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eLCRS - 머크 > 3 Rheumatology - Osteoarthritis + reactive Arthritis > Flashcards

3 Rheumatology - Osteoarthritis + reactive Arthritis Flashcards

1
Q

What is reactive arthritis?

A

sterile inflammation in joints (arthritis) following infection especially urogenital + gastrointestinal
(NOT DUE TO ONGOING INFECTION)

note:
- may be first manifestation of HIV or hepatitis C infection
- Symptoms follow 1-4 weeks after infection

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2
Q

What are important extra-articular manifestations of reactive arthritis?

A
  • Enthesopathy
  • Skin inflammation
  • Eye inflammation (Sterile conjunctivitis)

ocular - Sterile Conjunctivitis
genitourinary - sterile urethritis

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3
Q

musculoskeletal symptoms of reactive arthritis - Arthritis (joint)

A

Asymmetrical

Oligoarthritis
(<5 joints)

Lower limbs typically affected

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4
Q

musculoskeletal symptoms of reactive arthritis - ENTHESITIS (where tendons insert)

A

Heel pain (Achilles tendonitis)

Swollen fingers (dactylitis) –> whole finger is inflamed

Painful feet (metatarsalgia due to plantar fasciitis)

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5
Q

musculoskeletal symptoms of reactive arthritis - SPONDYLITIS (spine)

A

Sacroiliitis (inflammation of the sacro-iliac joints)

Spondylitis (inflammation of the spine)

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6
Q

Compare between Rheumatoid arthritis vs Reactive arthritis

A

LOOK AT NOTES for comparison table

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7
Q

what are the different methods to diagnose reactive arthritis?

A

Microbiology:

  • Microbial cultures (blood, throat, urine, stool, urethral, cervical)
  • Serology e.g. HIV, hepatitis C

Immunology:
- Rheumatoid factor (HLA-B27)

Synovial fluid examination:
- Especially if only single joint affected

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8
Q

Compare between

septic arthritis vs Reactive arthritis

A 
SEPTIC ARTHRITIS 
- can isolate bacterial pathogen 
\+ve Synovial fluid culture
Antibiotic therapy = yes 
Joint Lavage= yes

REACTIVE ARTHRITIS
Sterile = Synovial fluid culture
Antibiotic therapy =no
Joint Lavage = no

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9
Q

How is Reactive Arthritis treated?

A

majority of patients complete resolution occurs within 2-6 months

  • Articular symptoms –> give NSAIDS /intra-articular corticosteroid therapy
  • extra-articular –> symptomatic treatment
  • Refractory disease –> oral glucocorticoids

Generally: AVOID ANTIBIOTICS

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10
Q

Define Osteoarthritis

A

Chronic slowly progressive disorder –> due to failure of articular cartilage that typically affects joints of the hand, spine + weight-bearing joints (hips and knees)

  • loss of / damage of articular cartilage
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11
Q

Osteoarthritis typically affects :

A

Joints of the hand:

  • Distal interphalangeal joints (DIP)
  • Proximal interphalangeal joints (PIP)
  • First carpometacarpal joint (CMC)

Spine

Weight-bearing joints of lower limbs:

  • esp. knees and hips
  • First metatarsophalangeal joint (MTP)
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12
Q

Note:

Osteoarthritis can be associated with:

  • Joint pain
  • -> worse w activity
  • Joint Crepitus
  • -> creaking/ cracking sound of joint
  • Joint Stability
  • Joint instability
  • Joint enlargement
  • -> e.g heberden’s nodes
  • Joint stiffness
  • limitation of motion
A

-

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13
Q

What are some Radiographic features of osteoarthritis?

A
  • Joint space narrowing
  • Subchondral bony sclerosis
  • Osteophytes
  • Subchondral cysts
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14
Q

How do radiographic changes in rheumatoid arthritis vs osteoarthritis differ?

A

LOOK at notes for table comparison

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15
Q

What are causes of OA?

A

1) Defective and irreversible articular cartilage and damage to underlying bone due to:
- Abnormal joint components (congenital articular cartilage defect)
- Excessive loading on joints (w age/ physical activity)

2) Commonly due to lifestyle + activities + aging
3) Many factors can lead to abnormal stress or abnormal cartilage

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16
Q

What is synovial fluid ?

A

Hyaluronic acid (HA) -rich viscous fluid

viscosity = dependent on Hyaluronic acid composition

17
Q

Articular cartilage consists of:

A

o Type II collagen
o Proteoglycan (aggrecan) –> keeps articular cartilage hydrated
o chondrocytes

18
Q

note:

Articular cartilage has both Avascular and aneural structure

A

-

19
Q

What are ECM proteoglycans?

A

glycoproteins containing one or more sulphated glycosaminoglycan (GAG) chains

20
Q

What are GAGs ?

what are the different types of GAGs

A

GAGs = repeating polymers of disaccharides

different types of GAGs 
o Chondroitin sulphate 
o Heparan sulphate
o Keratan sulphate 
o Dermatan sulphate
o Heparin
21
Q

What is the major proteoglycan in articular cartilage ?

A

aggrecan

22
Q

Hyaluronic acid is the only non-sulphated GAG.

it is a major component of =
where it has a role of =

A

Hyaluronic acid is the only non-sulphated GAG.

it is a major component of = synovial fluid

and it has a role of = maintaining synovial fluid viscosity

23
Q

What are Cartilage changes in osteoarthritis?

A
  • reduced proteoglycan
  • reduced collagen
  • chondrocyte changes e.g. apoptosis
24
Q

What are Bone changes in osteoarthritis?

A

a) Changes in denuded sub-articular bone:
- Proliferation of superficial osteoblasts –> causes production of sclerotic bone e.g. subchondral sclerosis
- Focal stress on sclerotic bone can –> focal superficial necrosis

b) Bone formation at joint margins, osteophytes e.g. ‘Heberden’s + Bouchard’s nodes

25
Q

What are methods of managing osteoarthritis?

A

Education

Physical therapy – physiotherapy, hydrotherapy

Occupational therapy

Weight loss

Exercise

Analgesia
(Paracetamol, Non-steroidal anti-inflammatory agents, Intra-articular corticosteroid injection)

Joint replacement

26
Q

What are some therapeutic approaches of managing OA?

NOT APPROVED IN UK

A
  • Glucosamine and chondroitin sulphate
  • Intra-articular injections of hyaluronic acid
  • -> increases lubrication
27
Q

what are

a) osteophytes
b) Heberden’s nodes
c) Bouchard’s nodes

A

a) osteophytes = bony outgrowths

b) Heberden’s nodes = Osteophytes at the DIP joints
c) Bouchard’s nodes = Osteophytes at the PIP joints

eLCRS - 머크 (9 decks)

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