16. Inflammatory disease - RA - Kidd

Question 1

What are the three different categories for MSK pain?

Answer 1

Myalgia
Arthralgia
Back pain

Question 2

What is myalgia?

Answer 2

Pain in a muscle or group of muscles

Question 3

What is arthralgia?

Answer 3

Pain in a (small) joint

Question 4

What are the different sources of MSK pain?

Answer 4

Referred/radicular pain - central pain that is being referred to the MSK system

Non referred/radicular:
Bone
Soft tissue
Joint

Question 5

What are the three different types of inflammatory disorders?

Answer 5

Autoimmune disorder (RA)
Crystal arthropathy
Infection

Question 6

What is ‘polyarthritis’?

Answer 6

Arthritis that is affecting five or more joints simultaneously

Question 7

What is the incidence rate of RA?

Answer 7

12,000 new cases each year

Question 8

Is RA more common in males or females?

Answer 8

Males 3:1 women

Question 9

Is genu varus OA or RA?

Answer 9

Genu varus - OA

Question 10

Is genu valgus OA or RA?

Answer 10

Genu valgus - RA

Question 11

Why are Bakers cysts formed in RA?

Answer 11

Build up of synovial fluid
This cannot move anteriorly due to patella and cannot move laterally due to ligaments so forms posteriorly and the Bakers cyst forms

Question 12

What is a common differential diagnosis for Bakers cyst and WHY IS THIS DANGEROUS?

Answer 12

DVT

DVT - want to coagulate but coagulation is the worst possible thing for a Bakers cyst

Question 13

What occular complications can occur in RA?

Answer 13

Keratoconjunctivitis sicca
Scleritis and episcleritis
Scleromalacia perforans

Question 14

What is Keratoconjunctivitis sicca?

Answer 14

Sicca syndrome - cannot produce tears or saliva and this can result in massive conjunctivitis
Dry eyes stimulates an immune response and there is inflammation in the sclera

Question 15

What is a common peripheral symptom of early RA?

Answer 15

Carpal tunnel syndrome - tingling in the index finger

Question 16

What is a common central symptom of RA?

Answer 16

Subluxation of the cervical spine - can compress nerves and the spinal chord - myelopathy
‘Atlanto-axial subluxation’

Question 17

Define subluxation

Answer 17

Misalignment of the vertebrae - partial dislocation

Question 18

How does atlanto-axial subluxation present?

Answer 18

Hyper-reflexia

Spasticity

Question 19

What are systemic cardiac complications associated with RA?

Answer 19

Ischaemic heart disease

Pericarditis
Nodules
Endocarditis

Question 20

What is the major bone complication associated with RA?

Answer 20

Accelerated osteoporosis

Question 21

What is the current diagnostic criteria for RA?

Answer 21

Inflammation of three or more joints
Rheumatoid factor/anti-CCP
Raised ESR/CRP

Question 22

What is systemic lupus erythematous

Answer 22

Aka. lupus - autoimmune disease

Question 23

What are the two typical presentations of systemic lupus erythematous?

Answer 23

Butterfly rash over the face

Alopecia

Question 24

What is scleroderma?

Answer 24

Chronic hardening and contraction of the skin and the connective tissue

Question 25

What is the typical presentation of scleroderma?

Answer 25

Thickened, waxy appearance of the skin

In severe cases - fingers or hand may become necrotic

Question 26

What is dermatomyositis?

Answer 26

Inflammation of the skin and the underlying muscle tissue - degeneration of collagen

Question 27

What is ankylosing spondylitis?

Answer 27

Form of spinal arthritis

Question 28

Who is mainly affected by ankylosing spondylitis?

Answer 28

Young males

Question 29

What is reactive arthritis?

Answer 29

Joint pain and swelling triggered by another infection in the body

Question 30

Bow legs is genu varus or genu valgus?

Answer 30

Genu varum

Question 31

Location of bakers cyst is?

Answer 31

Behind the knee - posterior to the patella