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Arthritis Flashcards

1
Q

What is the commonest joint problem worldwide?

A

OA

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2
Q

Which type of joints does OA affect

A

Synovial

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3
Q

Risk factors OA

A 
AGE!! 
Joint trauma/injury 
Occupational 
FH 
Obesity 
F>M 
Gout
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4
Q

Which joint do Heberden’s nodes affect

A

Distal interphalangeal

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5
Q

Which joint do Bouchard’s nodes affect

A

Proximal interphalangeal

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6
Q

Clinical signs of OA

A 
Crepitus on movement 
Pain on movement 
Heberden's nodes (DIP)
Bouchard's Nodes (PIP)
Restricted movement 
Bony enlargement 
Joint effusion 
Bony instability
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7
Q

What is the RF in OA

A

-ve

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8
Q

X-ray signs of OA

A

Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis

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9
Q

Ix for OA

A

Examination
FBC
RF
X-ray

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10
Q

Symptoms OA

A 
Pain 
Worse on movement and or weight bearing 
Better on rest 
Stiffness <30 mins in the morning 
Swelling around the joint 
Crepitus 
Decrease ROM
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11
Q

Difference in morning stiffness between OA and RA

A

RA prolonged morning stiffness

OA typically lasts <30 mins

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12
Q

Conservative Rx of OA

A

Patient education
Exercise
Weight loss
Lifestyle change

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13
Q

Non-Pharmacological Rx of OA

A

Thermotherapy
Electrotherapy
Aids and devices
Manual therapy

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14
Q

Which non-pharmacological Rx do NICE NOT recommend

A

Acupuncture

Nutraceuticals

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15
Q

Pharmacological Rx of OA

A

Oral analgesia: NSAIDS

Topical analgesia: Capsaicin

Steroid I/A injections

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16
Q

Surgery options for OA

A

Joint replacement/Arthroplasty
Osteotomy
Arthrodesis

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17
Q

Who is given surgery in OA

A

People with severe OA that is impact got QO

When other managements have been tried and failed

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18
Q

Which signs would suggest the diagnosis is NOT OA

A

Trauma
Prolonged morning stiffness
Rapid deterioration of symptoms
Hot swollen joints

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19
Q

What type of arthritis is gout

A

Inflammatory

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20
Q

What is the pattern of gout disease

A

Recurrent attacks

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21
Q

Aetiology Gout

A 
M>F
Increasing Age
Red meat 
Alcohol 
FH gout 
Obesity 
Hypertension
DM
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22
Q

What causes gout

A

Elevated levels uric acid in the blood

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23
Q

Triggering factors for gout

A

Alcohol
Dehydration
Diuretics

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24
Q

Where in the body is gout most common

A

1st MTP of big toe

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25
Symptoms of gout
``` Red Hot Swollen Fiery painful joint Peeling overlying skin ```
26
Ix for gout
``` Serum urate (may be helpful) ASPIRATION ```
27
What are tophi
Massive accumulations of uric acid
28
What is the typical presentation of gout
1st MTP of big toe | Hot, red, swollen, painful
29
Rx acute flares of gout
High dose NSAIDs (Colcichine if NSAIDS CI) Rest and elevate the joint Steroid injections
30
What is given in acute flares of gout if NSAIDS are CI
Colchicine
31
What is a common side effect of Colchicine
Diarrhoea
32
When should you treat hyperuricaemia
``` Single attack of polyarticular gout Urate calculi Renal insufficiency Tophaceous gout If 2nd attack within 1 yr ```
33
Which Rx lower uric acid
Xanthine Oxidase inhibitors | Uricosuric agents
34
How do uricosuric agents work?
They increase rate excretion of uric acid in urine
35
Should you treat asymptomatic hyperuricaemia
No
36
Given examples of Xanthine Oxidase Inhibitors
Allopurinol | Febuxosat
37
Ddx for gout
Septic arthritis Cellulitis Reactive arthritis Pseudogout
38
What is it important to differentiate gout from
An infection of some sort | e.g septic arthritis
39
Overproduction causes of hyperuricaemia
``` Malignancy Lymphoproliferative disorders Tumour lysis syndrome Severe exfoliative psoriasis Drugs Inborn errors of metabolism HGPRT deficiency ```
40
Under excretion causes of hyperuricaemia
``` Elderly Male Renal impairment Hypertension Hypothyroidism Drugs Exercise, starvation, dehydration Lead poisoning ```
41
Which joint does Pseudogout typically affect
Knee
42
What cause pseudo gout
Calcium Pyrophosphate Deposition in the joints
43
Symptoms of pseudo gout
``` Similar to gout Attacks of joint: Pain Swelling Redness Tenderness Warmth Red, fiery hot joint ```
44
Rx for pseudo gout
NSAIDs Steroid injections Manage episodes as they arise
45
Is there prophylaxis for pseudo gout?
No
46
What type of arthritis is ankylosing spondylitis
Seronegative arthritis
47
Which antigen is seronegative arthritis commonly associated with
HLA B27
48
What is ankylosing spondylitis
Chronic inflammatory rheumatic disorder with a predilection for axial skeleton and sacroiliac joints
49
What is the typical onset (gender and age) of Ankylosing Spondylitis
M>F | 20-30s (young)
50
What is meant by a seronegative arthritis
Rheumatoid factor is negative (RF -ve)
51
What is the typical clinical picture of ankylosing spondylitis
``` young male (<30yrs) Gradual onset lower back pain Worse during night Morning spinal stiffness relieved by exercise Progressive loss of spinal movements ```
52
Dx for ankylosing spondylitis
Bloods: including HLA-B27 and RF MRI of spine!!
53
Is there a cure for ankylosing spondylitis
No cure
54
Rx for ankylosing spondylitis
No cure Physio. Exercise NSAIDS DMARDS: Sulfasalazine Anti-TNF Anti IL-7 Surgery: joint replacement Spinal surgery
55
Clinical features of ankylosing spondylitis
Low back pain Back stiffness which improves with activity Lasting >3/12 Limited ROM of lumbar spine in both lateral and forward flexion Limitation of chest expansion Bilateral sacroilitis
56
What are potential extra articular features of ankylosing spondylitis
``` Uveitis Aortic valve incompetence Heart blood Restrictive pulmonary disease Apical fibrosis IBD Osteoporosis Spinal fractures Acute iritis Cauda Equina syndrome ```
57
What are the clinical criteria for the New York Classification system (Ankylosing spondylitis)
Low back pain >3 months with stiffness that improves on activity Limited ROM of lumbar spine (both lateral and forward flexion) Reduced chest expansion (compared to normal values for age and sex)
58
What are the radiological criteria for the New York Classification system (Ankylosing Spondylitis)
Sacroilitis grade >2 bilaterally OR Sacroillitis grade 3-4 unilaterally
59
What combination of clinical and radiological is needed to diagnose Ankylosing Spondylitis according to the NY classification
1 radiological + 1 clinical classification
60
What are the 2 classification systems used for Ankylosing Spondylitis
New York Classification | ASAS Classification
61
Describe the ASAS classification for ankylosing spondylitis
Patients with >3 months history of back pain and <45yrs WITH Sacroilitis on imaging + >1 SpA feature Or WITH HLA-B27 +ve + 2 or more SpA features
62
What are the SpA features of the ASAS classification system (ankylosing spondylitis)
``` Inflammatory back pain Arthritis Enthesitis Uveitis Dactylitis Psoriasis Crohn's/Colitis Good response to NSAIDS FH of SpA HLA-B27 +ve Increased CRP ```
63
Describe grade 0 Radiological sacroilitis
Normal
64
Describe grade 1 radiological sacroilitis
Suspicious changes
65
Describe grade 2 radiological sacroilitis
Minimal abnormality small localised areas with erosion of sclerosis without alteration in joint width
66
Describe grade 3 radiological sacroilitis
Unequivocal abnormality - moderate or advances sacroilitis with 1 or more of: erosions, evidence of sclerosis, widening, narrowing or partial ankylosis
67
Describe grade 4 radiological sacroiliac
Severe abnormality - total ankylosis
68
What is psoriatic arthritis
Chronic inflammatory arthritis occurring in those affected with the autoimmune disease psoriasis
69
Does psoriatic arthritis always occur in those with psoriasis
No joint involvement only occurs in 10-4% of those with psoriasis
70
What type of arthritis is psoriatic arthritis
Seronegative (RF-ve)
71
Which antigen does psoriatic arthritis have a strong association with
HLA B27
72
Nails signs of psoriatic arthritis
``` Nail pitting Nail discolouration Nail thickening Dactylitis Palmar-plantar pustulosis ```
73
What is Dactylitis
Sausage fingers
74
Ix for psoriatic arthritis
Xray Bloods: HLA B27 RF
75
Does the severity of skin disease correlate to the severity of join disease in psoriatic arthritis
No
76
Types of psoriatic arthritis
``` Symmetrical DIP joint Asymmetrical Spinal Psoriatic arthritis mutilans ```
77
Rx for psoriatic arthritis
NSAIDS Corticosteroids DMARDS Biologics Physio. OT
78
DMARDs used to treat psoriatic arthritis
Sulfasalazine Methotrexate Leflunomide Cyclosporine
79
Biologics used to treat psoriatic arthritis
Ant-TNF therapy | Anti Il-17 and IL-23
80
Symptoms of psoriatic arthritis
``` Swollen fingers and toes Painful joints Plaques on skin Reduced ROM of joints Fatigue Nail changes: pitting, discolouration, thickening ```
81
What is reactive arthritis
Inflammatory arthritis that develops in response to an infection in a distant site in the body (cross reactivity)
82
What type of arthritis is reactive
Seronegative (RF -ve)
83
What is the classic triad of Reiter's Syndrome
Asymmetric oligoarthritis Urethritis Conjunctivitis
84
Ix for Reactive arthritis
``` RF (-ve) ESR CRP HLA-B27 Cultures (e.g stool, swabs) ```
85
Which types of infection are most likely to cause reactive arthritis
Urogenital (e.g sexually transmitted - e.g Chlamydia) GI (e.g diarrhoea) Throat infection (streptococcus)
86
Clinical features of reactive arthritis
``` Painful swollen joints Dactylitis Conjunctivitis Mouth ulcers Urethritis ```
87
Cure for reactive arthritis
No specific cure
88
Rx for acute reactive arthritis
NSAIDs Joints steroid injection Abx. (in chlamydia for contacts aw well) Splinting
89
Define chronic reactive arthritis
Symptoms last >6 months
90
Rx for chronic reactive arthritis
NSAIDs DMARDs: Sulphasalazine Methotrexate
91
What is enteropathic arthritis commonly associated with
Ulcerative colitis | Crohn's Disease
92
Which antigen is strongly associated with reactive arthritis
HLA-B27
93
Which antigen is strongly associated with enteropathic arthritis
HLA-B27
94
Rx for enteropathic arthritis
NSAIDs (difficult to sue) DMARDs (e.g Sulfasalazine) Steroids Biologics (anti-TNF)
95
What is enteropathic arthritis
Chronic inflammatory arthritis associated with the occurrence of IBD
96
What is septic arthritis
Infection of the joint
97
Which joint does septic arthritis commonly affect
knee
98
Risk factors for septic arthritis
``` Age DM OA RA Chronic renal failure Immunocompromised IV drug abuse Recent joint surgery Skin infection ```
99
Common organisms for septic arthritis
Staph. Aureus Haemophilus influenza Strep. Pyogenes E.coli
100
Route of infection for septic arthritis
``` Haematogenous (commonest) Eruption of bone abscess Direct invasion Penetrating wound Intra-articular injury Arthroscopy ```
101
Clinical features of septic arthritis
``` Acutely inflamed painful joint Fever (systemic symptoms) Tender joint Warmth over joint Redness Pain to move joint ```
102
Ix for septic arthritis
Bloods: FBC, WCC, ESR, CRP Urgent joint aspiration!!! Blood cultures X-ray USS
103
Urgent Ix for septic arthritis
Urgent joint aspiration
104
Rx for septic arthritis
Fluids Analgesia IV Abx (then switched to oral) Arthrocentesis
105
Ddx for septic arthritis
``` Acute osteomyelitis Trauma Irritable joint Haemophilia Rheumatic fever Gout ```

Musculoskeletal (13 decks)

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