Arthritis Flashcards
What is reactive arthritis?
A type of joint inflammation which occurs within 4 weeks post-infection, typically an STD. It commonly presents with arthritis, conjunctivitis and urethritis.
What is SLE?
Systemic Lupus Erythematosus is a relapsing-remitting autoimmune condition which causes joint pain, raynauds, oral/genital ulcers and a distinctive malar ‘butterfly’ rash which is nasolabial sparing.
What is a common respiratory complication of SLE?
Pleuritis
What is a common respiratory complication of Rheumatoid Arthritis?
ILD or pulmonary nodules
Name 4 different types of inflammatory arthritis
Rheumatoid, Ankylosing Spondylitis, Reactive, Psoriatic
What points should be covered in an arthritis history?
Pain Swelling Stiffness Function Joints affected Diurnal variation General malaise
What is rheumatoid arthritis?
An autoimmune condition causing symmetrical, inflammatory polyarthritis
What are some systemic features of rheumatoid arthritis?
- Scleritis
- Interstitial lung disease, nodules
- Pericarditis
- Skin nodules
- Cervical myelopathy
- Mononeuritis multiplex
What is osteoarthritis?
Chronic and progressive asymmetrical joint pain caused by cartilage loss and bone remodelling
What are the four characteristic features of osteoarthritis on X-ray?
- Subchondral sclerosis
- Joint space narrowing
- Osteophyte formation
- Subchondral cysts
What are the features of rheumatoid arthritis on X-ray?
- Juxta-articular osteopenia
- Soft tissue swelling
- Joint deformity
- Joint space narrowing
- Ill-defined marginal erosions
Which rheumatological condition typically causes dry eyes and mouth?
Sjorgens syndrome
What can cause back pain?
Prolapsed disc, trauma, fractures, ank spon, pregnancy, malignancy, paget’s, cauda equina, osteoporotic vertebral collapse, spinal infection
What is the treatment for septic arthritis?
IV flucloxacillin or vancomycin
What are some examples of DMARDS?
Methotrexate
Hydroxychloroquinine
Sulfasalazine
What is the main side effect of DMARDS?
Immunosuppresion
What are some examples of biologics?
TNFa inhibitors: infliximab, etanercept, adalimumab
B cell depletion: Rituximab
These are usually used in combo with methotrexate
What would be recorded on a joint aspiration in gout?
Monosodium urate crystals
What are the typical signs and symptoms of ankylosing spondylitis?
- Young man
- Gradual onset lower back pain, worst at night
- Morning stiffness relieved by exercise
- Global loss of spinal movement
- Question mark posture
- Bamboo spine (symmetrical blurring and narrowing of the joint space) on X-ray (NB this can only be seen in advanced disease)
Which HLA is involved in ank spon?
HLA B27
What happens to the hands in rheumatoid arthritis?
- Swelling of PIP joints
- Ulnar deviation
- Swan-necking
- Z-thumb
- Loss of bone density
- Rheumatoid nodules
What happens to the hands in osteoarthritis?
- Affects first MCP joint and DIPs
- Heberdens nodes (outer)
- Bouchards nodes (inner)
What features can be seen on x-ray of psoriatic arthritis?
Sausage finger, pencil in cup deformity
What is systemic sclerosis?
An autoimmune disease of connective tissue, characterised by thickened skin and vascular damage
What is dermatomyositis?
Insidious onset of progressive symmetrical proximal muscle weakness and inflammation, causing a characteristic purple rash around the eye and rash on the hands.
How does carpal tunnel syndrome usually present?
- Parasthesia in the fingers which is worse at night and occasionally feels like burning
- Positive phalanx sign
- Usually idiopathic
What is the classical presentation of polymyalgia rheumatica?
- Aged over 50
- 2 weeks of bilateral shoulder pain
- Evidence of acute phase response (raised ESR and CRP)
- Morning stiffness
What is the most common cause of posterior knee swelling?
Baker’s cyst
In which condition would you get well defined periarticular erosions in the affected joint?
Chronic gout
What is the difference between the aspirate from gout and pseudogout?
Pseudogout - bifringent rhomboid crystals
Gout - negatively bifringent needle-shaped urate crystals
What tends to occur in radial nerve palsy?
Wrist drop (wrist extensor muscles are controlled by radial nerve)
What is Finkelstein’s test?
Take the patients thumb and ulnar deviate the hand sharply. This elicits sharp pain along the distal radius and is a sign of de Quervain’s tenosynovitis
What tests assess for median nerve palsy?
Phalen’s and Tinel’s
What test assess for ulnar nerve palsy?
Froment’s sign
What is a common side effects of DMARDs such as methotrexate?
Immunosuppresion
If someone has severe rheumatoid arthritis, on what condition can they try biologics?
They must have tried low-dose glucocorticoids and two trials of six months of traditional DMARD monotherapy or combination therapy.
DMARDS - azothiaprine, ciclosporin, hydroxychloroquine, methotrexate
BIOLOGICS - infliximab
What does post-surgical DVT increase the likelihood of?
Pulmonary embolism - the best investigation for this is a CT pulmonary angiogram
What causes the following nail changes:
a) clubbing
b) heberden’s nodes
c) koilonychia
d) nail plate separation from nail bed (oncholysis)
e) nail thinning
a) respiratory problems
b) osteoarthritis
c) iron-deficiency anaemia
d) psoriatic arthritis
e) lichen planus
What four conditions is HLAB27 associated with?
PAIR
Psoriasis
Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis
