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MSK > Arthritis > Flashcards

Arthritis Flashcards

1
Q

‘Symmetrical inflammatory arthritis affecting the peripheral joints’ is what?

A

Rheumatoid arthritis

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2
Q

What problems occur if RA is left untreated?

A

Deformities, joint damage and loss of function

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3
Q

As well as the joints, RA can also cause inflammation in organs. True or false?

A

True

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4
Q

Which sex is more likely to suffer from RA? By how many times?

A

Women are 3 times more commonly affected than men

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5
Q

What age group does RA affect?

A

Any age group

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6
Q

What is RA known as when it occurs in under 16s?

A

Juvenile idiopathic arthritis

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7
Q

RA is an autoimmune disease. True or false?

A

True

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8
Q

HLA-DR4 mediates which condition?

A

Rheumatoid arthritis

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9
Q

What are some potential triggers for RA?

A

Smoking, stress, infections

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10
Q

The presence of antibodies in RA has what effect on the prognosis?

A

Generally implies a worse prognosis

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11
Q

What is the main structure affected by RA?

A

The synovium

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12
Q

Which two areas does synovium line?

A

Inside of synovial joint capsules and tendon sheaths

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13
Q

Which disease only affects joints which have synovium?

A

Rheumatoid arthritis

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14
Q

Where in the spine can RA affect? Why?

A

C1 and C2, only spinal joints with synovium

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15
Q

What causes the joint destruction in RA?

A

Inflammatory cytokines

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16
Q

RA can cause joint fusion. True or false?

A

True

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17
Q

Which biologic agent works by depleting B cells?

A

Retuximab

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18
Q

In RA, T cells cause macrophage activation to release what 3 things?

A

TNF alpha, IL-1 and IL-6

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19
Q

Rheumatoid factor is released by what type of cell?

A

B cells

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20
Q

Infliximab and adalimumab work by inhibiting what?

A

TNF alpha

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21
Q

Tocilizumab works by inhibiting what?

A

IL-6 receptor

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22
Q

On x-rays for RA, it often looks like bits of bone have been eaten off (erosion)- what causes this to happen?

A

Osteoclast activity

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23
Q

What do osteoblasts do?

A

Lay down bone

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24
Q

What do osteoclasts do?

A

Resorb bone (remove cells by gradual breakdown)

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25
Q

Which condition spares the DIP joints?

A

Rheumatoid arthritis

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26
Q

Early RA is defined as when since symptoms began?

A

Less than 2 years

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27
Q

What is the therapeutic window of opportunity for better outcomes in RA?

A

The first 3 months since symptom onset

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28
Q

What causes morning stiffness for more than 30 mins?

A

Rheumatoid arthritis

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29
Q

Rheumatoid arthritis is usually asymmetrical. True or false?

A

False- it is usually symmetrical, though it can present in one joint before the other

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30
Q

Will you see radiographic changes in early RA?

A

No

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31
Q

What are the two main inflammatory markers?

A

CRP and PV

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32
Q

Apart from autoantibodies and inflammatory markers, what else could be seen in routine blood tests of an RA patient?

A

Anaemia and raised platelets

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33
Q

What types of imaging can be used for RA? Which is the gold standard?

A

X-rays
Ultrasound
MRI (gold standard)

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34
Q

Compressing the MCP and MTP joints will be painful in what condition?

A

Rheumatoid arthritis

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35
Q

What two auto-antibodies are associated with RA?

A 
Rheumatoid factor (IgM)
Anti-CCP
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36
Q

Anti-CCP antibody is associated with which condition?

A

Rheumatoid arthritis

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37
Q

If a patient does not have the specific antibody, could they still have RA if the clinical signs were there?

A

Yes

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38
Q

What is tenosynovitis?

A

Tendon sheath inflammation

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39
Q

What is damage to the flexor tendons of the hand known as?

A

Trigger finger

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40
Q

Carpal tunnel is the compression of which nerve? Which fingers does this supply?

A

Median nerve- supplies the middle 3 fingers

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41
Q

What is palindromic rheumatism?

A

Rheumatoid arthritis which comes and goes

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42
Q

Can RA have systemic symptoms?

A

Yes

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43
Q

When should x-rays be done for RA?

A

Whenever a patient presents- it is standard to do an x-ray of the hands and feet, even if there are no symptoms there

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44
Q

Early rheumatoid will show what on an x-ray?

A

Nothing

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45
Q

What scoring system is used to assess RA?

A

DAS28

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46
Q

What parts of the body are missed out of the DAS28 system?

A

Feet and ankles

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47
Q

What DAS28 score is indicative of severe, active disease?

A

> 5.1

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48
Q

What DAS28 score is indicative of remission?

A

< 2.6

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49
Q

A DAS28 score of 3.2-5.1 indicates what?

A

Moderate disease

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50
Q

A DAS28 score of 2.6-3.2 indicates what?

A

Low disease activity

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51
Q

What group of drugs are the main treatment for RA?

A

DMARDs

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52
Q

What can be used as adjunctive therapy for RA?

A

NSAIDs and steroids

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53
Q

Can steroids be used as sole therapy?

A

No

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54
Q

Oral steroids can be stopped suddenly. True or false?

A

False- patients must be taken off oral steroids by gradually reducing the dose

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55
Q

What is the first line DMARD?

A

Methotrexate

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56
Q

What is a good second line DMARD (especially in pregnancy)?

A

Sulphasalazine

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57
Q

What should always be started together with a DMARD? Why is this?

A

Steroids- because DMARDs take a few months to start to work, the steroid controls the inflammation in the meantime

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58
Q

Why are patients on DMARDs monitored?

A

Bone marrow suppression- low WCC

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59
Q

Why should patients on methotrexate be told to look out for a dry cough or dyspnoea?

A

It can cause pneumonitis

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60
Q

What advice would you give to young women starting methotrexate?

A

Use contraception- you cannot get pregnant on this drug

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61
Q

When can you give a biologic drug in RA?

A

If there has been a failure to respond to at least two DMARDs, and a DAS28 score of > 5.1

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62
Q

Should methotrexate be co-prescribed with a biologic?

A

Yes

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63
Q

What are 2 major risk factors of biologics?

A
  • Immunosuppression

- Risk of reactivation of TB (patients should be screened)

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64
Q

What is the most common form of arthritis?

A

Osteoarthritis

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65
Q

Which arthritis is progressive and degenerative?

A

Osteoarthritis

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66
Q

What are 3 features of osteoarthritis?

A
  • Gradual thinning of cartilage
  • Loss of joint space
  • Formation of bony spurs
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67
Q

When does osteoarthritis typically set in?

A

Around aged 40

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68
Q

Cartilage consists mainly of which type of collagen fibres?

A

Type II

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69
Q

What type of pain is found in osteoarthritis?

A

Mechanical pain

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70
Q

When is OA pain better and worse?

A

Worse on activity and by the end of the day

Better with rest

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71
Q

What type of arthritis causes crepitus?

A

Osteoarthritis

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72
Q

What type of arthritis causes morning stiffness for < 30 mins?

A

Osteoarthritis

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73
Q

‘One of the most common ares to be affected is the. neck’ describes what condition?

A

Osteoarthritis

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74
Q

What are Heberden’s nodes?

A

Bony enlargements in OA seen at the DIPs

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75
Q

What are Bouchard’s nodes?

A

Bony enlargements in OA seen at the PIPs

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76
Q

What will the affected areas of OA feel like?

A

Hard and lumpy

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77
Q

What is a Baker’s cyst?

A

An effusion in the knee spreads into the popliteal fossa and bulges out

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78
Q

What can a Baker’s cyst be misdiagnosed as?

A

DVT

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79
Q

What can lumbar spine OA cause if it impinges on the spinal cord?

A

Spinal stenosis

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80
Q

Osteoarthritis is more common in which gender?

A

Females

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81
Q

What are 5 risk factors for OA?

A
  • Occupation
  • Hobbies
  • Previous Injury
  • Obesity
  • Co-morbidities
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82
Q

How do inflammatory markers come back usually in OA?

A

Normal

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83
Q

What are 4 typical x-ray changes of OA?

A
  • Loss of joint space
  • Subchondral sclerosis
  • Bony cysts
  • Osteophytes
84
Q

What are the primary affected joints of the hands in OA?

A

DIPs and CMCs

85
Q

What are some options of pharmacological treatment for OA?

A

NSAIDs and analgesia

86
Q

What are some non-pharmalogical treatments for OA?

A

Physiotherapy, weight loss, education, footwear

87
Q

Will drugs reverse or cure the symptoms of OA?

A

No

88
Q

What crystal arthropathy is associated with monosodium rate crystals?

A

Gout

89
Q

What crystal arthropathy is associated with calcium pyrophosphate dihidrate (CPPD) crystals?

A

Pseudogout

90
Q

How long do attacks of gout usually last?

A

2 weeks

91
Q

Is gout an inflammatory arthritis?

A

Yes

92
Q

Which sex is gout most common in?

A

Men

93
Q

Which arthropathy is most common in men?

A

Gout

94
Q

What are risk factors for gout?

A

Red meat, shellfish, alcohol

95
Q

What conditions can cause increased cell turnover (which increases purines)?

A

Psoriasis, infections, extreme diets

96
Q

What defines hyperuricaemia?

A

Serum uric acid > 7mg/dL

97
Q

What does hyperuricaemia mean in terms of having gout?

A

Does not mean you will definitely have gout- though it does increase the risk

98
Q

What are some ‘overproduction’ causes of gout?

A

Genetic, high cell turnover, overconsumption of purine rich foods

99
Q

What are some ‘under-excretion’ causes of gout?

A

Renal insufficiency, starvation, thyroid problems, drugs and alcohol

100
Q

When is the best time to measure serum urate?

A

2 weeks following an acute attack

101
Q

What are 3 different differentials of gout?

A
  • Septic arthritis
  • Trauma
  • Seronegative arthritis e.g. psoriatic
102
Q

Can gout become chronic after repeated acute attacks?

A

Yes

103
Q

What medication is often associated with chronic polyarticular gout?

A

Diuretics

104
Q

What will blood tests for gout show?

A

Raised inflammatory markers and WCC

105
Q

What will x rays for gout show in chronic vs acute attacks?

A

Acute- normal

Chronic- erosions, osteophytes, joint destruction

106
Q

What is the gold standard test for gout?

A

Joint aspirate

107
Q

Needle shaped crystals with negative birefringence relates to what?

A

Gout

108
Q

How do you manage an acute attack of gout?

A

NSAIDs, colchicine, steroids

109
Q

What are 3 lifestyle recommendations for gout?

A
  • Lose weight
  • Restrict risk factors
  • Fluids
110
Q

What is used for gout prophylaxis and when should it be started?

A

Allopurinol- 2-4 weeks after an acute attack

start low, go slow

111
Q

What is the target serum rate in gout?

A

< 0.3 mmol/l

112
Q

What can also be known as CPPD?

A

Pseudogout

113
Q

Pseudogout is more common in who?

A

Older population

114
Q

What is the only way to tell the difference between gout and pseudogout?

A

Joint aspirate

115
Q

Rhomboid shaped crystals with a weakly positive birefringence relates to what disease?

A

Pseudogout

116
Q

Is it possible to have both gout and pseudo gout?

A

Yes

117
Q

Should allopurinol be given for pseudo gout?

A

No

118
Q

What is caused by hydroxyapatite crystals?

A

Milwaukee shoulder

119
Q

What has a similar presentation to Milwaukee shoulder?

A

Septic arthritis

120
Q

Milwaukee shoulder causes an acute rapid deterioration, most common in females around ? years?

A

50-60

121
Q

Hydroxyapatite crystals will be detected under microscopy. True or false?

A

False- but an alizarin stain shows red clumps

122
Q

Does paracetamol cause any renal impairment?

A

No

123
Q

Is paracetamol safe in pregnancy?

A

Yes

124
Q

What are 2 examples of atypical analgesics?

A

Amitriptyline and gabapentin

125
Q

Should NSAIDs be used long term?

A

No

126
Q

Naproxen is what type of drug?

A

NSAID

127
Q

Do NSAIDs cause renal impairment?

A

Yes

128
Q

When is it important to not give NSAIDs?

A

In patients with asthma

129
Q

Celecoxib is what type of drug?

A

COX2 inhibitor (a type of NSAID)

130
Q

What is the benefit of COX2 inhibitors?

A

No risk of peptic ulceration

131
Q

What is the disadvantage of COX2 inhibitors? For this reason, who should they be given to?

A

They greatly increase CV risk- should only be given to patients with no other risk factors for this

132
Q

When should DMARDs be started?

A

Within 3 months of symptoms starting

133
Q

What are two reasons for blood tests on patients on methotrexate?

A
  • Low WCC

- Liver damage

134
Q

What supplement must be given to patients on methotrexate?

A

Folic acid

135
Q

What are 4 rheumatological uses for methotrexate?

A
  • Rheumatoid
  • Psoriatic
  • Connective tissue diseases
  • Vasculitis
136
Q

Does the teratogenic effect of methotrexate apply to males?

A

Yes

137
Q

If a patient with RA was to develop a cough and SOB soon after diagnosis, what is this likely to be?

A

Pneumonitis

138
Q

If a patient with RA was to develop a cough and SOB a long time after diagnosis, what is this likely to be?

A

RA associated pulmonary fibrosis

139
Q

What other DMARD is often used in combination with methotrexate?

A

Sulphasalazine

140
Q

What DMARD can cause reduced sperm count? Is it reversible?

A

Sulphasalazine- yes

141
Q

What DMARD can cause Stevens Johnsons Syndrome?

A

Sulphasalazine

142
Q

What is a teratogenic DMARD that is not methotrexate?

A

Leflunomide

143
Q

What DMARD should you move patients toil methotrexate is causing too many side effects?

A

Leflunomide

144
Q

Does hydroychloroquine have any effect in joint damage?

A

No

145
Q

What DMARD can cause irreversible retinopathy?

A

Hydroxychloroquine

146
Q

How are biologics given?

A

Subcutaneous injection

147
Q

What 3 diseases are anti-TNF agents used for?

A
  • RA
  • Psoriatic
  • Ankylosing spondylitis
148
Q

Biologics have been said to increase risk of cancer. What kind specifically?

A

Melanoma

149
Q

What type of drug used for RA exacerbates heart failure?

A

ANti-TNF biologics

150
Q

What medications should be given alongside steroids?

A

Calcium and vitamin D

151
Q

What drug should be used in gout patients who cannot tolerate allopurinol?

A

Febuxostat

152
Q

Allopurinol and febuxostat are what type of drugs?

A

Xanthine oxidase inhibitors

153
Q

What does xanthine oxidase do?

A

Changes purines into uric acid

154
Q

When should febuxostat be used with caution?

A

Ischaemic heart disease

155
Q

What other rheumatological condition can occur as a side effect of allopurinol?

A

Vasculitis

156
Q

What can allopurinol and methotrexate combined cause?

A

Irreversible bone marrow suppression

157
Q

What are another group of drugs which can be used for gout but are uncommon?

A

Uricosurics

158
Q

You must come off methotrexate for how long before trying to conceive?

A

3 months

159
Q

What are drug options for patients during pregnancy?

A

Sulphasalazine or biologics

160
Q

RA gets worse in pregnancy. True or false?

A

False- it usually gets better, but there is often a flare up after birth

161
Q

Are sponyloarthropathies inflammatory?

A

Yes

162
Q

What makes individuals genetically predisposed to spondyloarthropathies?

A

Being HLA-B27 positive

163
Q

Being from where makes you more likely to be HLA-B27 positive?

A

Northern countries

164
Q

Being HLA-B27 + means you will definitely have one of the conditions it is associated with. True or false?

A

False

165
Q

What are the 4 conditions that come under the spondyloarthropathies?

A
  • Reactive arthritis
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Enteropathic arthritis
166
Q

When is inflammatory pain better/worse?

A

Worse with rest and better with activity

167
Q

Do you get morning stiffness with inflammatory pain?

A

Yes

168
Q

What area of the body is involved in sponydloarthropathies which is not involved in other kinds?

A

The spine and sacroiliac joints

169
Q

What is enthesitis?

A

Inflammation at insertions of tendons into bones

170
Q

What is dactylitis?

A

‘Sausage digits’- inflammation of an entire digit

171
Q

Is peripheral arthritis common in ankolysing spondylitis?

A

No

172
Q

When does AS usually occur? Which sex is it more common in?

A

Usually late teens or early adulthood, more common in males

173
Q

What can happen to the vertebrae in AS, causing patients to have limited movement?

A

Fusion

174
Q

What can happen to chest expansion in AS?

A

Reduced

175
Q

What blood tests are important for AS?

A

Inflammatory markers

HLA-B27

176
Q

What condition is Bamboo spine associated with?

A

Ankolysing spondylitis

177
Q

Can an x-ray be normal in AS?

A

Yes, in early disease

178
Q

What is the best test for AS?

A

MRI

179
Q

How can you tell AS apart from osteoarthritis?

A

AS in inflammatory, OA is not

180
Q

What will happen to bone density in AS?

A

Decreased

181
Q

What will happen to bone density in OA?

A

Normal, maybe increased

182
Q

Can you have psoriatic arthritis without psoriasis?

A

Yes (around 10%)

183
Q

What are the findings with regards to rheumatoid nodules and factor in psoriatic arthritis?

A

Negative

184
Q

What nail features can be seen in psoriatic arthritis?

A

Pitting and onycholysis

185
Q

What happens in arthritis mutilans?

A

Lots of joint destruction very quickly

186
Q

What disease may show erosions, osteolysis and enthesis on x-ray?

A

Psoriatic arthritis

187
Q

Which biologic is particularly useful for psoriatic arthritis?

A

Secukinumab (anti- IL-17)

188
Q

What cell mediates psoriatic arthritis?

A

T cells

189
Q

What are some non-medical treatments for psoriatic arthritis?

A

Physiotherapy, occupational therapy, orthotics/chiropodists

190
Q

What causes reactive arthritis to occur?

A

An infection of some sort

191
Q

Is reactive arthritis inflammatory?

A

Yes (inflammatory synovitis)

192
Q

Can microorganisms be cultured from reactive arthritis?

A

No

193
Q

How soon after an infection do symptoms of reactive arthritis occur?

A

1-4 weeks

194
Q

What are the commonest types of infection to cause reactive arthritis?

A

Urogenital, enterogenic

195
Q

What age group and sex is reactive arthritis most common in?

A

20s-40s, with equal sex distribution

196
Q

Are individuals who suffer from reactive arthritis HLA-B27 positive?

A

Yes

197
Q

Reiter’s syndrome is a class of reactive arthritis made up of what 3 things?

A
  • Urethritis
  • Conjunctivitis/uveitis/iritis
  • Arthritis
198
Q

Is reactive arthritis symmetrical? How many joints tend to be affected?

A

No, usually 1 joint or can be up to 4

199
Q

What should you do in reactive arthritis to rule out infection?

A

Joint fluid analysis

200
Q

What are the main treatments involved in reactive arthritis?

A

NSAIDs and corticosteroids

201
Q

When should you give DMARDs in reactive arthritis?

A

If resistant or chronic

202
Q

Is it possible to develop chronic reactive arthritis?

A

Yes

203
Q

What condition is enteropathic arthritis associated with?

A

IBD

204
Q

What will be the relation between arthritis and IBD flare ups?

A

Arthritis will be worse during a flare up

205
Q

What skin condition may be associated with enteropathic arthritis and IBD?

A

Pyoderma gangrenosum

206
Q

What medication should you NOT give in enteropathic arthritis? Why?

A

NSAIDS- they can exacerbate IBD

MSK (6 decks)

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