Arthritis Flashcards
Juvenile idopathic arthritis
key features, antibodies, mx
<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
RF c/f
- Indigenous aussie
- Young (5-15)
- Post Step. pyogenes infection (sore throat)/Group A strep
- Migratory polyarthritis
- Fever, malaise
PF diagnosis criteria
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
Investigations in RF
- Streptococcal ASO titres»
- Streptococcal Anti DNAse B
- ESR, CRP
- ECG
- Throat swab - 1st to confirm GAS
- FBC
MX of RF
- Penicillin
Benzylpenicillin IM
Phenoxymethylpenicillin oral BD - Paracetamol, Aspirin - arthritis
- Diuretics - cardiac involvemet
- Bed rest 2 weeks
- Prophylactic long term penicillin
Osteoarthritis main joints involved are?
Degenerative
More common:
First carpometacarpal (CMC)joint of thumb
DIP*
First metatarsophalangeal (MTP) joint
C/F of osteoarthritis
- Pain on waking up, upto 5 mins
- Pain ↑with movement, ↓with rest
- Restricted movements
Crepitus on palpation
Osteophytes, ↓joint space on Xray
HEBERDEN NODULES - DIP (HD)
BOUCHARD NODULES - PIP
Nodules seen in osteoarthritis
HEBERDEN NODULES - DIP (HP)
BOUCHARD NODULES - (PIP)
Rx of osteoarthritis
Analgesics
What is Rheumatoid arthritis
Autoimmune symmetrical polyarthritis
Difference in presentation of RA and OA
RA:
↓Joint pain on movement
PIP»DIP
Morning stiffness for hours
OA:
↑Pain on movement
DIP»PIP
Morning stiffness for lesser duration (5mins)
C/F of RA
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
What renal condition is a/w RA
Amyloidosis
What cardiac condition is a/w RA
Pericarditis
Myocarditis
*What cervical spine condition is a/w RA
ATLANTOAXIAL SUBLUXATION
**Xray to exclude this before Sx and intubation
Felty syndrome
RA
Spleenomegaly
Neutropenia
Caplan syndrome
RA
Pneumoconiosis
Antibodies in RA
RA factor sensitive not specific
Anti CCP - specific (anti cyclic citrulinated peptide)
Xray picture in RA
- Joint space erosion
- Osteoporosis of juxta-articular bone
- ↓Bone space
- Cysts
- Subluxation
- Ankylosing
Mx of RA
Monotherapy with methotrexate
+/- DMARDs
DMARDs
Methotrexate
NSAIDs
Low dose steroids
Folic acid supplementation - better GIT, Liver
Triple therapy in RA
Methotrexate +
Sulfasalazine +
HCQ
When methotrexate monotherapy does not work
Monosodium urate crystals in joint space seen in?
Gout
Diagnosis of gout
First time/confirmatory - synovial fluid aspiration
Xray - Needle shaped, negative birefringence uric acid crystals. punched out joint space
Mx of gout
NSAID - avoid in renal impairment
Steroids
Low dose Colchicine (in renal impairment)
