Arthritis Flashcards
What is the cause of OA?
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
What is OA the most common cause of?
Hip Pain!
What is the M:F prevalence of OA?
1:3
What is nodal osteoarthritis?
This is OA in the DIP and the PIP joints and is seen unilaterally in the hands of post menopausal women
What are the risk factors for OA?
Previous joint trauma Obesity Hypermobility FH Occupation
What are the symptoms of OA?
Joint pain Smooth bony swellings Stiffness Loss of range of movement Loss of function
What are the signs of OA?
Limited ROM Bone swelling Joint effusion Muscle wasting Smooth bony out-pouches Heberdens nodes(DIP) Bouchards nodes (PIP)
What are the investigations for OA?
Full history and hand/ joint examination
X-ray
MRI
Arthroscopy -early fissuring and surface erosion
What is the management of OA?
Treat symptomatically
NSAID’s
Hyaluronic acid derivatives
Heat packs and v occasionally surgery to replace joints etc
What are the 3 HALLMARK symptoms of OA?
Joint stiffness in the morning that lasts for longer than 3o minutes
Joint pain
Activity exacerbates the pain
Give 3 DD’s of OA
Gout
Malignancy
Other arthritis forms
Septic arthritis
What is Rheumatoid Arthritis?
This is a chronic systemic autoimmune condition causing symmetrical arthritis in the small joints of the hands and feet
What is the epidemiology if RA?
3% of the population
M:F =1:2
Women before menopause have the greater risk
What 2 genes can be afftemed in RA? How do these teens affect the prognosis?
HLA-DR4
HLA-DR1
These both carry a worse prognosis
What re the risk factors for RA?
Infection
Trauma
Smoking
What are the key symptoms of RA?
Morning stiffness lasting longer than an hour
Affects more than 3 joints in the hands and feet
Symetrical pattern
Nodules present
Whta it THE diagnostic test for RA?
Anti CCP = Anti-cyclic citrullinated protein antibody
What are some other necessary investigations in RA? Why is RF also raised in another condition?
Rhematoid factor - non-specific also increase in Sjoren’s syndrome
X-ray
FBC =anaemia and increased rheumatoid factor
Joint aspiration
What is the 1st line management of RA?
NSAID’s
Disease Modifying Anti Rhematic Drugs (DMARD) eg METHOTREXATE and Sulfazaline
What other managements can we use
Biologics eg Rituximab
Cortocosteroids
Phsioptherapy etc
What re some of the features in the hand suggestive of RA?
Swollen, arm joints
Muscle wasting
Limited ROM
Disturbed sleep
What are some of the systemic sings on RA?
Lymphadenopathy Splenomegaly Anaemia Vasculitis Diffuse fibrosis and effusion of the lungs Scleritis/cataracts/glaucoma
What is your DD of RA?
SLE
What is the other name of Seronegative arthritis?
Spondyloarthritis
What is seronegative arthritis?
This is an inflammatory joint disease afftecing the spine and the sacroiliac joints
What is the HALLMARK of the investigation is seronegative? Hint: Clue is literally in the name
Negative RF
What gene is SNA associated with?
HLA-B27
What is the main type of SNA?
Ankylosing Spondylitis
When do men tend to present with AS?
Around age 16
What is the pathogenesis of AS?
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
What are the clinical features of AS?
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
What are the systemic features of AS?
Peripheral OA
Uveitis
Aortic incompetence
Nail dystrophy
What examination test do you want to do?
Schrober’s test
What investigations are you going to do?
What is the grading scale of the imaging?
X-ray/ MRI
0-4 depending on the severity
Bloods show raised ESR and CRP
What are the management options?
Spinal exercises
NSAID’s Anti-TNF
DMARDS
Surgical for fusion of joints
Is AS familial?
Yes
What percentage of those with Psoriasis have psoriatic arthritis?
10%
What are the associations with PA?
Smoking, RA
HLA-B27
What are the clinical features of PA?
Plaques on the skin
Arthritis and pain in the weight bearing joints
What are the investigations?
Clinical diagnosis
What is the management of PA?
Same as RA -DMARDs
What is reactive arthritis, what is it also known?
Reiter’s syndrome
What are the associations of reactive A?
STI's Acute diarrhoea GI infection Salmonella Shigella Campylobacter
What are the 3 ‘E” symptoms of reactive arthritis?
Cant See - conjunctivitis
Cant Pee - urethritis
Cant bend at the knee - arthritis affects the knee and ankle
What are the investigations of reactive arthritis?
Blood culture
Stool sample
STI screen
raised EsR and CRP
What are the managements of reactive arthritis?
Rx the original infection and then reassure the arthritis should have cleared in 4 months if it has not then consider DMARD’s
What is JIA?
Systemic inflammatory disorder that affects children under the age of 16
What is a very common presentation of JIA?
A child who has a new limp or is refusing to walk
What are the 3 subtypes of JIA?
Pauciarticular
Polyarticular
Systemic onset
What are the 3 types of pauarticular?
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
What are the features of polyarticular?
5 or more joints and tend to affect more girls, they also have systemic disease
Can be RF +/-
What are the features of systemic onset? What is it otherwise known as?
They have other features such as rash, lymphadenopathy
Hepatosplenomegaly, PE, fevers
What are the managements of JIA?
NSAIDs
DMARDs
Biologics
