29 Questions
Which of the following is NOT a pathologic change seen in degenerative joint disease (DJD)?
Thickening of synovial membrane
What is the primary feature of degenerative joint disease (DJD) in terms of symptoms?
Deep aching in the joint
Which term is used to describe articular cartilage affected by degenerative joint disease (DJD)?
Yellow and opaque
What is the most common cause of lower back pain related to degenerative joint disease (DJD)?
OA of the spine
Which of the following is a common physical finding associated with degenerative joint disease (DJD)?
Joint instability
What does loss of articular cartilage in degenerative joint disease (DJD) lead to?
Joint subluxation and deformity
What is the most common cause of death in persons with lupus?
Kidney failure
Which medication is effective in treating lupus nephritis but is associated with significant toxicity?
Cyclophosphamide
What is the characteristic skin rash seen in dermatomyositis?
Heliotrope rash
What is the initial symptom of both polymyositis and dermatomyositis?
Fever, swelling, malaise, and fatigue
Which of the following medications is an alternative to cyclophosphamide for treating lupus while preserving reproductive function?
Azathioprine
Which of the following is NOT a characteristic of inclusion body myositis?
Sudden onset of muscle weakness
What is the most common chronic inflammatory disease of the axial skeleton affecting the sacroiliac joints and spine?
Ankylosing spondylitis
What is the primary site of pathologic findings in ankylosing spondylitis?
Enthesis
What is the cause of the characteristic "bamboo" appearance of the spine in ankylosing spondylitis?
Calcification of the spinal ligaments
What is the significance of the HLA-B27 genetic marker in ankylosing spondylitis?
It is a risk factor for developing the disease
Which of the following is NOT a goal of treatment for ankylosing spondylitis?
Prevent weight gain
Which of the following medications is used to control pain and inflammation in ankylosing spondylitis, but does not retard disease progression?
Aspirin and NSAIDs
Which of the following is NOT a common complication of rheumatoid arthritis?
Osteoarthritis
Which of the following is a Disease-Modifying Anti-Rheumatic Drug (DMARD) used in the treatment of rheumatoid arthritis?
Methotrexate
What is the primary function of misoprostol in the treatment of rheumatoid arthritis?
Reducing the incidence of gastric ulcers
Which of the following supplements is NOT mentioned as potentially beneficial for rheumatoid arthritis patients?
Glucosamine
What is the most common cause of osteoporosis?
Unknown
What is the primary mechanism of action of adalimumab in the treatment of rheumatoid arthritis?
Blocking TNF-alpha
Which of the following diagnostic tests is NOT mentioned in the text for rheumatoid arthritis?
Positive antinuclear antibody (ANA) test
Which type of osteoporosis is more common?
Postmenopausal osteoporosis (type I)
Which of the following is not a factor that contributes to the development of osteoporosis?
Increased bone formation
What is the earliest manifestation of osteoporosis?
Acute onset of back pain in the middle to lower thoracic region
Which of the following best describes the pathophysiology of osteoporosis?
Bone resorption exceeds bone formation gradually after menopause
Study Notes
ANKYLOSING SPONDYLITIS (Marie-Strumpell disease)
- Chronic inflammatory disease of the axial skeleton affecting the sacroiliac joints and spine
- Etiology is UNKNOWN; HLA-B27 genetic marker is present
- Pathophysiology: inflammation of the spine, leading to fibrous scar tissue and new bone growth, causing vertebrae to fuse together
- Enthesis: primary site of pathologic findings where ligaments, tendons, and joint capsule enter the bone
- Patient may experience chest pain that worsens during inspiration
- The spine loses its normal lordotic curve, and the patient may have a "poker back" deformity or kyphosis at the cervicodorsal junction with knees flexed in an attempt to move the head upright
- Goals of treatment: relieve pain and stiffness, achieve and maintain best possible alignment of spine, strengthen paraspinal muscles, and prevent complications
COMPLICATIONS OF ANKYLOSING SPONDYLITIS
- Compression neuropathy like carpal and tarsal tunnel syndromes and ulnar nerve palsy
- Atlantoaxial (C1 and C2) subluxation and cervical subluxation
- Rheumatoid vasculitis: inflammation and blockage of small blood vessels
- Pericarditis
- Pulmonary complications
COLLABORATIVE CARE MANAGEMENT FOR ANKYLOSING SPONDYLITIS
- Diagnostic tests: elevated ESR, C-reactive protein positive, anemia, and positive rheumatoid factor
- Medications: NSAIDs, DMARDs, steroids, and biologics like Anakinra and Adalimumab
- Health promotion and prevention: use of supplements like DHEA, fish oil, flaxseed, and gamma-linoleic acid, and a diet rich in calcium and vitamin D
OSTEORARTHRITIS (DEGENERATIVE JOINT DISEASE)
- Primary (idiopathic): most common type of non-inflammatory joint disease
- Secondary joint disease: caused by any condition that damages cartilage, subjects joints to chronic stress, or causes joint instability
- Pathophysiology: erosion of articular cartilage, thickening of subchondral bone, and formation of osteophytes
- Pain: primary feature, described as deep aching in the joint, relieved by rest
- Loss of articular cartilage causes decreased joint motion and subluxation and deformity
- Effusion causes joint laxity
- Muscular atrophy and crepitus are present
- Varus deformity is common in OA
COLLABORATIVE CARE MANAGEMENT FOR OSTEORARTHRITIS
- Diagnostic tests: LE cell test
- Medications: NSAIDs, corticosteroids, and methotrexate
- Health promotion and prevention: use of supplements like fish oil, flaxseed, and gamma-linoleic acid, and a diet rich in calcium and vitamin D
POLYMYOSITIS AND DERMATOMYOSITIS
- Most common inflammatory muscle diseases
- Rheumatic connective tissue disease
- Idiopathic inflammatory myopathies
- Inclusion body myositis: characterized by an insidious onset of progressive proximal and distal muscle weakness
- Myositis overlap syndrome: myositis in association with cancer, connective tissue disease like RA, SLE, or scleroderma
- Pathophysiology: inflammation of muscle fibers and connective tissue, leading to extensive tissue necrosis and destruction of muscle fibers
- Fever, swelling, malaise, and fatigue: initial symptoms of both disorders
- Heliotrope rash: dusky red lesion found in the periorbital region along with periorbital edema
- Gottron's papules: scaly, erythematous lesions over the MCP or IP joints, knees, elbows, or medial malleoli
- Calcinosis: a condition in which calcium salts are deposited in the skin and subcutaneous tissue
COLLABORATIVE CARE MANAGEMENT FOR POLYMYOSITIS AND DERMATOMYOSITIS
- Diagnostic tests: elevated serum enzymes such as creatine kinase, aldolase, lactate dehydrogenase, and transaminases
- Goals of treatment: relieve pain and stiffness, achieve and maintain best possible alignment of spine, strengthen paraspinal muscles, and prevent complications
- Medications: NSAIDs, corticosteroids, and methotrexate
OSTEOPOROSIS
- Most common bone disorder
- Classified as either: Senile – type II, Postmenopausal- type I, or Idiopathic
- Cause is UNKNOWN, results from loss of calcium in the bone
- Pathophysiology: imbalance between bone resorption and bone formation, leading to osteopenia and osteoporosis
- Low bone mass: critical element in the diagnosis of osteoporosis
- Osteoporosis is usually asymptomatic until fractures occur
- Risk factors: loss of natural estrogen at menopause, chronic calcium deficiency, diets high in fat, and glucocorticoid use
Learn about Ankylosing Spondylitis (Marie-Strumpell disease), a chronic inflammatory disease of the axial skeleton affecting the sacroiliac joints and spine. Explore its etiology, pathophysiology including spondylitis and enthesitis, genetic marker HLA-B27, and more.
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