Rheumatology

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Author:
sgustafson
ID:
75391
Filename:
Rheumatology
Updated:
2011-04-18 13:04:27
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rheumatology
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rheumatology wk2 bk4
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  1. 3 key inflammatory cytokines
    • Activated by PAMPs or DAMPs
    • TNF (tumor necrosis factor)
    • IFN (interferon)
    • IL-1beta
  2. regulatory mechs that protect against self-reactive Abs
    • double signaling/costimulation
    • regulatory T-cells
    • apoptosis
  3. Factors contributing to tolerance failure
    • genetic susceptibility: altered cytokine production/response, altered apoptosis, autoantigen exposure
    • microbial exposure, toxins, UV light
  4. findings characteristic of arthritis
    • joint swelling
    • increased warmth and/or erythema
    • joint tenderness to palpation
    • joint effusion
    • pain on passive range of motion of affected joint = most specific sign
  5. indications for arthrocentesis
    • (joint aspiration)
    • rule out septic joint
    • evaluate for crystal arthopathy
    • determine whether an effusion is inflammatory/noninflammatory
    • theraputic drainage (pain relief, remove damaging enzymes)
  6. monoarticular arthritis
    • usually acute inflammatory symptoms
    • most common: septic arthritis, crystal arthropathy - present identically, must get synovial fluid
  7. septic arthritis
    • most monoarticular (80-90%)
    • can be acute or chronic
    • medical emergency: marker for underlying infection, >3d irrev joint damage
    • nongonococcal: hematogenous, innoculation, adj tissue infection - usually Staph aureus gram +
    • gonococcal: STD, purulent arthritis + effusion, blood and mucosal cultures +, synovial fliud -, tenosynovitis, skin lesions
  8. crystal arthropathy: gout pathophysiology
    • inflammatory response to urate crystals mediated by innate immune system
    • increased production: increased cell turnover, intake of food, alcohol, mutations in metabolizing genes
    • decreased excretion:
    • acute/chronic renal failure
    • drugs that interfere with excretion: thiazide diuretics most common
    • diabetes: increased insulin levels can interfere with excretion
    • genetic predisposition: polymorphisms in renal urate transporters
  9. gout presentation
    • hyperuricemia
    • sudden onset of monoarthritis
    • lasts 3-10d
    • tenosynovitis and bursitis also common
    • low grade fever, tophi, bony erosions
    • urate crystals can cause nephropathy
    • negatively birefingent needle-shaped crystals
    • CPPD distinguished by postively birefringent rhomboid-shaped crystals
  10. osteoarthritis
    • non-immune, mechanically-induced (altered joint loading)
    • most common, 13.9% >25yr, 33.6% >65yr
    • joint pain relieved by rest
    • stiffness <30min
    • decreased range of motion & crepitus
    • tenderness to palpation w/o swelling
  11. Rheumatoid Arthritis
    • symmetric inflammatory polyarthritis, small joints of the hands, 0.1-1.1%, women @ 2-3x risk
    • good outcomes w/early treatment
    • autoimmune, cigarette smoking incr. risk for ppl w/HLA-DRB1 allele
    • pannus formation, osteoclast activation
    • insidious onset, granulomatous nodules, dry eyes -> keratitis
    • C1/C2 impingement
    • Felty's syndrome - splenomegaly/neutropenia
    • Increased risk of B cell lymphoma
    • Marginal bony erosions, joint space narrowing
    • Anti-CCP: specific, not sensitive, cna be + before onset, incr erosions
  12. seronegative spondyloarthropathies
    • asymmetric oligoarticular peripheral arthritis
    • sacroilitis/spondylitis (assoc. w/HLA-B27), enthesitis, extraskeletal involvement
    • negative test for rheumatoid factor
    • reactive, ankylosing spondylitis, psoriatic
  13. ankylosing spondylitis (AS)
    • bilateral symmetric sacroilitis
    • enthesitis of spinal ligaments -> erosions -> syndesmophytes -> vertebral fusion
    • 90% susceptibility due to genetics, more common in men
    • stiffness >30min w/improvement upon activity
    • pseudofractures
  14. reactive arthritis
    • type of seronegative spondyloarthropathy
    • develops 1-4 wks post infection
    • acute, asymmetric, chronic in 15-50%
    • sacroilitis in 20%
    • ulcers - oral/genital
    • conjunctivitis, uveitis

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