Rheumatology Quiz

1. List the MAJOR side effect of corticosteroids on each of 8 body systems.
Go to the "Pharmacy Tool Kit" for this information.

2. List radiographic characteristics of OA, RA and AS.
View radiographic images with description of : hand with RA; knee with OA

OA:
a. subchondral sclerosis (and cysts)
b. osteophyte formation
c. assymetrical cartilage damage and joint narrowing (both micro and macro)
* Important Note: only 40% of patients with severe radiographic osteoarthritis have pain.  What are the implications for the PT?

RA:
a. periarticular osteopenia
b. erosion of the bone and cartilage around the outside margin of the joint
c. symmetrical loss of cartilage and joint space (both micro and macro)

Ankylosing Spondylitis (AS):
a. Initially, SI joints narrow and eventually ankylose.
b. Progressive (in the cranial direction) ossification of the annular ring, PLL, (ALL), and interspinal ligaments, which form syndesmophytes

3. Identify the common lab work associated with the following rheumatic diseases (matching test):
RA, SLE, AS, Polymayalgia Rheumatica, Gout or Pseudogout
Go to the "Lab Tool Kit" for this information.

4.CREST Syndrome is a variation of Limited Cutaneous Systemic Sclerosis (lcSSc). CREST stands for:
calcinosis
Raynauds Syndrome
esophageal dysmobility
sclerodactyl (induration/hardening of the skin of fingers and toes)
telangiectasias (chronic dilation of groups of capillaries causing elevated dark red blotches on the skin)

5. Identify and describe the most commonly affected joint sites in OA and RA

 

RA

OA

UC

“Piano Key” deformity: distal ulna displaced dorsally

 

RC

Volar subluxation of proximal carpals on radius

 

Carpals

erosions and instability

 

CMC

instability toward flexion or extension that feeds into either of the following thumb deformities

CMC #1 a common problem with bony hypertrophy, pain, and decreased motion

Thumb

deformities of the thumb (see Nalebuff's classifications):
1) "Z" thumb

  1. MCP flex
  2. IP hyperextension

2) deformity opposite of the "Z" thumb
       -     MCP hyperextension
       -     IP flex

 

MCP
  1. Ulnar drift of phalanges
  2. Volar subluxation of phalanges on MC, especially #2 and 3 (prominent knuckles)

1st MCP (thumb)
bony hypertrophy and mild instability

IPs

Swan Neck:
PIP ext. + DIP flex.

 

PIP: Bouchard’s nodes (osteophytes and angulation)

DIP: Heberden’s nodes (osteophytes and angulation)

Boutonniere (Button Hole):
PIP flex + DIP ext.
Synovitis at the PIP causes the ED slips (inserts in the dorsal 2nd phalanx) to move volarly, causing PIP flexion

Remember a dorsal hand burn could cause a similar deformity

DIP appear less involved than OA, but bony marginal erosions occur

 

 

 

Spine

C-spine: risk of atlanto-axial subluxation

osteophytes of C and L spine reduce size of foramina and spinal canal, impinging on n roots, cord.

 

 

 

Tarsals

erosions and instability; pronation

 

MTP

MT heads are prominent; cock-up toes; hallux valgus

hallux valgus

 

 

 

6. Categories of drugs and common drugs prescribed in rheumatic disease (matching test).

Disease Modifying Anti-Rheumatic Drug (DMARD)
methotrexate (Rheumatrex)
cyclophosphamide (Cytoxan)
azathioprine, (Imuran)
cyclosporine (Neoral)

Biologic Response Modifier (BRM)
etanercept (Enbrel)
inflixamab (Remicade)

Corticosteroid
prednisolone (Prelone)
prednisone (Deltasone)
dexamethasone (Decadron)
hydrocortisone (Cortef)
cortisone (Cortone)
methylprednisolone (Medrol)

NSAID
naproxen (Naprosyn)
piroxicam (Feldene)
diflunisol (Dolobid)
ibuprofen (Advil, Motrin, Nuprin, others)
indomethacin (Indocin)

Gout agent
allopurinol (Lopurin) [taken daily as preventive agent]
colchicine  [taken PRN to handle intermittent flares]