Arthritis Flashcards
What is the most common form of arthritis?
osteoarthritis
What type of disorder is OA?d
degenerative due to imbalance between wear and repair of cartilage
What may put people at a higher risk of OA?
previous fractures Perthes disease SUFE (slipped capital femoral epiphysis ) congenital disclocation of hip cartilage injury crystal arthropathy Inflammatory arthritis Meniscal tears Genu varum or valgum
Name the 4 typical radiographic findings of an osteoarthritic joint. (LOSS)
Loss of joint space
Osteophytes
Sclerosis
Subchondral cysts
What is the most common seropositive inflammatory arthropathy?
RA
What does RA most commonly affected?
small joints of hands and feet as well as cervical spine
Hipes, kneses shoulders and elbows can also be affected
Is RA more common in men or women and by how much?
women are 2-3 times more likely
What are CRP and ESR usually in RA?
raised
List clinical features of RA.
morning stiffness synovitis (doughy swelling) pain deformity loss of function
What can occur on the skin in RA?
cutaneous rheumatoid nodules
How can internal organs be affected in RA?
rheumatoid lung, ischaemic heart disease
What do X rays show in RA?
hypotrophic artritis:
no osteophytes, sclerosis or bone cysts
Instead - PERIARTICULAR EROSIONS
What is seen on X ray in OA (what is the pictre type called)?
hypertrophic
What operations may be performed for rheumatoid arthritis?
synovectomy joint replacement joint excision tendon transfers arthrodesis (fusion) cervical spine stabilisation
Which joints tend to be affected in SLE?
hands and knees
What type of arthritis are spongyloarthropathies?
seronegative
In what are patients often HLA-B27 positive on serological testing?
spongyloarthropathies
What is ankylosing spondylitis?
chronic inflammatory disease of spine and sacro-iliac joints leading to eventual fusion of intervertebral joints and Sacro iliac joints
Who is more likely be affected by AnkSpon, men or women?
men (3:1)
What conditions are associated with AnkSpon?
aortitis, pulmonary fibrosis and amyloidosis
What do X rays show in AnkSPon?
bony spures known as syndesmophytes which can make a bridge over the intervertebral disc, resulting in fusion, known as BAMBOO SPINE
Is surgery commonly used in AnkSpon?
NO
Is kyphoplasy to straighten the spine in AnkSpon commonly used?
No - iss controversial and carries considerable risk
How common is psoriactic arthritis in people with skin psoriasis?
30%
In what type of arthritis are there normally nail changes including pitting and onycholysis?
psoriatic
What is the very aggressive type of psoriatic arthritis that 5% of patients have?
arthritis mutilans
What does enteropathic arthritis involve?
spine and peripheral joints, occurring in patients with IBD, coeliac, bowel resections and some GI infections
How many IBD sufferers will get enteropathic arthritis?
10-20%
What is reactive arthritis?
occurs in response to infection in other part of body, eg GI or genitourinary
Large joints around the KNEE become inflamed 1-3 weeks after the infection
What is the triad of symptoms which may occur in reactive arthritis?
Reiter’s syndrome:
- urethritis
- uveitis
- arthritis
What is gout?
a crystal arthropathy caused by deposition of urate crystals within a joint, usually due to hyperuricaemia
What is uric acid the final compound in the breakdown of?
purines in DNA metabolism
What may cause the yperuricaemia in gout?
renal underexcretion (eg caused by diuretics/renal failure) seafood, red meat, alcohol
What can trigger the formation of uric acid crystals?
dehydration, trauma, surgery, chemotherapy
What is the classic site of gout?
first MTP joint (known as Podagra)
What are the two next most common sites of gout?
ankle and knee
How does gout present?
intensely painful red hot swollen joint
What are gouty tophi?
painless white accumulations of uric acid occurring in soft tissues and erupting through skin
What can chronic gout result in?
destructive erosive arthritis
What is the treatment for gout?
NSAIDs, corticosteroids, apioid analgesics and colchicine (if you can’t tolerate NSAIDs)
How is a definitive diagnosis of gout made?
polarized microscopy (uric acid crystals are needle shaped and display negative birefringence - change from yellow to blue)
What can prevent recurrent attacks in gout?
allopurinol or probenecid (don’t start until acute attack has settled)
What is pseudogout?
crystal arthropathy causing acute arthritis caused by CALCIUM PYROPHOSPHATE crystals
What term is used when calcium pyrophosphate deposition occurs in cartilage and other soft tissues in absence of acute inflammation?
chondrocalcinosis
What is the umbrella term for chrondocalcinosis and pseudogout?
CPPD
What does CPPD tend to affect?
knee, wrist and ankle
What are the treatments for pseudogout?
NSAIDs, steroids, occassionly colchicine
