Arthritides Flashcards
Septic arthritis summary card
Direct bacteria inoculation or haematogenous spread in joint caused by Staph aureus > 30yo and Neisseria gonorrohoea < 30yo
= RFs: pre-existing joint disesae, IVDU, alcoholism, immunosuppression, prosthetic joints
= acutely inflammed tender, swollen joint, decreased range of movement, systemically unwell (fever), knee most commonly affected
= urgent joint aspiration (green/yellow, WBCC), bloods (blood cultures, WCC, ESR/CRP), imaging (X-ray, MRI)
= IV antibiotics after aspiration, analgesia, consider joint washout with GA
Gout summary card
Uric acid crystals forming due to alcohol excess, being male, increased cell turnover rate (lymphoma), purine rich diet (meat, seafood), renal impairement, drugs (aspiring, diuretics, cytotoxics)
= rapid onset, severe pain, decreased range of movements, toph deposit over extensor joint surfaces (elbows/knees)
= bloods, x-ray (rat-bite erosions in late, soft tissue swelling and joint effusion in early), synovial fluid has -ve birefringent needle shaped crystals
= acute mx: NSAIDs/colchicine
= chronic mx: conservative + allopurinol
Pseudogout summary card
Inflammation secondary to calcium pyrophosphate dihydrate crystals forming
= osteoarthritis, haemochromatosis, hyperPTH, DM, joint damage, elderly women
= similar to gout, affects wrists/kness
= synovial fluid has +ve birefringent rhomboid-shaped crystals, x-ray (chondrocalcinosis, erosions)
= conservative mx, treat underlying cause
Reactive arthritis summary card
Sterile arthritis affecting lower limb 3-30 days after urethritis/dysentery
= Chlymadia (urogenital), Salmonella, Campylobacter, Shigella, Yersinia (GI)
= males (9:1), HLA-B27, precedes infection
= asymmetrical oligoarthritis, worse in mornings, knee mainly, mouth ulcers
= enthesitis (achilles), keratoderma blenorrhagia (brown raised plaques on soles and palms), urcinate balanitis (painless and plaque-like lesion on shaft/glans of penis), conjuctivitis
Reactive arthritis triad
‘Reiter’s’
Arthritis, urethritis, conjunctivitis
- can’t see, can’t pee, can’t climb a tree
Osteoarthritis summary card
Degradation of cartilage and underlying bone resulting in inflammation and osteophyte formation
= FHx of OA, physical/manual occupation, obesity, female, age > 50
= DIPs, PIPs, thumb CMC, knees, hips affected
= gradual onset, pain worse at end of day, worse w/ movement, relieved by resting
= Bouchard’s (PIP), Herberden’s (DIP), fixed flexion deformities, crepitus, thumb squaring, antalgic gait
What does an X-ray show if pt has osteoarthritis?
L oss of joint space
O steophytes
S ubchondral sclerosis
S ubchondral cysts
Rheumatoid arthritis presentation
Chronic systemic inflammatory disease characterised by symmetrical, deforming, peripheral polyarthritis
= early joint inflammation of MCPs, PIPs, wrist, MTPs (+ve squeeze test)
= late joint damage and deformity; Z-thumb, swan-neck, Boutonniere, ulnar deviation of fingers at MCP
= rheumatoid nodules over bony prominences, amyloidosis, anaemia, scleritis
Rheumatoid arthritis ix
Bloods
- increased CRP/ESR (in active disease)
- rheumatoid factor (+ve 70% cases)
- anti-cyclic citrullinated peptide antibodies (anti-CCP; most sensitive)
Imaging
- X-ray
- US + MRI can identify synovitis more accurately
Amyloidosis summary card
Disorder characterised by protein deposition in abnormal fibrillar formation, resistant to degradation
- pt hx: years of paraproteinaemiea/chronic inflammatory disease, non-specific sx, nephrotic syndrome
AL amyloid (primary)
= lymphoma, multiple myeloma, NGUS
= restrictive cardiomyopathy, peripheral neuropathy
= proliferation of plasma cell clone; monoclonal immunoglobulins, forming fibrillar protein deposits
AA amyloid (secondary)
= RA, IBD, chronic infection (TB), bronchiectasis, osteomyelitis
= splenomegaly, nephrotic syndrome, hepatomegaly
= chronic inflammation elevated serum amyloid A, forming fibrillar protein deposits
What ix are found in amyloidosis?
Histological diagnosis from biospy from affected tissue
=> +ve congo-red staining w/ red-green birefringence under polarised high powered light microscopy
Men are PEAR HEADS
P soriatic arthritis
E nteropathic arthritis
A nkylosing spondylitis
R eactive arthritis
H LA B27 E nthesitis A symmetrical oligoarthritis w/ axial involvement and extraarticular involvement D actylitis S eronegative
*more common in men
Extraarticular features of spondyloarthritides
IBD, aortic regurgitation, anterior uveitis, psoriaform rashes, oral ulcers
Psoriatic arthritis summary card
Asymmetrical oligoarthritis (hands and feet), distal interphalangeal predominant, spondylitis, arthritis mutilans, symmetrical polyarthritis (rhumatoid-like) = nail changes (80%): pitting, oncholysis, suburyral hyperkeratosis = x-ray: 'pencil-in-cup' deformity
Ankylosing spondylitis summary card
Presents with back pain, worse in morning, improves w/ exercise, midline, insidious onset (> 3 months duration)
= progressive loss of spinal movement, sacroiliac tenderness
= RFs: FHx, age < 30, HLA-B27, male
= MRI most sensitive to detect early disease, eplvic x-ray but shows late signs