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MSK > Arthritis > Flashcards

Arthritis Flashcards

1
Q

Rheumatoid arthritis is symmetrical. True/false?

A

True

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2
Q

Women are how many more times likely to develop RA than men?

A

Three times

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3
Q

UK prevalence of RA in % is?

A

1%

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4
Q

Which haplotype is associated with RA?

A

HLA-DR4

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5
Q

Name two triggers of RA

A
  • Smoking

- Stress

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6
Q

The main structure affected in RA is the…

A

Synovium

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7
Q

C1/C2 vertebral joint is rich in synovium. True/false?

A

True

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8
Q

C1/C2 are the only vertebra readily affected by RA. True/false?

A

True - other areas don’t have as much synovium

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9
Q

Pure RA involves cartilage degeneration. True/false?

A

False - no cartilage

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10
Q

Osteoarthritis involves synovium. True/false?

A

False - only cartilage is involved in pure OA

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11
Q

Both B and T cells are involved in RA. True/false?

A

True

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12
Q

RA always has autoantibodies present. True/false?

A

False - seronegative RA exists

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13
Q

In RA, which cells are over stimulated to progressively resorb the bone?

A

Osteoclast

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14
Q

Early RA is defined as that which has…

A

Two years of onset of RA symptoms

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15
Q

What is the therapeutic window to begin RA medication and ensure good outcomes?

A

3 months

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16
Q

Having negative antibody screen rules out RA. True/false?

A

False - seronegative RA

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17
Q

The three most commonly affected joints in RA are….

A

PIP, MCP and MTPs

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18
Q

Trigger finger is a type of

A

Tenosynovitis

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19
Q

Palindromic rheumatism is continual/episodic

A

Episodic

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20
Q

Rheumatoid Factor is which class of antibody?

A

IgM

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21
Q

Rheumatoid Factor is present in which % of patients?

A

20-50%

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22
Q

Rheumatoid Factor is how specific for RA?

A

70-80%

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23
Q

Anti-Cyclic Citrullinated Peptide is how specific for RA?

A

90-99%

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24
Q

Patients can be RF negative and anti-CCP positive. True/false?

A

True

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25
Q

The current classification system for RA is the…

A

2010 ACR/ EULAR classification

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26
Q

Which % of RA diagnosis is clinical and history (as opposed to investigation)?

A

90%

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27
Q

In RA, early morning stiffness typically lasts…

A

> 30 minutes

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28
Q

In OA, early-morning stiffness typically lasts

A

<30 minutes

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29
Q

Inflammatory markers are always raised in RA. True/false?

A

False

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30
Q

Plain X-rays are a useful form of diagnosing early RA. True/false?

A

False - no signs

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31
Q

Treatment changes of RA can be monitored with which investigation?

A

USS

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32
Q

What’s the gold-standard imaging standard for RA?

A

MRI

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33
Q

MRI can distinguish X from Y, making it useful in differential of R.A?

A 
X = Synovitis
Y = Synovial effusion
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34
Q

A DAS28 of <2.6 is considered to be

A

Remission

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35
Q

A DAS28 of >5.1. indicates

A

Active disease

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36
Q

Upon diagnosis of RA, DMARDs should be immediately commenced. True/false?

A

False - initial step with aspirin/NSAIDs, then add steroids, then trial DMARD

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37
Q

Patients on DMARD should be measured how often?

A

6 weeks DAS score taken

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38
Q

If more than 5 joints are involved, intra-articular steroid injection is recommended. True/false?

A

False - 5 is limit

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39
Q

Which drug must be co-prescribed with methotrexate?

A

Folic acid

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40
Q

Parenteral methotrexate has a risk of pneumonitis. True/false?

A

True

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41
Q

Which criteria is needed to move up treatment in RA?

A

DAS28>5.1 on 2 occasions at least 4 weeks apart

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42
Q

What investigations are important before commencing anti-TNF drugs?

A

Screen for latent TB, hepB/C, HIV, VZV

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43
Q

Describe late-stage RA signs of the hand (3)

A
  • Boutonniere
  • Ulnar deviation
  • Swan-necking
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44
Q

IPEX Syndrome is caused by a mutation in which gene? What does this gene do?

A

FOXP3

Develops regulatory T-cells

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45
Q

HLA-B27 is associated with which disease?

A

Ankylosing spondylitis

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46
Q

RA is which type of hypersensitivity?

A

Type 4

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47
Q

SLE is which type of hypersensitivity disease?

A

Type 3

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48
Q

All _____ cells express MHC class I on their membrane.

A

Nucleated

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49
Q

ANA is useful in making RA diagnosis. True/false?

A

False

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50
Q

Which cartilage type covers the surface of bone in synovial joints?

A

Hyaline

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51
Q

Proteoglycans in hyaline cartilage are hydrophilic/phobic?

A

Philic

52
Q

Joint healing is done with which type of cartilage? Why is this “worse”?

A

Replacement is fibrocartilage, which has a greater friction and is less wear resistant

53
Q

The underlying pathology in osteochondritis dessicans is…

A

Loss of blood supply. Bone +/- cartilage can shear off.

54
Q

Cartilage regeneration can be done in all cases of OA. True/false?

A

False - only applicable in osteochondritis dessicans

55
Q

Cartilage regeneration surgery is possible in the patello-femoral joint. True/false?

A

False

56
Q

Partial knee replacement has higher or lower fail rate than TKR?

A

Higher

57
Q

What’s the average expectancy of a TKR?

A

15-20 years

58
Q

What’s the risk of deep infection in TKR replacement?

A

1%

59
Q

Paracetamol is a pure analgesic with very little anti-inflammatory property. True/false?

A

True

60
Q

Example NSAIDs used in arthritis (3)

A
  • Ibuprofen
  • Naproxen
  • Diclofenac
61
Q

Side-effects of NSAIDs (3)

A
  • Peptic ulceration
  • Dyspepsia
  • Oesophagitis
62
Q

COX-2 is commonly targeted by which class of drug?

A

NSAID

63
Q

DMARDs have analgesic properties. True/false?

A

False - pure anti-inflammatories

64
Q

DMARDs should be started how soon after a RA diagnosis?

A

Within 3 months

65
Q

Step 1 treatment option for RA is (2)

A

Non-opioid analgesic (such as aspirin, paracetamol or NSAID) +/- adjuvant

66
Q

Step 2 treatment option for pain in RA Is

A

Weak opioid for mild to moderate pain (e.g. codeine) +/- non-opioid

67
Q

Step 3 treatment option for RA pain is…

A

Strong opioid for moderate to severe pain (e.g. morphine) +/- non-opioid

68
Q

Which DMARDs have the “least” toxicity profile?

A

1) Methotrexate

2) Sulfasalazine

69
Q

What’s the MoA of methotrexate?

A

Unknown - only known it is a folate antagonist

70
Q

Side effects of methotrexate include (3)

A

1) Lecopenia
2) Hepatitis
3) Later, cirrhosis

71
Q

How long should methotrexate be stopped prior to conception? Why?

A

At least 3 months - it is highly teratogenic

72
Q

Side-effects of sulfasalazine include (4)

A

1) Nausea
2) Rash/mouth ulcers (potentially Stevens-Johnson Syndrome)
3) Neutropenia
4) Oligospermia

73
Q

Hydroxychloroquine has what effect on joint damage?

A

None

74
Q

Hydroxychloroquine is used in which type of disease?

A

Connective tissue diseases (such as SLE, Sjorgen’s, RA)

75
Q

Sodium aurothiomate is a type of what?

A

DMARD - not used any more due to BM suppression and kidney damage

76
Q

Penicillinamine as a DMARD has which side-effects?

A

Same as gold - kidney damage,BM suppression

77
Q

Which DMARDs require regular FBCs & LFTs?

A

Methotrexate and sulfasalazine

78
Q

Biologic therapies are delivered via which route?

A

S/C

79
Q

What are side-effects of biologics?

A
  • Malignancy (especially skin cancer)
  • Risk of infection (especially TB)
  • Contraindicated in pulmonary fibrosis
80
Q

Tocilizumab targets what?

A

IL-6

81
Q

Abatacept targets what?

A

CTLA-4 (blocking T-cell activation)

82
Q

Ustekinumab targets what?

A

IL-12 and IL-23 (involved in psoriatic arthritis)

83
Q

What’s more common, sternoclavicular joint arthritis or AC joint arthritis?

A

AC joint

84
Q

Symptoms of glenohumeral OA include (3)

A

1) Pain
2) Crepitus
3) Loss of ROM

85
Q

Reverse geometry shoulder replacement is an alternative surgery which involves which muscle? What condition is it used for?

A

Deltoid & treatment of rotator cuff tear

86
Q

OA is commonly polyarticular. True/false?

A

False - RA tends to be polyarticular

87
Q

RA tends to involve the joint spaces narrowing early on. True/false?

A

False - OA has early narrowing

88
Q

Which hand joints are commonly implicated in OA?

A

DIP + PIP

89
Q

MCP joints are involved in OA/RA?

A

RA

90
Q

What are the hand signs of OA?

A

1) Heberdens (DIP) nodes

2) Bouchard nodes (PIP)

91
Q

Psoriatic arthritis can result in which sign on x-ray?

A

Pencil-in-cup

92
Q

What % of rheumatoid arthritis presents as a monoarthritis?

A

30%

93
Q

What common presentations are associated with RA?

A

Trigger finger, tenosynovitis, carpal tunnel, palindromic rheumatism

94
Q

What is more specific, Rheumatoid Factor or anti-CCP?

A

Anti-CCP

95
Q

Anti-CCP is only positive at symptom onset in RA, T/F?

A

False - it can be positive for years before symptoms

96
Q

Anti-CCP is associated with smoking, T/F?

A

True

97
Q

Anti-CCP will be high/low with disease severity, true or false?

A

True

98
Q

Anti-CCP is a useful marker in judging treatment of RA. T/F?

A

False - will always be positive

99
Q

Steroids can be used as a monotherapy in RA, T/F?

A

False - only as a bridge between flares

100
Q

How many DMARDs can be given at once?

A

3 (plus steroids plus aspirin/NSAIDs)

101
Q

List 2 anti-TNFalpha antibodies?

A

Infliximab, adaluminab

102
Q

List 1 anti-TCR antibody

A

Abatacept

103
Q

List 1 anti-Bcell antibody

A

Rituximab

104
Q

Biologics are ONLY used if which criteria are met?

A

If patient fails to respond to 2 DMARDs (one of which is MTX) AND has a Das28 of >5.1 on at least 2 occasions 4 weeks apart.

105
Q

T/F: Live vaccines can be given in biologic therapy?

A

False

106
Q

C1-C2 subluxation is a complication of RA, T/F?

A

True - C1 and C2 are rich in synovium.

107
Q

A young woman with rheumatoid arthritis mentions she is thinking of starting a family. Her current medication is MTX 15mg/weekly. What should she do about her medication/

A

Come off it and wait 3 months before trying to conceive. Replace with steroids + possibly another DMARD (?)

RA will improve in pregnancy

108
Q

A 36 year old man has very sore joints despite treatment with MTX, SZS and hydroxychloroquine. His DAS28 is 5,88. He is commenced on a new therapy but later returns with cough, 2 stone weight loss, night sweats and fever. What has likely occured?

A

He likely has an underlying infection (e.g. TB) which has been reactivated by his anti-TNFalpha therapy.

109
Q

A 42 year old female is commenced on aspirin, steroids and methotrexate for his rheumatoid arthritis. He has crackles at both lung bases. Which medication is likely responsible & condition?

A

Methotrexate - methorexate pneumonitis

110
Q

Which NSAID is COX-2 selective? Why is using this advantageous?

A

Celecoxib.

It has a lower chance of giving peptic ulcer.

111
Q

GI Side effects of NSAIDs

A

Dyspepsia, oesophagitis, gastritis, peptic ulcer, small/large bowel ulcer

112
Q

Is renal impairment a side-effect of NSAID use?

A

Yes

113
Q

Which lab results will DMARDs improve in patients with RA?

A

ESR, CRP

114
Q

What are the side-effects of methotrexate? (5)

A

1) Leucopaenia/ thrombocytopenia
2) Hepatitis
3) Pneumonitis
4) Rash/ mouth ulcers (SJS)
5) Teratogenic

115
Q

What are the side-effects of leflunomide?

A

Similar to MTX (low WBCs and PLTs, hepatitis, pneumonitis, teratogenic)

116
Q

What are the side-effects of sulfasalazine? (4)

A

1) Rash/mouth ulcers (SJS)
2) Neutropenia
3) Reversible oligozoospermia
4) Hepatitis

117
Q

What is the main side-effect of hydroxychloroquine?

A

Retinopathy

118
Q

How much more effective is anti-TNF therapy than conventional DMARDs?

A

1.5x

119
Q

How are anti-TNFs administered?

A

S/C

120
Q

List some anti-TNF drugs (3)

A

1) Etanrecept
2) Adaluminab
3) Infliximab

121
Q

What are the side-effects of anti-TNF drugs? 2

A

1) Risk of TB infection
2) Possible cancer (esp skin)

Contraindicated in certain situations e.g. pulmonary fibrosis, heart failure

122
Q

Secukinab inhibits what?

A

IL-17

123
Q

Tocilizumab inhibits what?

A

IL-6 (used in RA)

124
Q

Abatacept inhibits what? What is it used in?

A

Activation of T-cells

Used in psoriatic arthritis

125
Q

Is rituximab used in spondyloarthropathy?

A

No (only in RA and CTD)

126
Q

RA hand signs

A

Boutinnere’s deformity, ulnar deviation, swan neck

MSK (21 decks)

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