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Yr 3 MedEd > Arthritides > Flashcards

Arthritides Flashcards

1
Q

Name 1 degenerative arthritis.
Name 3 inflammatory arthritides
Name 2 infective arthritides

A
  • osteoarthritis
  • Rheumatoid arthritis, seronegative spondyloarthropathies, crystal arthropathy
  • Septic arthritis, osteomyelitis
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2
Q

Give 4 risk factors for primary osteoarthritis

A

Primary: obesity, occupation, age, female gender

Primary is wear and tear

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3
Q

Give 4 aetiologies of secondary osteoarthritis

A
  • Inflammatory arthritides
  • Metabolic conditions- haemochromatosis, Wilson’s disease
  • Trauma
  • Deformity- developmental dysplasia of the hip

Secondary is pre-existing joint abnormality

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4
Q

Give 4 features of the presentation of osteoarthritis.

What 2 types of joints does it affect

Give two signs in the hands of osteoarthritis.

A
  • Pain worse at end of day
  • joint stiffness, especially after inactivity
  • Joint crepitus
  • Restricted activity.

Affects asymmetrically

  • Weight bearing joints- hip and knee.
  • Heavy use joints- DIP, PIP, 1st CMC, wrist

Heberden’s nodes (DIP), Bouchard’s nodes (PIP).

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5
Q

Give 4 x-ray findings of osteoarthritis.

Give 2 joint aspirate findings of osteoarthritis.

A

Osteoarthritis X-ray is LOSS

  • Loss of joint space
  • Osteophytes
  • Subchondral sclerosis
  • Subchondral cysts.

Joint aspirate:

  • Straw coloured fluid
  • Increased viscosity
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6
Q

What is the definition of rheumatoid arthritis.

What two characteristics does it have?

A
  • Chronic (>6 weeks) systemic inflammatory disease.

- Characterised by symmetrical deforming polyarthritis and extra-articular manifestations.

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7
Q

Give 2 risk factors for rheumatoid arthritis.

What is the ratio of male to female?

A
  • HLA DR4 mutation
  • Smoking

1:2 male:female

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8
Q

Give 3 presenting features of rheumatoid arthritis.

Which joints are affected?

A
  • Pain worse at start of day
  • Joint stiffness for >1hr in morning
  • Restricted activity.

Joints affect symmetrically

  • Small joints of hand (PIP, MCP, wrist) but NOT DIP
  • Other joints: hip, knee, shoulders
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9
Q

Give 5 signs in hands of rheumatoid arthritis

A
  • Wrist- radial deviation
  • MCP: Ulnar deviation of fingers, Z-deformity of thumb
  • PIP/ DIP: Boutonniere deformity, Swan neck deformity
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10
Q
  • Give 2 signs of synovial inflammation in rheumatoid arthritis.
  • Give 3 extra-articular features of rheumatoid arthritis
  • Give 3 systemic symptoms of rheumatoid arthritis.
A

Synovial: tenosynovitis, bursitis

Extra-articular: rheumatoid nodules, lymphadenopathy, Felty syndrome: (splenomegaly, neutropenia, anaemia of chronic disease).

Systemic: fever, weight loss, fatigue

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11
Q

Give 3 blood test results reflecting rheumatoid arthritis.

Give 2 antibodies found in rheumatoid arthritis.

Give 4 X-Ray findings in rheumatoid arthritis.

A
  • Anaemia of chronic disease, raised ESR/ CRP, low albumin.
  • Rheumatoid factor (IgM against IgG).
  • Anti- CCP- most specific.
  • uniform joint space narrowing
  • Juxta-articular osteopenia
  • Joint erosions at joint margins
  • Joint deformity and destruction
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12
Q

What is deposited in primary amyloidosis?
- Which conditions is it associated with?

What is deposited in secondary amyloidosis?
- Which conditions is it associated with?

A

Primary amyloidosis: AL

  • Deposition of immunoglobulin light chain.
  • Associated with multiple myeloma, lymphoma, Waldenstron’s macroglobulinaemia.

Secondary: AA

  • Deposition of serum amyloid A: acute phase protein.
  • Associated with RA, IBD, Chronic infections
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13
Q

Give 6 features of presentation of amyloidosis.

A
  1. Nephrotic syndrome
  2. Hepatosplenomegaly
  3. Carpal tunnel syndrome + peripheral neuropathy
  4. Periorbital purpura
  5. Restrictive cardiomyopathy (AL)
  6. Macroglossia (AL)
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14
Q

How is protein deposition determined to be amyloid?

A
  • Demonstrates Apple-green Birefringence under polarised light with Congo Red stain
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15
Q

List the 4 seronegative spondyloarthropathies

A

PEAR:

  • Psoriatic arthritis
  • Enteropathic arthritis
  • Ankylosing spondylitis
  • Reactive arthritis
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16
Q

List the 5 features of seronegative spondyloarthropathies

A

HEADS:

  • HLA B27
  • Enthesitis
  • Asymmetrical oligoarthritis with axial involvement and extra-articular involvement
  • Dactylitis
  • Seronegative

More common in men

17
Q

Which demographic is affected by ankylosing spondylitis?
Which joints are affected?

Describe the pain, stiffness and spinal movement in ankylosing spondylitis.

What is the characteristic posture?
Which test assess loss of lumbar flexion?

A
  • Young men <40
  • Spine (enthesitis) and sacroiliac joints (arthritis)
  • Gradual onset pain, morning stiffness
  • Loss of spinal movement with eventual bone fusion- “bamboo spine”.
  • Question mark posture: Loss of lordosis, kyphosis, neck hyperextension.
  • Schober’s test
18
Q

Give the AAA of extra-articular features of ankylosing spondylitis.

A
  • Anterior uveitis
  • Apical lung fibrosis
  • Aortic regurgitation
19
Q

What is the most sensitive investigation for ankylosing spondylitis?

What does a late stage X-Ray show in ankylosing spondylitis?

A
  • MRI

- Syndesmophytes and bamboo spine.

20
Q

When does reactive arthritis occur?

Give 2 GU and 2 GI infections causing reactive arthritis.

A
  • sterile inflammation 2 weeks after extra-articular infection
  • Chlamydia, gonorrhoea; shigella, campylobacter
21
Q

Give 3 presenting features of reactive arthritis

A
  • Arthritis: asymmetrical, oligoarthritis of lower limbs & spondylitis
  • Enthesitis: Dactylitis, achilles tendonitis, plantar fasciitis
  • Reiter’s syndrome: conjunctivitis, urethritis, arthritis: “can’t see, can’t pee, can’t climb a tree).
22
Q

What are the two common causative organisms of septic arthritis?

Give 2 risk factors for septic arthritis.

A
  • Staph. Aureus, Neisseria Gonnorhoea- usually haematogenous spread.
  • Joint damage: RA, prosthetic joint, gout.
  • Infection risk: immunosuppression, diabetes, IVDU.
23
Q

Give 4 presenting features of septic arthritis.

A

Acute monoarthritis, usually affecting the knee.

  • Exquisite pain
  • Redness and swelling
  • Restricted ROM
  • FEVER
24
Q

Give 2 blood results in septic arthritis.

Give 3 features of joint aspirate (before ABx).

A
  • Increased WCC, increased CRP
  • Turbid, yellow
  • Low viscosity
  • Increased WCC- neutrophils >90%.
25
Q

Differentiate gout and pseudo gout by the following

  • Pathology
  • Epidemiology
  • Risk factors
A

Gout:

  • Monosodium urate crystals
  • Obese, middle aged men
  • Hyperuricaemia, alcohol, tumour lysis syndrome, diuretics

Pseudogout:

  • Calcium pyrophosphate crystals
  • Elderly women
  • Hyper PTH, hypoPO4, hypo Mg, Wilsons, acromegaly, haemochromatosis
26
Q

How does gout present acutely and chronically?

A
  • Acute: classically 1st MTP. Precipitated by trauma, infection.
    (pseudo gout is classically large joints)

Chronic: Polyarticular arthritis, tophi deposits, urate kidney stones.

27
Q

How long does uric acid take to appear in blood test in gout?

How does the joint aspirate appear in gout and pseudo gout?

What appears under polarised light in gout and pseudo gout joint aspirate?

A

uric acid appears 4-6 weeks.

Aspirate: turbid, yellow fluid, low viscosity, increased WCC.

Gout: needle shaped crystal, negatively birefringent

Pseudogout: rhomboid shaped, positively birefringent

28
Q

How does x-ray differentiate gout and pseudo gout?

A
  • Gout: rat bite erosions

- Pseudo: white lines of chondrocalcinosis

29
Q

What is the usual causative organism of osteomyelitis?

What are the 3 routes of infection in osteomyelitis?

A
  • Staphylococcus aureus.
  • Haematogenous spread: IVDU, immunosuppression, diabetes, sickle cell- SALMONELLA
  • Contiguous spread: cellulitis, localised infection
  • Direct inoculation: penetrating injury
30
Q

Give 3 presenting features of osteomyelitis.

Which bones are affected in children and adults?

Which imaging is most sensitive in osteomyelitis investigation?

A
  • Inflammation- pain and swelling
  • Reduced mobility
  • Fever

Children: long bones
Adults: Vertebrae- Pott’s disease (TB).

MRI is most sensitive.

Yr 3 MedEd (31 decks)

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