2- Inflammatory Arthropathies

Question 1

List features suggestive of joint inflammation

Answer 1

Joint pain
Swelling
Morning stiffness
Improvement with exercise
Synovitis

Question 2

What is the most prevalent seropositive arthropathy?

Answer 2

Rheumatoid arthritis

Question 3

Men are more affected than women by RA. True/False?

Answer 3

False

Women 3:1 men

Question 4

What age is the typical onset of RA?

Answer 4

35-50yrs

Question 5

There is a genetic component to RA. True/False?

Answer 5

True

Question 6

What is the basic pathogenesis behind RA?

Answer 6

Autoimmunity; synovium becomes inflamed and destroys articular cartilage, causing joint destruction

Question 7

List clinical features of RA

Answer 7

Symmetrical synovitis
Pain
Morning stiffness
Rheumatoid nodules

Question 8

Which joints in the hand are affected my RA?

Answer 8

MCP
PIP
Wrist

Question 9

Which autoantibodies are associated with RA?

Answer 9

Anti-CCP

Rheumatoid factor

Question 10

XR is useful at the onset of RA. True/False?

Answer 10

False

Often shows no joint abnormality in early stages

Question 11

Outline treatment for RA

Answer 11

DMARDs
NSAIDs
Analgesia
Injected/oral steroid
Biologics

Question 12

List the main seronegative arthropathies

Answer 12

Ankylosing spondilitis
Psoriatic arthritis
IBD arthritis
Reactive arthritis

Question 13

Which HLA is often associated with seronegative arthropathies?

Answer 13

HLA-B27

Question 14

Where does ankylosing spondilitis usually affect?

Answer 14

Spine

Sacroiliac joints

Question 15

Who is more affected by AS - males or females?

Answer 15

Males 3:1 females

Question 16

What is the age of onset of AS?

Answer 16

20-40yrs

Question 17

List clinical features of AS

Answer 17

Spinal pain/stiffness
Improvement with exercise
Loss of lumbar lordosis
Increased thoracic kyphosis

Question 18

Which test is used to assess lumbar spine flexion?

Answer 18

Schobers test

Question 19

What does AS show on XR?

Answer 19

Sclerosis/fusion of sacroiliac joints
Syndesmophytes (bony spurs)
“Bamboo spine”

Question 20

Outline treatment for AS

Answer 20

NSAIDs
Physiotherapy
Anti-TNF

Question 21

Psoriatic arthritis is usually symmetrical. True/False?

Answer 21

False

Question 22

What are the main nail changes that occur in psoriatic arthritis?

Answer 22

Onycholysis

Pitting

Question 23

Which GU infections can typically cause reactive arthritis?

Answer 23

Chlamydia

Neisseria

Question 24

Which GI infections can typically cause reactive arthritis?

Answer 24

Salmonella

Campylobacter

Question 25

Which triad of symptoms are included in Reiter’s syndrome (a form of reactive arthritis)?

Answer 25

Urethritis
Uveitis/Conjunctivitis
Arthritis

Question 26

What causes gout?

Answer 26

High levels of uric acid, causing deposition of urate crystals within a joint

Question 27

What is uric acid a product of?

Answer 27

The breakdown of purines in DNA metabolism (adenine, guanine)

Question 28

What are gout tophi?

Answer 28

Painless white accumulations of uric acid that can erupt through the skin

Question 29

How do gout crystals appear on polarised microscopy?

Answer 29

Negatively birefringent (yellow) needle-shaped crystals

Question 30

Outline treatment of acute gout

Answer 30

NSAID/colchicine (for those intolerant of NSAID)
Steroid
Analgesia

Question 31

What is the drug of choice for sufferers of recurrent gout?

Answer 31

Allopurinol

Question 32

What causes pseudogout?

Answer 32

Deposition of calcium pyrophosphate crystals

Question 33

What does chondocalcinosis mean?

Answer 33

Deposition of calcium pyrophosphate crystals in cartilage in the absence of acute inflammation