2- Inflammatory Arthropathies Flashcards
List features suggestive of joint inflammation
Joint pain Swelling Morning stiffness Improvement with exercise Synovitis
What is the most prevalent seropositive arthropathy?
Rheumatoid arthritis
Men are more affected than women by RA. True/False?
False
Women 3:1 men
What age is the typical onset of RA?
35-50yrs
There is a genetic component to RA. True/False?
True
What is the basic pathogenesis behind RA?
Autoimmunity; synovium becomes inflamed and destroys articular cartilage, causing joint destruction
List clinical features of RA
Symmetrical synovitis
Pain
Morning stiffness
Rheumatoid nodules
Which joints in the hand are affected my RA?
MCP
PIP
Wrist
Which autoantibodies are associated with RA?
Anti-CCP
Rheumatoid factor
XR is useful at the onset of RA. True/False?
False
Often shows no joint abnormality in early stages
Outline treatment for RA
DMARDs NSAIDs Analgesia Injected/oral steroid Biologics
List the main seronegative arthropathies
Ankylosing spondilitis
Psoriatic arthritis
IBD arthritis
Reactive arthritis
Which HLA is often associated with seronegative arthropathies?
HLA-B27
Where does ankylosing spondilitis usually affect?
Spine
Sacroiliac joints
Who is more affected by AS - males or females?
Males 3:1 females
What is the age of onset of AS?
20-40yrs
List clinical features of AS
Spinal pain/stiffness
Improvement with exercise
Loss of lumbar lordosis
Increased thoracic kyphosis
Which test is used to assess lumbar spine flexion?
Schobers test
What does AS show on XR?
Sclerosis/fusion of sacroiliac joints
Syndesmophytes (bony spurs)
“Bamboo spine”
Outline treatment for AS
NSAIDs
Physiotherapy
Anti-TNF
Psoriatic arthritis is usually symmetrical. True/False?
False
What are the main nail changes that occur in psoriatic arthritis?
Onycholysis
Pitting
Which GU infections can typically cause reactive arthritis?
Chlamydia
Neisseria
Which GI infections can typically cause reactive arthritis?
Salmonella
Campylobacter
Which triad of symptoms are included in Reiter’s syndrome (a form of reactive arthritis)?
Urethritis
Uveitis/Conjunctivitis
Arthritis
What causes gout?
High levels of uric acid, causing deposition of urate crystals within a joint
What is uric acid a product of?
The breakdown of purines in DNA metabolism (adenine, guanine)
What are gout tophi?
Painless white accumulations of uric acid that can erupt through the skin
How do gout crystals appear on polarised microscopy?
Negatively birefringent needle-shaped crystals
Outline treatment of acute gout
NSAID/colchicine (for those intolerant of NSAID)
Steroid
Analgesia
What is the drug of choice for sufferers of recurrent gout?
Allopurinol
What causes pseudogout?
Deposition of calcium pyrophosphate crystals
What does chondocalcinosis mean?
Deposition of calcium pyrophosphate crystals in cartilage in the absence of acute inflammation
