Rheumatology - Exam 1

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63 Terms

1
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osteoporosis definition

  • disease causing architectural deterioration of bone tissue leading to increased bone fragility

  • affects cancellous bone most

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primary osteoporosis

due to aging

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secondary osteoporosis

side effect of medication

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osteoporosis clinical manifestations

  • loss of height

    • affects curvature of spine

  • postural changes

  • back pain

  • fractures

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osteoporosis risk factors

  • age >50

  • low estrogen levels

  • low testosterone levels

  • genetics/family history

  • long periods of immobilization

  • sedentary lifestyle

  • malabsorption disorders

  • eating disorders

  • poor nutrition

  • excess alcohol, tobacco, caffeine, consumption

  • hyperthyroidism

  • diabetes mellitus

  • medications

    • chemotherapy

    • heparin

    • glucosteroids

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how estrogen affects bone growth

estrogen facilitates osteoblasts and inhibits osteoclasts

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osteoporosis PT intervention

WB exercise & ROM

change diet

increase balance - decrease risk of falls

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osteoporosis medical management

  • bisphosphonates

    • inhibit osteoclasts, facilitate osteoblasts

  • estrogen replacement therapy

  • selective estrogen receptor modulators (SERMs)

  • calcium supplementation

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categories of arthritis

  • infectious

    • septic arthritis

  • degenerative

    • osteoarthritis

  • inflammatory

    • rheumatoid arthritis

    • ankylosing spondylitis

    • juvenile idiopathic arthritis

    • polymyalgia rheumatica

  • metabolic

    • gout

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osteoarthritis

degenerative pathology within synovium, articular cartilage, and underlying subchondral bone

  • progressive damage/loss of cartilage

    • due to abnormal mechanical loading

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osteoarthritis risk factors

  • obesity

  • prolonged stresses on joints

  • previous injuries/surgeries

  • hypermobility

  • infection

  • other diseases

    • gout

    • diabetes mellitus

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primary osteoarthritis

idiopathic

  • potentially due to genetics and/or increased age

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secondary osteoarthritis

due to pre-existing joint abnormalities

  • trauma, injury, disease

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osteoarthritis signs and symptoms

  • unilateral involvement

  • pain

  • swelling without warmth/redness

  • crepitus

  • loss of ROM

  • locking

  • short-term stiffness

  • worsening with inactivity or overactivity

  • Heberden’s and Bouchard’s nodules

  • affects distal and proximal IP joint, spares carpometacarpal joint

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osteoarthritis diagnostic criteria

  • pain with radiologic findings

  • >50 years of age

  • morning stiffness >30 minutes

  • crepitus with motion

  • blood tests rule out rheumatologic diseases

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osteoarthritis radiograph findings

  • joint space narrowing

  • subchondral sclerosis

  • subchondral cyst formation

  • osteophyte formation

  • loose bodies

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osteoarthritis treatment

  • medications

    • acetaminophen

    • NSAIDs

  • supplements

    • glucosamine

    • chondroitin

  • injections

    • corticosteroids

    • hyaluronic acid

  • PT/OT

  • surgery

    • arthroplasty

    • partial replacement

    • microfracture

    • fusion (arthrodesis)

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rheumatoid arthritis

  • chronic, systemic autoimmune disease characterized by both articular and extra-articular findings

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rheumatoid arthritis effects

synovial hypertrophy

  • increased macrophages and fibroblasts

  • inflammatory cell infiltration

  • angiogenesis

  • pannus formation

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rheumatoid arthritis joint clinical manifestations

  • insidious onset

  • joints

    • bilateral

    • edematous and warm

    • prolonged stiffness

    • irreversible deformities

      • ulnar deviation

      • boutonniere deformity

      • swan-neck deformity

  • spine

    • cervical spine

    • atlantoaxial subluxation

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rheumatoid arthritis constitutional symptoms

  • fatigue

  • weight loss

  • generalized, diffuse pain

  • weakness

  • depression

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rheumatoid arthritis integumentary clinical manifestations

  • palmar erythema

  • petechia and purpura

  • rheumatoid nodules

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rheumatoid arthritis neurologic clinical manifestations

  • peripheral neuropathies

  • compressive cervical myelopathy

  • stocking glove myelopathy

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rheumatoid arthritis cardiopulmonary clinical manifestations

  • myocardial infarction

  • congestive heart failure

  • airway inflammation

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rheumatoid arthritis medications

  • analgesics

  • NSAIDs

  • corticosteroids

  • disease modifying anti-rheumatic drugs (DMARDs)

  • cytokine inhibitors

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gout

characterized by deposition of urate crystals in joints

  • urate crystals are a byproduct of nucleotide breakdown

  • urate crystal deposits (tophi) disrupt osteoclast/osteoblast homeostasis and trigger cell damage and inflammation

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gout risk factors

  • diet

    • high in alcohol

    • high in red meat

    • high in seafood

  • genetics

  • AMAB

  • increasing age

  • comorbidities affecting heart and metabolic system

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gout clinical manifestations

  • severe pain, swelling, and inflammation of LE joints

    • 1st MTP frequently affected

  • flare ups at night or early morning

  • fever

  • tachycardia

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gout medical management

  • diet and lifestyle modifications

  • corticosteroids

  • NSAIDs

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juvenile idiopathic arthritis

A type of arthritis that occurs in children <16 y.o.a (1-4 & 9-14) and is characterized by persistent joint inflammation, pain, and swelling. It can affect growth and development and may have various subtypes.

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juvenile idiopathic arthritis clinical manifestations

  • pathological changes similar to RA

    • increased synovial fluid viscosity

    • pannus formation

  • asymmetric joint involvement

  • pain

  • edema

  • erythema/warmth

  • rash

  • conjuctivitis

  • fever

  • fatigue

  • weight loss

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juvenile idiopathic arthritis treatment

  • NSAIDs

  • corticosteroids

  • DMARDs

  • biologic immunomodulators

  • surgery

    • joint replacement

    • synovectomy

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juvenile idiopathic arthritis prognosis

  • ~70% experience full remission with treatment

  • lack of treatment = permanent joint damage, osteoporosis, joint contractures

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septic arthritis

joint inflammation triggered by bacteria, viruses, or fungi

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septic arthritis risk factors

  • recent surgery

  • RA

  • shared needles

  • unprotected sex

  • immunocompromise

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septic arthritis clinical manifestations

  • severe 10/10 pain

  • edema

  • erythema

  • fever

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lack of treatment of septic arthritis can lead to

  • permanent joint damage and disability

  • death

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polymyalgia rheumatica

a condition characterized by widespread muscle pain and stiffness, especially in the shoulders and hips

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polymyalgia rheumatica clinical manifestations

  • pain, aching, stiffness in bilateral axial joints

  • prolonged morning/inactivity stiffness

  • weakness

  • fatigue

  • low-grade fevers

  • weight loss and anorexia

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polymyalgia rheumatica risk factors

  • AFAB

  • age >50

  • genetics

  • smoking

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polymyalgia rheumatica treatment

corticosteroids

DMARDs

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ankylosing spondylitis

chronic inflammatory arthritis of axial joints involving inflammation, fibrosis, and calcification of attachment points for skeletal muscle, ligaments, synovium, and cartilage

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ankylosing spondylitis risk factors

AMAB

genetics

smoking

30-50 years of onset

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ankylosing spondylitis clinical manifestations

  • back pain, stiffness, reduced mobility

  • SIJ and hip pain

  • relief of pain and stiffness with movement

  • postural abnormalities

  • chest pain and shortness of breath

  • uveitis

  • inflammatory bowel disease

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ankylosing spondylitis treatment

NSAIDs

DMARDs

corticosteroids

spinal osteotomy

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diffuse idiopathic skeletal hyperostosis (DISH)

ossification of ligaments, typically in cervical spine among 4 consecutive segments

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diffuse idiopathic skeletal hyperostosis (DISH) medical management

no cure

surgery is rare

medications

  • acetaminophen

  • opioids

Therapeutic exercise utilized to slow progression and reduce symptoms

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degenerative disc disease

degeneration of intervertebral disc due to the loss of proteoglycans

disc becomes more fibrotic

thinning disc leads to increased loading of articular facets

osteophyte formation and narrowing of intervertebral foramen

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degenerative disc disease clinical manifestations

In a dermatomal pattern

  • weakness

  • pain

  • numbness

  • paresthesias

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degenerative disc disease treatment

pain management - NSAIDs, acetaminophen, corticosteroids

muscle relaxants

laminectomy

spinal fusion

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heterotopic ossification

abnormal formation of bone within soft tissues occuring 3 weeks to 3 months post initial injury

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heterotopic ossification risk factors

trauma

surgery

spinal cord injury

genetics

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heterotopic ossification clinical manifestations

loss of ROM

pain

swelling

tenderness

warmth

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heterotopic ossification treatment

NSAIDs and bisphosphonates prevent formation

AROM/PROM

surgical resection

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osteomalacia (rickets)

softening of bones caused by a lack of calcium phosphate in the bone matrix due to a prolonged deficiency of Vitamin D

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How is vitamin D linked to calcium

Vitamin D facilitates absorption of calcium

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osteomalacia clinical manifestations

  • bone pain felt over a large area

  • myalgias and muscle spasms

  • weakness

  • waddling gait

  • bowing of long bones

  • fractures

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osteogenesis imperfecta

fragile bones that break easily due to genetic mutation in type 1 collagen gene resulting in a lack of flexibility that collagen normally provides

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osteogenesis imperfecta clinical manifestations

  • frequent manifestations

  • blue sclera

  • recurrent nosebleeds

  • weakness

  • hypermobility

  • hearling loss

  • cardiovascular complications

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osteogenesis imperfecta treatments

bisphosphonates

Vitamin D and calcium supplements

intramedullary rod placement surgery

bracing and assistive devices

water based exercise

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paget’s disease

skeletal remodeling disorder that causes bones to become bigger

increased osteoclasts/osteoblast activity

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paget’s disease clinical manifestations

bone pain

enlarged bones

abnormal curvatures in bones

hearing loss

abnormal pain and constipation due to increased calcium levels

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paget’s disease treatments

bisphophonates

ORIF and/or joint replacements

avoidance of intense physical activity