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MSK Revision > Arthritis > Flashcards

Arthritis Flashcards

1
Q

What is the cause of OA?

A

This is a contain where there is loss of cartilage and synovium in synovial joints, with associated joint space narrowing, there is all decreased collagen synthesis

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2
Q

What is OA the most common cause of?

A

Hip Pain!

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3
Q

What is the M:F prevalence of OA?

A

1:3

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4
Q

What is nodal osteoarthritis?

A

This is OA in the DIP and the PIP joints and is seen unilaterally in the hands of post menopausal women

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5
Q

What are the risk factors for OA?

A 
Previous joint trauma
Obesity 
Hypermobility 
FH 
Occupation
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6
Q

What are the symptoms of OA?

A 
Joint pain
Smooth bony swellings
Stiffness
Loss of range of movement 
Loss of function
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7
Q

What are the signs of OA?

A 
Limited ROM
Bone swelling 
Joint effusion 
Muscle wasting 
Smooth bony out-pouches
Heberdens nodes(DIP)
Bouchards nodes (PIP)
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8
Q

What are the investigations for OA?

A

Full history and hand/ joint examination
X-ray
MRI
Arthroscopy -early fissuring and surface erosion

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9
Q

What is the management of OA?

A

Treat symptomatically
NSAID’s
Hyaluronic acid derivatives
Heat packs and v occasionally surgery to replace joints etc

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10
Q

What are the 3 HALLMARK symptoms of OA?

A

Joint stiffness in the morning that lasts for longer than 3o minutes
Joint pain
Activity exacerbates the pain

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11
Q

Give 3 DD’s of OA

A

Gout
Malignancy
Other arthritis forms
Septic arthritis

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12
Q

What is Rheumatoid Arthritis?

A

This is a chronic systemic autoimmune condition causing symmetrical arthritis in the small joints of the hands and feet

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13
Q

What is the epidemiology if RA?

A

3% of the population
M:F =1:2
Women before menopause have the greater risk

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14
Q

What 2 genes can be afftemed in RA? How do these teens affect the prognosis?

A

HLA-DR4
HLA-DR1
These both carry a worse prognosis

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15
Q

What re the risk factors for RA?

A

Infection
Trauma
Smoking

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16
Q

What are the key symptoms of RA?

A

Morning stiffness lasting longer than an hour
Affects more than 3 joints in the hands and feet
Symetrical pattern
Nodules present

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17
Q

Whta it THE diagnostic test for RA?

A

Anti CCP = Anti-cyclic citrullinated protein antibody

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18
Q

What are some other necessary investigations in RA? Why is RF also raised in another condition?

A

Rhematoid factor - non-specific also increase in Sjoren’s syndrome
X-ray
FBC =anaemia and increased rheumatoid factor
Joint aspiration

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19
Q

What is the 1st line management of RA?

A

NSAID’s

Disease Modifying Anti Rhematic Drugs (DMARD) eg METHOTREXATE and Sulfazaline

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20
Q

What other managements can we use

A

Biologics eg Rituximab
Cortocosteroids
Phsioptherapy etc

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21
Q

What re some of the features in the hand suggestive of RA?

A

Swollen, arm joints
Muscle wasting
Limited ROM
Disturbed sleep

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22
Q

What are some of the systemic sings on RA?

A 
Lymphadenopathy
Splenomegaly 
Anaemia 
Vasculitis 
Diffuse fibrosis and effusion of the lungs
Scleritis/cataracts/glaucoma
23
Q

What is your DD of RA?

A

SLE

24
Q

What is the other name of Seronegative arthritis?

A

Spondyloarthritis

25
Q

What is seronegative arthritis?

A

This is an inflammatory joint disease afftecing the spine and the sacroiliac joints

26
Q

What is the HALLMARK of the investigation is seronegative? Hint: Clue is literally in the name

A

Negative RF

27
Q

What gene is SNA associated with?

A

HLA-B27

28
Q

What is the main type of SNA?

A

Ankylosing Spondylitis

29
Q

When do men tend to present with AS?

A

Around age 16

30
Q

What is the pathogenesis of AS?

A

There is inflammation at the enthuses ie where the ligament joints to the vertebra
This heals and causes new bine formation
This eventually leads to the fusion of the vertebra
This causes the fixed spinal deformity = kyphosis

31
Q

What are the clinical features of AS?

A 
Spine and lower back pain 
Present in the later teenage years
Their e more stiff in the morning 
Woken during the night 
Relieved by exercise
32
Q

What are the systemic features of AS?

A

Peripheral OA
Uveitis
Aortic incompetence
Nail dystrophy

33
Q

What examination test do you want to do?

A

Schrober’s test

34
Q

What investigations are you going to do?

What is the grading scale of the imaging?

A

X-ray/ MRI
0-4 depending on the severity
Bloods show raised ESR and CRP

35
Q

What are the management options?

A

Spinal exercises
NSAID’s Anti-TNF
DMARDS
Surgical for fusion of joints

36
Q

Is AS familial?

A

Yes

37
Q

What percentage of those with Psoriasis have psoriatic arthritis?

A

10%

38
Q

What are the associations with PA?

A

Smoking, RA

HLA-B27

39
Q

What are the clinical features of PA?

A

Plaques on the skin

Arthritis and pain in the weight bearing joints

40
Q

What are the investigations?

A

Clinical diagnosis

41
Q

What is the management of PA?

A

Same as RA -DMARDs

42
Q

What is reactive arthritis, what is it also known?

A

Reiter’s syndrome

43
Q

What are the associations of reactive A?

A 
STI's
Acute diarrhoea
GI infection 
Salmonella 
Shigella
Campylobacter
44
Q

What are the 3 ‘E” symptoms of reactive arthritis?

A

Cant See - conjunctivitis
Cant Pee - urethritis
Cant bend at the knee - arthritis affects the knee and ankle

45
Q

What are the investigations of reactive arthritis?

A

Blood culture
Stool sample
STI screen
raised EsR and CRP

46
Q

What are the managements of reactive arthritis?

A

Rx the original infection and then reassure the arthritis should have cleared in 4 months if it has not then consider DMARD’s

47
Q

What is JIA?

A

Systemic inflammatory disorder that affects children under the age of 16

48
Q

What is a very common presentation of JIA?

A

A child who has a new limp or is refusing to walk

49
Q

What are the 3 subtypes of JIA?

A

Pauciarticular
Polyarticular
Systemic onset

50
Q

What are the 3 types of pauarticular?

A 
1 = most common and more common in girls, 4 or less joints are affected, positive ANA
2 = more boys , affecting lower limbs older than 8
3 = more girls, any age, asymmetrical UL and LL, FH psoriasis
51
Q

What are the features of polyarticular?

A

5 or more joints and tend to affect more girls, they also have systemic disease
Can be RF +/-

52
Q

What are the features of systemic onset? What is it otherwise known as?

A

They have other features such as rash, lymphadenopathy

Hepatosplenomegaly, PE, fevers

53
Q

What are the managements of JIA?

A

NSAIDs
DMARDs
Biologics

MSK Revision (14 decks)

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