excretion.

Why are humans prone to gout?

They lack the enzyme uricase.

What commonly triggers an acute gout attack?

Trauma, surgery, illness, alcohol, or medications.

Which joint is most commonly affected in acute gout?

The first metatarsophalangeal (MTP) joint of the great toe.

What are tophi?

Deposits of monosodium urate crystals in tissues.

What are the four phases of gout?

Asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout, and chronic tophaceous gout.

What are the signs of acute gouty arthritis?

A warm, red, swollen, and extremely tender joint.

What is intercritical gout?

Asymptomatic periods between acute attacks.

What characterizes chronic tophaceous gout?

Tophi formation and chronic deforming arthritis.

What medications treat acute gout attacks?

NSAIDs and corticosteroids.

What medications help prevent gout recurrence?

Allopurinol and uricosuric agents.

What are growing pains?

Benign nocturnal pains of the calves, shins, and thighs in children.

What is joint hypermobility?

Excessive mobility of a joint beyond normal limits.