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Y2 MSK > Artheropathies > Flashcards

Artheropathies Flashcards

1
Q

what is the difference between arthropathy, arthralgia and arthritis

A

arthropathy joint disease
arthralgia joint pain
arthritis joint inflam

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2
Q

name 5 seronegative arthropathies

A 
OA
ank spon
psoriatic arthritis
reactive arthritis
IBD arthritis
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3
Q

where are Heberden and Bouchards nodes in osteoarthritis

A

Heberden DIP

Bouchard PIP

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4
Q

bony swellings are seen in osteoarthritis. true or false

A

true

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5
Q

osteoarthritis pain is relieved by rest. true or false

A

true

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6
Q

what is seen in the knee that is linked to osteoarthritis

A

baker’s cyst

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7
Q

what is the first line investigation for osteoarthritis

A

x-ray

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8
Q

what is seen on x-ray is osteoarthritis

A

L loss of joint space
O osteophytes
S subchondral sclerosis
S subchondral cysts

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9
Q

what drug can be given for osteoarthritis pain relief

A

TOP/PO NSAID, capsaicin

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10
Q

what drug can be given during osteoarthritis flare ups

A

intraarticular CCS

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11
Q

what surgeries can be offered for OA

A

arthroplasty, arthrodesis, osteotomy

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12
Q

what is arthroplasty

A

joint replacement

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13
Q

what is arthrodesis

A

surgical induction of ossification of a joint

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14
Q

what is osteotomy

A

removing 1 or both sides of a joint surface

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15
Q

what age can qualify for a total hip replacement

A

older than 65

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16
Q

what are some indications for total hip replacement

A

pain whilst taking analgesia, pain in the night, impaired activities of daily living

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17
Q

what are some side effects of NSAIDs

A

peptic ulcers, renal disease, CVD, asthma, exacerbation, dyspepsia

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18
Q

what gender is RA more common in

A

women

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19
Q

what lifestyle factors affects rheumatoid arthritis

A

smoking

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20
Q

what genetic type predisposes rheumatoid arthritis

A

HLA-DR4

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21
Q

what is seen on x-ray in rheumatoid arthritis

A

soft tissue swelling, juxta-articular osteopaenia, subluxation, loss of joint space

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22
Q

which joints in the hand / feet are commonly affected by rheumatoid arthritis

A

MCP, MTP, PIP

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23
Q

describe how a joint affected by rheumatoid arthritis would appear on examination

A

swollen, warm, tender

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24
Q

what type hypersensitivity is rheumatoid arthritis

A

iv

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25
Q

what clue in the history helps differentiate rheumatoid and osteoarthritis

A

rheumatoid arthritis morning stiffness for longer than 30 minutes

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26
Q

name some extra-articular presentations of rheumatoid arthritis

A

rheumatoid nodule, pulmonary nodule, eye disease

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27
Q

what blood tests would you order for rheumatoid arthritis

A

FBC, CRP, PV, CCP, ACPA, RF

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28
Q

which autoantibody is most specific for rheumatoid arthritis

A

anti-CCP

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29
Q

which autoantibodies are less specific for rheumatoid arthritis

A

rheumatoid factor, ACPA

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30
Q

what is seen on mri in rheumatoid arthritis

A

bone marrow oedema

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31
Q

what is seen on ultrasound in rheumatoid arthritis

A

synovitis

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32
Q

what score is used to measure rheumatoid arthritis disease activity

A

DAS28

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33
Q

what DAS28 score indicates remission

A

<2.6

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34
Q

what DAS28 score qualifies treating with a biologic

A

> 5.1

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35
Q

what is the standard combination of medications for rheumatoid arthritis patients

A

NSAID + PO/IM CCS + DMARD

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36
Q

what is the 1st line DMARD for rheumatoid arthritis

A

methotrexate

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37
Q

what are the important side effects of methotrexate

A

pneumonitis, teratogen, hepatotoxic, mouth ulcer

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38
Q

what DMARD can be tried instead of methotrexate for rheumatoid arthritis if the patient has side efffects

A

leflunomide

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39
Q

which DMARDs for rheumatoid arthritis are suitable in pregnancy

A

1st sulfazalazine

2nd azathioprine

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40
Q

what drug can be given as an adjuvant to DMARDs in rheumatoid arthritis

A

hydroxychloroquine

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41
Q

how quickly should DMARDs be started for rheumatoid arthritis

A

within 3 months

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42
Q

which biologic would be used first for rheumatoid arthritis

A

IM infliximab

43
Q

what is the mechanism of infliximab

A

anti-TNF

44
Q

which biologic would be used 2nd for rheumatoid arthritis

A

rituximab

45
Q

what is the mechanism of rituximab

A

CD20 B cells

46
Q

what are some important side effects of biologics

A

reactivate latent TB, teratogen, > melanoma risk

47
Q

what deformities caused by rheumatoid arthritis can be seen on the hands?

A

Boutonniere, swan neck, Z shape thumb

48
Q

what is a spondyloarthropathy

A

arthritis affecting spine and sacroiliac joints

49
Q

give 4 examples of spondyloarthropathies

A

ank spon, psoriatic arthritis, reactive arthritis, enteropathic arthritis

50
Q

what is enthesitis

A

inflam at insertion of tendon to bone

51
Q

give 2 examples of enthesitis

A

plantar fasciitis, achilles tenditinitis

52
Q

what gender and age are risk factors for ank spon

A

men in late teens / early adult

53
Q

what genetic type is a risk factor for ank spon

A

HLA-B27

54
Q

ank spon mainly affects small joints. true or false

A

false, affects large joints

55
Q

what are the extra-articular presentations of ankylosing spondylitis

A

anterior uveitis, photophobia, pulmonary fibrosis

56
Q

what blood tests would be done for ankylosing sponylitis

A

CRP, PV, ESR (all raised)

57
Q

what imaging is done for ank spon

A

MRI, XR

58
Q

what is seen on MRI in ank spon

A

sacroilitis, bone marrow oedema

59
Q

what is seen on XR in ank spon

A

Romanus lesions, enthesitis, syndesmophyte, bamboo spine

60
Q

what are the first line medications for ank spon

A

pain relief + biologic

61
Q

what biologics are given for ank spon

A

anti-TNF

anti-IL17

62
Q

what drugs are given for ank spon if it affects a peripheral joint

A

methotrexate, sulfasalazine

63
Q

psoriatic arthritis is always symmetric. true or false

A

false. can be asymmetric

64
Q

what areas of the body are affected by psoraitic arthritis

A

just spine or
just DIP or
same pattern as RA

65
Q

what is seen on the hand in psoriatic arthritis

A

nail changes, sausage finger (dactylitis)

66
Q

what is seen on xr in psoriatic arthritis

A

pencil in cup, erosions, whiskering enthesopathy

67
Q

management options for psoriatic arthritis

A

steroids, methotrexate, sulfasalazine, biologics

68
Q

what is the other name for reactive arthritis

A

reiter’s syndrome

69
Q

what predisposes reactive arthritis

A

UTI or gastroenteritis 1-4wk before

70
Q

genetic predisposition to reiter’s syndrome

A

HLA-B27

71
Q

what are the 3 components that must be present for a diagnosis of reiter’s syndrome

A

urethritis
uveitis/conjunctivitis
arthritis

72
Q

what joints are affected by reactive arthritis

A

asymmetric lower limb

73
Q

investigations for reiter’s syndrome

A

ESR, CRP, PV, FBC, XR, blood/urine/stool culture

74
Q

management of reactive arthritis

A

should resolve 6mth. NSAID + CCS

75
Q

management of reactive arthritis present for >6mth

A

DMARD

76
Q

what condition is associated with enteropathic arthritis

A

IBD

77
Q

what parts of the body are affected by enteropathic arthritis

A

asymmetric large joints

78
Q

what is seen on ultrasound in enteropathic arthritis

A

synovitis

79
Q

management of enteropathic arthritis

A

treat IBD, DMARD if resistant

80
Q

what gender is a risk factor for gout

A

men

81
Q

what aspect of diet is a risk factor for gout

A

alcohol, purines (red meat, shellfish, red wine, chickpeas etc.)

82
Q

is gout hypertrophic or erosive

A

erosive

83
Q

what are purines converted to in the body

A

uric acid

84
Q

what is deposited at joints in gout

A

monosodium

85
Q

what medications are risk factors for gout

A

diuretic, cyclosporine

86
Q

what joint is most commonly affected by gout

A

1st MTP

87
Q

what sign is seen in chronic gout

A

tophi

88
Q

what is the gold standard test for diagnosing gout and what does it show

A

joint aspirate for polarised light microscopy showing needle shaped crystals and negative birefringence

89
Q

what is seen on XR in an acute gout attack

A

nothing

90
Q

what is seen on XR in recurrent gout

A

erosions, osteophytes, destructive arthritis

91
Q

management of gout during an acute attack

A

naproxen or colchicine

92
Q

side effect of colchicine

A

diarrhoea

93
Q

when is gout prophylaxis indicated

A

> 2 attacks, XR changes, renal stones, tophi

94
Q

prophylactic management of gout

A

allopurinol

95
Q

mechanism of allopurinol

A

xanthine oxidase inhibitor

96
Q

side effect of allopurinol

A

skin rash

97
Q

alternative to allopurinol if side effect (skin rash)

A

febuxostat

98
Q

age thats a risk factor for pseudogout

A

70-80 years

99
Q

joints affected by pseudogout

A

knee, wrist, ankle

100
Q

what is seen on xr in pseudgout

A

chondrocalcification

101
Q

what is seen on microscopy of joint aspirate in pseudogout

A

rhomboid chape calcium pyrophosphate crystals, weakly positive birefringence

102
Q

management options for pseudogout

A

NSAID, colchicine, CCS

103
Q

how do you monitor a DMARD

A

LFT, FBC 6 monthly

104
Q

name 5 DMARDs

A

methotrexate, leflunomide, sulfazalazine, azathioprine, hydroxychloroquine

Y2 MSK (20 decks)

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