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Musculoskeletal > Arthritis > Flashcards

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
Q

Symptoms of gout

A 
Red 
Hot 
Swollen 
Fiery painful joint 
Peeling overlying skin
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26
Q

Ix for gout

A 
Serum urate (may be helpful)
ASPIRATION
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27
Q

What are tophi

A

Massive accumulations of uric acid

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28
Q

What is the typical presentation of gout

A

1st MTP of big toe

Hot, red, swollen, painful

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29
Q

Rx acute flares of gout

A

High dose NSAIDs (Colcichine if NSAIDS CI)
Rest and elevate the joint
Steroid injections

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30
Q

What is given in acute flares of gout if NSAIDS are CI

A

Colchicine

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31
Q

What is a common side effect of Colchicine

A

Diarrhoea

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32
Q

When should you treat hyperuricaemia

A 
Single attack of polyarticular gout 
Urate calculi 
Renal insufficiency 
Tophaceous gout 
If 2nd attack within 1 yr
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33
Q

Which Rx lower uric acid

A

Xanthine Oxidase inhibitors

Uricosuric agents

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34
Q

How do uricosuric agents work?

A

They increase rate excretion of uric acid in urine

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35
Q

Should you treat asymptomatic hyperuricaemia

A

No

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36
Q

Given examples of Xanthine Oxidase Inhibitors

A

Allopurinol

Febuxosat

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37
Q

Ddx for gout

A

Septic arthritis
Cellulitis
Reactive arthritis
Pseudogout

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38
Q

What is it important to differentiate gout from

A

An infection of some sort

e.g septic arthritis

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39
Q

Overproduction causes of hyperuricaemia

A 
Malignancy 
Lymphoproliferative disorders 
Tumour lysis syndrome
Severe exfoliative psoriasis 
Drugs 
Inborn errors of metabolism 
HGPRT deficiency
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40
Q

Under excretion causes of hyperuricaemia

A 
Elderly 
Male 
Renal impairment 
Hypertension 
Hypothyroidism 
Drugs 
Exercise, starvation, dehydration
Lead poisoning
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41
Q

Which joint does Pseudogout typically affect

A

Knee

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42
Q

What cause pseudo gout

A

Calcium Pyrophosphate Deposition in the joints

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43
Q

Symptoms of pseudo gout

A 
Similar to gout 
Attacks of joint:
Pain 
Swelling
Redness 
Tenderness
Warmth 
Red, fiery hot joint
44
Q

Rx for pseudo gout

A

NSAIDs
Steroid injections

Manage episodes as they arise

45
Q

Is there prophylaxis for pseudo gout?

A

No

46
Q

What type of arthritis is ankylosing spondylitis

A

Seronegative arthritis

47
Q

Which antigen is seronegative arthritis commonly associated with

A

HLA B27

48
Q

What is ankylosing spondylitis

A

Chronic inflammatory rheumatic disorder with a predilection for axial skeleton and sacroiliac joints

49
Q

What is the typical onset (gender and age) of Ankylosing Spondylitis

A

M>F

20-30s (young)

50
Q

What is meant by a seronegative arthritis

A

Rheumatoid factor is negative (RF -ve)

51
Q

What is the typical clinical picture of ankylosing spondylitis

A 
young male  (<30yrs)
Gradual onset lower back pain 
Worse during night 
Morning spinal stiffness relieved by exercise 
Progressive loss of spinal movements
52
Q

Dx for ankylosing spondylitis

A

Bloods:
including HLA-B27 and RF

MRI of spine!!

53
Q

Is there a cure for ankylosing spondylitis

A

No cure

54
Q

Rx for ankylosing spondylitis

A

No cure

Physio.
Exercise
NSAIDS

DMARDS:
Sulfasalazine

Anti-TNF
Anti IL-7

Surgery:
joint replacement
Spinal surgery

55
Q

Clinical features of ankylosing spondylitis

A

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
Q

What are potential extra articular features of ankylosing spondylitis

A 
Uveitis 
Aortic valve incompetence
Heart blood 
Restrictive pulmonary disease
Apical fibrosis 
IBD 
Osteoporosis 
Spinal fractures 
Acute iritis 
Cauda Equina syndrome
57
Q

What are the clinical criteria for the New York Classification system (Ankylosing spondylitis)

A

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
Q

What are the radiological criteria for the New York Classification system (Ankylosing Spondylitis)

A

Sacroilitis grade >2 bilaterally
OR
Sacroillitis grade 3-4 unilaterally

59
Q

What combination of clinical and radiological is needed to diagnose Ankylosing Spondylitis according to the NY classification

A

1 radiological + 1 clinical classification

60
Q

What are the 2 classification systems used for Ankylosing Spondylitis

A

New York Classification

ASAS Classification

61
Q

Describe the ASAS classification for ankylosing spondylitis

A

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
Q

What are the SpA features of the ASAS classification system (ankylosing spondylitis)

A 
Inflammatory back pain 
Arthritis 
Enthesitis 
Uveitis 
Dactylitis
Psoriasis 
Crohn's/Colitis 
Good response to NSAIDS 
FH of SpA 
HLA-B27 +ve
Increased CRP
63
Q

Describe grade 0 Radiological sacroilitis

A

Normal

64
Q

Describe grade 1 radiological sacroilitis

A

Suspicious changes

65
Q

Describe grade 2 radiological sacroilitis

A

Minimal abnormality small localised areas with erosion of sclerosis without alteration in joint width

66
Q

Describe grade 3 radiological sacroilitis

A

Unequivocal abnormality - moderate or advances sacroilitis with 1 or more of: erosions, evidence of sclerosis, widening, narrowing or partial ankylosis

67
Q

Describe grade 4 radiological sacroiliac

A

Severe abnormality - total ankylosis

68
Q

What is psoriatic arthritis

A

Chronic inflammatory arthritis occurring in those affected with the autoimmune disease psoriasis

69
Q

Does psoriatic arthritis always occur in those with psoriasis

A

No joint involvement only occurs in 10-4% of those with psoriasis

70
Q

What type of arthritis is psoriatic arthritis

A

Seronegative (RF-ve)

71
Q

Which antigen does psoriatic arthritis have a strong association with

A

HLA B27

72
Q

Nails signs of psoriatic arthritis

A 
Nail pitting 
Nail discolouration 
Nail thickening 
Dactylitis 
Palmar-plantar pustulosis
73
Q

What is Dactylitis

A

Sausage fingers

74
Q

Ix for psoriatic arthritis

A

Xray
Bloods:
HLA B27
RF

75
Q

Does the severity of skin disease correlate to the severity of join disease in psoriatic arthritis

A

No

76
Q

Types of psoriatic arthritis

A 
Symmetrical 
DIP joint 
Asymmetrical 
Spinal 
Psoriatic arthritis mutilans
77
Q

Rx for psoriatic arthritis

A

NSAIDS
Corticosteroids

DMARDS
Biologics
Physio.
OT

78
Q

DMARDs used to treat psoriatic arthritis

A

Sulfasalazine
Methotrexate
Leflunomide
Cyclosporine

79
Q

Biologics used to treat psoriatic arthritis

A

Ant-TNF therapy

Anti Il-17 and IL-23

80
Q

Symptoms of psoriatic arthritis

A 
Swollen fingers and toes
Painful joints 
Plaques on skin 
Reduced ROM of joints
Fatigue 
Nail changes: pitting, discolouration, thickening
81
Q

What is reactive arthritis

A

Inflammatory arthritis that develops in response to an infection in a distant site in the body (cross reactivity)

82
Q

What type of arthritis is reactive

A

Seronegative (RF -ve)

83
Q

What is the classic triad of Reiter’s Syndrome

A

Asymmetric oligoarthritis
Urethritis
Conjunctivitis

84
Q

Ix for Reactive arthritis

A 
RF (-ve)
ESR 
CRP 
HLA-B27 
Cultures (e.g stool, swabs)
85
Q

Which types of infection are most likely to cause reactive arthritis

A

Urogenital (e.g sexually transmitted - e.g Chlamydia)
GI (e.g diarrhoea)
Throat infection (streptococcus)

86
Q

Clinical features of reactive arthritis

A 
Painful swollen joints 
Dactylitis 
Conjunctivitis 
Mouth ulcers
Urethritis
87
Q

Cure for reactive arthritis

A

No specific cure

88
Q

Rx for acute reactive arthritis

A

NSAIDs
Joints steroid injection
Abx. (in chlamydia for contacts aw well)
Splinting

89
Q

Define chronic reactive arthritis

A

Symptoms last >6 months

90
Q

Rx for chronic reactive arthritis

A

NSAIDs

DMARDs:
Sulphasalazine
Methotrexate

91
Q

What is enteropathic arthritis commonly associated with

A

Ulcerative colitis

Crohn’s Disease

92
Q

Which antigen is strongly associated with reactive arthritis

A

HLA-B27

93
Q

Which antigen is strongly associated with enteropathic arthritis

A

HLA-B27

94
Q

Rx for enteropathic arthritis

A

NSAIDs (difficult to sue)
DMARDs (e.g Sulfasalazine)
Steroids
Biologics (anti-TNF)

95
Q

What is enteropathic arthritis

A

Chronic inflammatory arthritis associated with the occurrence of IBD

96
Q

What is septic arthritis

A

Infection of the joint

97
Q

Which joint does septic arthritis commonly affect

A

knee

98
Q

Risk factors for septic arthritis

A 
Age 
DM 
OA 
RA 
Chronic renal failure 
Immunocompromised  
IV drug abuse 
Recent joint surgery 
Skin infection
99
Q

Common organisms for septic arthritis

A

Staph. Aureus
Haemophilus influenza
Strep. Pyogenes
E.coli

100
Q

Route of infection for septic arthritis

A 
Haematogenous (commonest)
Eruption of bone abscess
Direct invasion 
Penetrating wound 
Intra-articular injury 
Arthroscopy
101
Q

Clinical features of septic arthritis

A 
Acutely inflamed painful joint 
Fever (systemic symptoms)
Tender joint 
Warmth over joint 
Redness 
Pain to move joint
102
Q

Ix for septic arthritis

A

Bloods:
FBC, WCC, ESR, CRP

Urgent joint aspiration!!!
Blood cultures
X-ray
USS

103
Q

Urgent Ix for septic arthritis

A

Urgent joint aspiration

104
Q

Rx for septic arthritis

A

Fluids
Analgesia
IV Abx (then switched to oral)
Arthrocentesis

105
Q

Ddx for septic arthritis

A 
Acute osteomyelitis 
Trauma 
Irritable joint 
Haemophilia 
Rheumatic fever 
Gout

Musculoskeletal (13 decks)

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