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Arthritis Flashcards

1
Q

Juvenile idopathic arthritis
key features, antibodies, mx

A

<16 yr old
>6wks arthritic pain
2-4 joints commonly involved, >5 can also occur
Mainly fingers, wrist

Ab- ANA»RA
Rx- Depending on severity
Analgesics, Steroids, Methotrexate

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2
Q

RF c/f

A
  1. Indigenous aussie
  2. Young (5-15)
  3. Post Step. pyogenes infection (sore throat)/Group A strep
  4. Migratory polyarthritis
  5. Fever, malaise
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3
Q

PF diagnosis criteria

A

2 major+ (or) 1 major, 2 minor +

MAJOR - JONES
J- Joint involvement
O- Myocarditis
N- Nodules subcutaneous
E- Erythema marginatum (target like)
S- Syndenhams chorea

MINOR - CAFE PAL
C- CRP↑
A- Arthralgia (mono)
F- Fever
E- ESR↑
P- Prolonged PR interval (1st degree heart block)
A- Anamnesis (previous h/o) of rheumatism
L- Leucocytosis

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4
Q

Investigations in RF

A
  1. Streptococcal ASO titres»
  2. Streptococcal Anti DNAse B
  3. ESR, CRP
  4. ECG
  5. Throat swab - 1st to confirm GAS
  6. FBC
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5
Q

MX of RF

A
  1. Penicillin
    Benzylpenicillin IM
    Phenoxymethylpenicillin oral BD
  2. Paracetamol, Aspirin - arthritis
  3. Diuretics - cardiac involvemet
  4. Bed rest 2 weeks
  5. Prophylactic long term penicillin
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6
Q

Osteoarthritis main joints involved are?

A

Degenerative
More common:
First carpometacarpal (CMC)joint of thumb
DIP*
First metatarsophalangeal (MTP) joint

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7
Q

C/F of osteoarthritis

A
  1. Pain on waking up, upto 5 mins
  2. Pain ↑with movement, ↓with rest
  3. Restricted movements

Crepitus on palpation
Osteophytes, ↓joint space on Xray

HEBERDEN NODULES - DIP (HD)
BOUCHARD NODULES - PIP

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8
Q

Nodules seen in osteoarthritis

A

HEBERDEN NODULES - DIP (HP)
BOUCHARD NODULES - (PIP)

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9
Q

Rx of osteoarthritis

A

Analgesics

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10
Q

What is Rheumatoid arthritis

A

Autoimmune symmetrical polyarthritis

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11
Q

Difference in presentation of RA and OA

A

RA:
↓Joint pain on movement
PIP»DIP
Morning stiffness for hours

OA:
↑Pain on movement
DIP»PIP
Morning stiffness for lesser duration (5mins)

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12
Q

C/F of RA

A

Bimodal presentation, 25-50 and 65-75yrs
F>M
1. Pain, deformity
2. Swelling of MCP, Wrist, Elbow

Signs:
SWAN NECK - hyperflexion of DIP
BOUTONNIERE - hyperflexion of PIP
Z deformity - Thumb
ULNAR DEVIATION
RHEUMATOID NODULE

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13
Q

What renal condition is a/w RA

A

Amyloidosis

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14
Q

What cardiac condition is a/w RA

A

Pericarditis
Myocarditis

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15
Q

*What cervical spine condition is a/w RA

A

ATLANTOAXIAL SUBLUXATION
**Xray to exclude this before Sx and intubation

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16
Q

Felty syndrome

A

RA
Spleenomegaly
Neutropenia

17
Q

Caplan syndrome

A

RA
Pneumoconiosis

18
Q

Antibodies in RA

A

RA factor sensitive not specific
Anti CCP - specific (anti cyclic citrulinated peptide)

19
Q

Xray picture in RA

A
  1. Joint space erosion
  2. Osteoporosis of juxta-articular bone
  3. ↓Bone space
  4. Cysts
  5. Subluxation
  6. Ankylosing
20
Q

Mx of RA

A

Monotherapy with methotrexate
+/- DMARDs

DMARDs
Methotrexate
NSAIDs
Low dose steroids
Folic acid supplementation - better GIT, Liver

21
Q

Triple therapy in RA

A

Methotrexate +
Sulfasalazine +
HCQ

When methotrexate monotherapy does not work

22
Q

Monosodium urate crystals in joint space seen in?

23
Q

Diagnosis of gout

A

First time/confirmatory - synovial fluid aspiration
Xray - Needle shaped, negative birefringence uric acid crystals. punched out joint space

24
Q

Mx of gout

A

NSAID - avoid in renal impairment
Steroids
Low dose Colchicine (in renal impairment)

25
Q

Prophylactic drug for gout

A

For recurrent gout, high uric acid levels, tophi, kidney stones
Allopurinol 100-300mg (Xanthine oxidase inhibitor)
Febuxostat
Probenecid

If pt develops acute gout while using allopurinol,
do not discontinue.

26
Q

Calcium pyrophosphate crystals in joint space is seen in?

A

Pseudo-gout/Chondro-calcinosis
OA pts with crystal deposition in one joint, mc knee

27
Q

Xray in chondrocalcinosis

A

Rhomboid shaped positive birefringence

28
Q

Mx of pseudogout

A
  1. PCM
  2. Indomethacin
  3. Colchicine
  4. Steroid injection into joint space
29
Q

What is Spondyloarthropathy

A

Arthritis of spondyles of vertebra
Asymmetrical
Absent RA
HLA B27 +

30
Q

Ankylosing Spondylitis (severe) on Xray

A

Bamboo spine (Lumbar mainly affected)

31
Q

Investigations in Ankylosing Spondylitis

A

1st Xray
2nd MRI - confirmatory

32
Q

Mx of Ankylosing Spondylitis

A

Mild (Sacroilitis) - NSAIDs
Severe (Bamboo sign) -
Immunomodulators (Infliximab)

33
Q

Reiters syndrome (cant see, cant pee, cant climb a tree)

A

Reactive arthritis
Young
Following Salmonella, Shigella(GIT), Chlamydia (UGT)
↑ESR CRP
A/w HLA B27

Urethritis + Conjunctivitis + Arthritis(knee, ankle,heel)

NSAIDs, Steroids, methotrexate, sulfasalazine

Rheumatology (6 decks)

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