Arthritis Flashcards
What is osteoarthritis?
How does it occur?
Imbalance between breakdown and repair of articular cartilage
Result from mechanical stress (repeated trauma, obesity etc.)
Symptoms of Osteoarthritis are…
Insidious:
- Aching, poorly localised pain (Worse with activity, better with rest)
- Reduced motion
- Limp
- Crepitus
- Bony enlargement (Heberden’s DIP /Bouchard’s nodes PIP)
- Bowing/knock-knees
- Joint swelling
What joints are commonly affected by OA?
- Hips
- Knees
- Spine
- Small hand/foot joints
What’s the joint fluid like in OA?
Non-inflammatory (WBC <1,500)
Yellow, Clear fluid
Osteoarthritis X-rays show?
FLOSS:
- Flattened bone
- Loss of joint space
- Osteophytes (Bone spur growth)
- Subchondral cysts
- Subchondral sclerosis
Treatment for OA
Analgesia
Paracetamol, NSAIDs, Topical NSAIDs, capsaicin, IA injections (steroids, hyaluronic acid)
Surgery for specific joint (non-operative options exhausted + impact QoL)
Exercise, weight loss (even if painful)
Stop painful activities
Heat packs, TENS, functional aids
Physio for muscle strengthening, prevent falls
Treatment steps for OA
- Holistic assessment - pain and comorbidities
- Core (self-treatment, info, weight loss)
- Non-pharmacological (heat packs, OT aids)
- Pharmacological
- Surgical
What is rheumatoid arthritis?
Autoimmune disease attacking joints
Destruction of bone + Cartilage
Inflamed synovium
Joint instability, Chronic pain, loss of/poor function
Symptoms of Rheumatoid Arthritis
- Morning stiffness, improved with activity
- Affects more than three joints, persists >6 weeks
- Swelling of hand joints (PIP, MCP, not DIP)
- Ulnar deviation/Boutonniere’s deformity
- Symmetrical swelling
- Extra-articular features (anaemia, subcutaneous nodules, vasculitis, interstitial lung disease, sarcopenia) Sjogren’s)
What’s the joint fluid like in RA?
Turbid yellow (high WBC <50,000)
Investigations for RA?
Rheumatoid factor +ve in >85%
Anti-CCP antibody positive in 75%
Imaging findings in RA?
- Soft tissue swelling
- Erosions
- Deformity
- Joint space narrowing
- Periarticular osteopenia
(Bony changes are late stage)
Treatment for RA?
DMARDs: Methotrexate (XXX PREGNANCY), Sulfasalazine
Biologics - ok in pregnancy!: TNF-a inhibitors e.g. etanercept, adalimumab, (best combo with DMARD)
Corticosteroids (Oral, IM, IA)
What is Gout?
Inflammation of 1+ joints due to uric acid crystal deposits in joints or tissues
(Most common Inflammatory arthritis in men)
Gout Risk Factors?
- Obesity
- Alcohol
- Dietary purines
- Chronic renal insufficiency
Symptoms of Gout?
Episodic acute joint pain
90% monoarticular (1st MTP joint is most common)
Precipitated by trauma, surgery, alcohol, infection
What’s the joint fluid like in Gout?
Crystals present (diagnostic) (high WBC >50,000 - similar to septic arthritis)
Investigations for gout?
Joint aspiration; sodium urate crystals.
High serum uric acid (may be normal)
Blood culture to exclude septic arthritis
Gout X-ray findings?
Negative bar soft tissue swelling
Calcium in articular cartilage (chondrocalcinosis) pathognomic for pseudogout
Management of Gout?
Acute: NSAIDs, Colchicine (dysuria side effect), Steroids (MUST NOT BE SEPTIC A)
Prophylaxis: Allopurinol, uricosuric agents, canakinumab, lifestyle factors
What is Septic Arthritis?
Acute arthritis due to infection, normally bacterial, from haematogenous seeding (travel in blood)
Unusual organisms and site seen in IVDUs (PWIDs)
Risk Factors for Septic Arthritis?
Older, previous joint pathology, skin infection, DM
Symptoms of Septic Arthritis?
And what joints does it normally affect?
Abrupt joint swelling and pain, fever, inflammation and pain (both passively and actively)
50% in knee, Sternoclavicular joint in IVDUs (PWIDs)
What’s the joint fluid like in Septic Arthritis?
Most commonly Staph aureus
IVDUs - Pseudomonas
Very high WBC (50,000-100,000)
Investigations for septic arthritis?
Bloods: High WBC, High ESR, High CRP
Imagining: negative - maybe soft tissue swelling
What is Seronegative Arthritis?
Give examples
Multisystem disease
Inflammatory arthritis without rheumatoid factor in the blood
Ankylosing spondylitis psoriatic arthritis, IBD-linked arthritis, reactive arthritis
Spondylitis vs Spondylosis?
Spondylitis is inflammation affecting the vertebrae, and 1+ vertebral joints
Spondylosis is degeneration of intervertebral discs
Presentation of Seronegative Arthritis?
Mainly axial skeleton: Low back pain, Spine curvature loss, fixed flexion of knees and hips
Enthesitis and Dactylitis
Peripheral arthritis of skin, arms, legs, eyes, gut
What is Ankylosing Spondylitis?
Type of seronegative arthritis
Chronic inflammation of vertebral joints - as well as entheses and peripheral joints.
Can also affect the gut
Treatment of Ankylosing Spondylitis?
Physiotherapy NSAIDs (short-term) DMARDs (sulfasalazine) Biologics (anti-TNF e.g. infliximab, etanercept) Osteoporosis treatment
Presentation of Ankylosing Spondylitis?
Majority young men Inflammatory back pain Bilateral sacroiliitis High CRP Painful eye HLA B27 positive positive Schobers test
What is Psoriatic Arthritis?
Inflammatory arthritis that primarily affects skin and joints - can affect axial skeleton
Spectrum and overlaps with RA and AS
Symptoms of Psoriatic Arthritis?
Psoriatic skin and nail changes (plaques, pitting, onycholysis)
Morning joint stiffness
Enthesitis and Dactylitis
Involvement of DIP joints (unlike RA)
Treatment for Psoriatic Arthritis?
Physiotherapy Occupational therapy for functional aids DMARDs (sulfasalazine, methotrexate) Biologics (anti-TNF) Steroids (few IA injections per year if monoarthritis) NSAIDs
What is Reactive Arthritis?
Sterile inflammation
Post-infection outside the joint capsule
Symptoms of Reactive Arthritis?
Post-infectious (salmonella, shigella, campylobacter, borrelia, neisseria, strep) Systemic disease 1 -4 joints arthritic Enthesitis and Dactylitis Affects skin and mucus membranes
Treatment for Reactive Arthritis?
NSAIDs
Steroids (IA injections)
Antibiotics for chlamydia (acute)
NSAIDs and DMARDs (chronic)
Things that exacerbate gout?
Bendroflumethiazide (thiazide diuretics - normally for oedema and hypertension), ACEi
Purine rich foods
Alcohol and sugary drinks
What is Pseudogout?
Compared to gout
Type of Crystal Arthritis
Calcium pyrophosphate - not sodium urate crystals - in knee not toes
Elderly women not men
Intercurrent illness not associate with uric acid (tophi)
Treatments for Pseudogout?
NSAIDs
Steroids (IA injections)
(acute)
- unlikely to reoccur
