Professional Documents
Culture Documents
Sabrina Fallavollita
Outline
Inflammation
The Rheumatologic History
Sinovial Fluid Analysis
Rheumatologic Antibodies
Approach to Acute Monoarthritis
Septic Arthritis
Crystal Arthropathies
Approach to Polyarthritis
OA
RA
Approach to SLE
Approach to Seronegative Arthropathies
Approach to Chronic Pain Disorders
Epidemiology
Approach To Monoarthritis
Bacterial arthritis
Fungal arthritis
Parasitic arthritis
Internal derangement or
trauma
Meniscus Injury
Ligament tears
Neuropathy (Charcot's
Joint)
Gout, Pseudogout and
other crystal-induced
arthritis
Lyme Disease
Arthritis
Osteitis Deformans (Paget's
Disease)
Osteoarthritis
Osteomyelitis
Ischemia or infection
Ischemic bone (avascular
necrosis)
Acute Retroviral Syndrome
(initial HIV Presentation)
Neoplasms
Osteoid Osteoma
Villonodular synovitis
Trauma
Overuse injury
Fractures
Hemarthrosis
Septic Arthritis
Joint Pain
Joint swelling
Septic Ankle
Septic Shoulder
Joints affected with intravenous Drug Abuse
Sacroiliac joint
Sternoclavicular joint
Symphysis pubis
Causes
Young sexually active adults
Crystal Arthropathies
Obesity
Diabetes Mellitus
Hyperlipidemia
Hypertension
Atherosclerosis
Alcohol use
Thiazide Diuretics
Renal insufficiency
Myeloproliferative disease
Gout
Sinovial Fluid
Polarizing Microscopy
Negatively birefringent
Needle shaped Uric
Acid crystals
Gram Stain and Culture
Rule out Septic Arthritis
Treatment
Indomethacin
Polyarthritis
Polyarthritis
Acute Polyarthritis (inflammation in more
than 4 joints)
Viral (MMR, Parvovirus, enterovirus)
Borrelia burgdorferi
Chronic Polyarthritis: Symptoms of joint
pain and swelling lasting >6 weeks
<50: RA, SLE, psoriatic arthritis, other
spondyloarthropathies
>50: MOSS (mature onset seronegative
spondyloarthropathy) and Crystal induced
Osteoarthritis
Osteoarthritis
Most common form of arthritis
Associated functional Impairment
Pathophysiology
Primary lesion resides in the articular cartilage
Abnormal cartilage repair and remodeling
Chondrocytes produce proteolytic enzymes
Proteolytic enzymes destroy cartilage
End result
Asymmetric joint cartilage loss
Subchondral sclerosis (bone density increased)
Subchondral cysts
Marginal osteophytes
Signs
Distribution of Osteoarthritis
Joints spared
Wrist spared
Metacarpal-phalangeal
joints spared (except
thumb)
Elbow spared
Ankle spared
Joints commonly involved
Knee , Hip Foot Osteoarthritis
hand
Distal interphalangeal
joints (Heberden's
Nodes)
Proximal interphalangeal
joints (Bouchard's
Nodes)
First carpometacarpal
joint (thumb)
Cervical and lumbar spine
Pharmacologic Treatment
Acetaminophen 1 gram PO qid
NSAIDs (cautious use in the elderly)
Avoid Feldene - higher risk of GI toxicity
Be cautious due to CNS effects (esp.
Indomethacin
Intra-articular Corticosteroid injection
Avoid more than 3-4 times per year
Sodium hyaluronate (Synvisc) in Knee
Osteoarthritis
Topical Capsaicin cream for refractory joint pain
Rheumatoid Arthritis
Rheumatoid Arthritis
Affects all ethnic groups
Peak incidence 4-6 th decades
Most widely used criteria ACR
Diagnosis is based on the clinical
Treatment
Epidemiology/ Etiology
Prevalence
Native American
African American
Hispanic
Chinese
Filipino
Etiology
Idiopathic
Drug Induced
Procainamide
Isoniazid
Hydralazine
Minocycline
Phenytoin
Ethosuximide
D-Penicillamine
Management
Reevaluate every 3-6 months
Employ measures to relieve Fatigue
Sunscreen and other protection due to
photosensitivity
Reduce risk of infection (e.g.
Immunizations)
Birth Control is critical during
exacerbations
Spondyloarthropathies
Distribution of Spondyloarthritis
Fibromyalgia
Epidemiology
Women account for 75% of fibromyalgia
patients
Peak Incidence: ages 20 to 60 years old
Most common rheumatic cause of chronic
diffuse pain
Incidence
Rheumatology patients: 15%
General medical patients: 5%
General population: 2%
Distribution of Fibromyalgia
( 11/18 tender points)
Cervical spine
Anterior chest
Thoracic spine
Low back
Pain worse in the morning and at the
end of the day
Symptoms persist at least 3 months
Associated Conditions
Non-restorative sleep
(alpha-delta sleep)
Sleep Apnea
Nocturnal myoclonus
Restless Leg
Syndrome
Atypical Paresthesias
(63%)
Anxiety (48%)
Rheumatoid Factor
Ig that binds to the constant portion of
Complement
30 blood proteins that serve as
Cryoglobulins
Igs that precipitate when serum <4C
Type I --> monoclonal IgM,
Lymphoproliferative disease
Type II--> monoclonal IgG,
Type III --> polyclonal
Type II + III --> chronic infection Hep
C, vasculitis, Infectious Diseases
Questions?