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Rheumatology > Arthritis > Flashcards

Arthritis Flashcards

1
Q

Which joint is commonly affected in septic arthritis?

A

The knee

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2
Q

What are the risk factors for septic arthritis?

A

Imunouppression

Pre existing joint disease

Diabetes

Recent joint surgery

Prosthetic joints

IV drug use

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3
Q

What investigation would you do if you suspected septic arthritis?

A

Obs
FBC
History
Joint aspiration of synovial fluid for MICROSCOPY and CULTURE do not wait to treat before results come back if you suspect septic arthritis

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4
Q

What in the history may point you toward septic arthritis?

A

Very unwell

Other infections - chest infection / gastro infection / central line / skin infections

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5
Q

If a prosthetic joint is involved in septic arthritis who must you refer to?

A

Orthopeadics

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6
Q

Describe a common pattern of disease in serum negative spondyloarthropathies

A

Asymmetrical, large joint, mono/oligoarthropathy

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7
Q

What are the four main spondyloarthropathies?

A
  1. Psoariatic arthritis
  2. Enteric arthritis
  3. Reactive arthritis
  4. Ankylosing spondylitis
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8
Q

What are the six common features of sponyloarthropathies?

A
  1. Human Leukocyte Antigen B27 (HLA-B27) positive increases the risk of sponyloarthropathies
  2. Axial arthritis - pain in the spine / sacroiliac joints
  3. Asymmetrical large joint oligo/mono arthritis
  4. Enthesitis - inflammation of the tendons
  5. Dactylitis - inflammation of a single digit
  6. Extra articular features
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9
Q

What are the extra articular features of sponyloarthropathies

A
  1. Uveitis - red eye
  2. Oral ulcers
  3. Aortic valve incompetence
  4. IBD
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10
Q

What does ankylosis mean?

A

Fusion of the bones causing stiffening of the joints

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11
Q

What are the main features of ankylosing spondylitis?

A 
Male
Under 30
Lower back pain of a gradual onset
Worse at night
Spinal stiffness
Relieved by exercise
Reduced back flexion
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12
Q

How would you make a diagnosis of ankylosing spondylitis?

A

Clinical picture
Schobers test
X Ray showing sacrolitis or erosions and reduced joint space

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13
Q

How do you perform schobers test?

A

Looks for reduced flexion in the spine

Mark a point 10cm above the dimples of venus

On forward flexion this should increase to over 15 cm

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14
Q

What level do the dimples of venus correlate too?

A

L5 - posterior superior iliac spine

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15
Q

How do you manage ankylosing spondylitis?

A

Conservative - physio therapy and exercise

Analgesia and anti inflammatories - NSAIDS

Biologics

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16
Q

Which medications do not have an affect on ankylosing spondylitis?

A

DMARDS and STERIODS

17
Q

What extra articular features are associated with psoariatic arthritis?

A

Nail changes - leukonychia / pitting
Synovitis
Dactylitis
Rashes

18
Q

What is included in crystal arthopathies?

A

Gout and psuedogout

19
Q

What is the cause of gout

A

Build up of urate crystals in the joint space, due to excess urate

20
Q

Risk factors for gout

A

Male
Overweight
Dietary purine - red wine, meat

Decreased kidney function

Diuretic use

Infection

Dehydration

21
Q

Where does gout most commonly occur?

A

The metacarpal phalangeal joint of the big toe
Ankle
Foot
Wrist

22
Q

Are there any complications of gout?

A

Chronic renal failure due to build up of urate

23
Q

What is the gold standard investigation for gout?

A

Synovial fluid aspiration - gram stained / cultured / microscopy
Looks at the bacteria and the cells for mono sodium urate

24
Q

What is the treatment for gout?

A

Naproxen - fast acting oral NSAID

25
Q

When wwould you not use naproxen for gout?

A

If it is contra indicated as in chronic renal failure

26
Q

What would you prescribe if naproxen is contra indicated?

A

Colchicine

27
Q

What is the common side effect of colchicine

A

Diarrhoea

28
Q

When and what do you prescribe for prophylaxis of gout?

A

Allopurinol

When 2 attacks or more in a year

1 attack a year + risk factors such as tophi present, poor kidney function, long term diuretic treatment

Rheumatology (5 decks)

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