Arthritis Flashcards
How many joints are examined when a new patient is seen in clinic?
78 joints are examined
What, in basic, is arthritis?
Inflammation of the joints
What type of joints are the majority of joints in the body?
synovial joints
What are the four features that comprise every synovial joint?
- articular cartilage
- synovial membrane
- fibrous capsule
- synovial fluid
What is significant about the way in which the synovial joint is designed?
It allows for transmission of loads across the joint and movement of bone ends relative to each other with minimal friction and wear
What parts of the synovial joint are involved in reducing friction?
articular cartilage and synovial fluid
What is the difference between a simple joint and a complex joint?
a simple joint contains 2 articulating surfaces
a complex joint contains more than 2 articulating surfaces
How does arthritis affect the synovial joint?
the synovial membrane pumps out pro-inflammatory chemicals
this leads to more synovial fluid being produced
the synovial lining becomes thicker
inflammation of the joint can be felt
What is the main aim of arthritis management?
to reduce inflammation and make the patient feel better
What is often a side effect of arthritis, due to reduced ability to work?
depression due to pain and restricted ability to do normal day to day things
What is the most common type of arthritis?
osteoarthritis
What does cartilage look like on an X-ray?
Cartilage does not show up on an X ray
What is a main factor that escalates the severity of osteoarthritis?
obesity
this is because there is more weight putting pressure on the joints
What chemical can worsen osteoarthritis in obese people?
fatty tissue releases lectins
these cause inflammation all over the body
What are the stages of development of osteoarthritis?
- layer of cartilage over the joint begins to flake away with age
- this causes a low level of inflammation within the joint
- the joint lining becomes inflamed and produces more synovial fluid
- this leads to inflammation
What are the final 2 stages in advanced osteoarthritis development?
- the joint starts to remodel once all the cartilage has worn away
osteocytes (bits of bone that have regrown) form
- large cysts form within the bone
How can you tell if osteocytes have developed?
you can feel lumps on the bones as they change shape
Why does osteoarthritis lead to weaker muscles?
Due to the pain of the swelling, people use the muscles less around the affected joint
How do weakened muscles affect the progression of osteoarthritis?
Weak muscles cause the pain to become worse
the muscle strength is not there to support the damaged joint
How is osteoarthritis diagnosed?
Through clinical examination and X-Ray findings
What blood tests are used to diagnose osteoarthritis?
There are no specific blood tests
Antibody and CRP tests should be normal
What is the most common clinical finding in a patient with osteoarthritis?
Crepitis and osteocytes (bony swellings)
this is the feeling/sound of grinding/crunching
What other organs can be affected by osteoarthritis?
OA does not affect other organs, only the joints
What causes inflammatory arthritis?
It is autoimmune - the immune system attacks the synovial lining, leading to inflammation
What is a common symptom of someone with inflammatory arthritis?
Stiffness that lasts for more than 30 minutes in the morning
What blood tests can be used to diagnose inflammatory arthritis?
Raised CRP and ESR
They are not raised very high (around 20-40)
What other signs are present with inflammatory arthritis?
- definite joint swelling
2. inflammatory back pain
What age range does inflammatory arthritis affect?
Any age range, not just older people
What causes rheumatoid arthritis?
It is autoimmune
antibodies are produced that fight the joints and cause inflammation
What gender and age range are most commonly affected by rheumatoid arthritis?
females
most common age is 40-50s
What joints are most commonly affected by rheumatoid arthritis?
the small joints of the hands and feet
What are the clinical signs of rheumatoid arthritis that a patient will mention?
- joint swelling with heat and pain
2. morning stiffness
What are the 2 blood tests that can be used to diagnose rheumatoid arthritis?
Rheumatoid factor
CCP antibody
What is significant about rheumatoid arthritis being ‘systemic’?
It can affect other organs
What is the basis of treatments for rheumatoid arthritis?
suppression of the immune system
How can joints affected by rheumatoid arthritis be easily identified?
Rheumatoid nodules develop
Why can foot ulcers develop in untreated rheumatoid arthritis?
they develop due to vasculitis
this is inflammation of the blood vessels
What is significant about rheumatoid arthritis and cardiovascular health?
any condition that causes inflammation leads to increased cardiovascular risk, especially in smokers
How may treatment for rheumatoid arthritis negatively affect the patient?
due to immunosuppression, they are more likely to contract rarer diseases and septic arthritis
Why is there an increased osteoporosis risk in rheumatoid arthritis?
Steroid injections/tablets are used to treat RA
They are toxic to bones and increase risk of osteoporosis
What is the danger of osteoporosis?
A reduction in bone strength leads to an increased risk of fracture
What is spondyloarthritis?
any form of arthritis that causes inflammation within the spine
What is psoriasis?
scaly white plaques on the skin
usually in the hair or on the elbows
What % of people with psoriasis go on to contract psoriatic arthritis?
10%
What are the 2 characteristics of psoriatic arthritis?
Iritis - red inflamed eyes
Achilles - inflammation of tendon sites
Does psoriatic arthritis affect other organs?
Yes, but not as much as rheumatoid arthritis
What is dactylitis and when is it seen?
“sausage toes/fingers”
inflammation of the tendon in the finger/toe leads to a very swollen appearance in psoriatic arthritis
What is meant by telescoping in psoriatic arthritis?
The joints shrink down into themselves
This is no longer painful when it has been present for a long time
What age range tends to be affected by ankylosing spondylitis?
Younger people
It is more common in men
What are the side effects of ankylosing spondylitis?
- inflammatory back pain
- iritis
- achilles tendon
How can ankylosing spondylitis affect the spine if it is left untreated?
The spine can become fused
The ligament coming in front of the spine becomes ossified
The patient cannot rotate their spine and it becomes stuck in a single position
What is the most common example of crystal arthritis?
gout
What causes gout?
having too much uric acid in the body
if there is too much, it cannot dissolve in the blood and forms crystals in the joints
Why is paracetamol not given to gout patients?
It is very painful
What are tophi?
Lumps of uric acid crystal that form commonly on ears, fingers and the elbow
What can increase the risk of gout?
- genetic disposition
- beer and red wine
- more common in men
How can untreated gout affect the bones?
permanent bone damage known as a rat bite erosion
What is pseudo-gout?
calcium pyrophosphate crystals (not uric acid) that cause similar symptoms to gout
