Arthritis Flashcards
What is Osteoarthritis?
Prgressive degeneration of articular cartilage.
Considered a disease of ‘Wear and Tear’
What are the causes of Osteoarthritis?
Primary - Risk Factors
Secondary - Pre-Existing Abnormalities (RA, Haemochromatosis, Trauma, Deformities)
How does Osteoarthritis typically present?
Pain worse at the end of the day
Joint Stiffness after inactivity
Joint Crepitus
Asymmetrical - Mainly on the weight-bearing (Hip, Knee) and Heavy Use (DIP, PIP, 1st CMC, Wrist) joints.
How should you investigate a suspected case of Osteoarthritis?
X-Ray, LOSS
Loss of joint space
Osteophytes
Subchondral Sclerosis
Subchondral Cysts
Joint Aspirate
Straw-coloured fluid with increased viscosity
Define Rheumatoid Arthritis.
Chronic (>6 Weeks), Systemic inflammatory disease causing:
Symmetrical deforming polyarthritis (>4 Joints)
and
Extra-Articular Manifestations
What are the main risk factors for Rheumatoid Arthritis?
HLA DR4
Smoking
Co-existence of other autoimmune diseases
How does Rheumatoid Arthritis typically present?
Pain worse at the start of the day
Morning Stiffness (>1 Hour)
Small joints of the hands
Hip, Knee, Shoulders
Which joint is typically spared in RA?
DIP
What are the key late signs that can often be seen in patients with RA?
Radial Deviation
Ulner Deviation of Fingerts
Z-Deformity
Boutoinniere Deformity
Swan Neck Deformity
What are the main Extra-Articular features you may observe in a patient with RA?
Rheumatoid Nodules
Lymphadenopathy
Episcleritis
Pleuritis
Pericarditis
Amyloidosis
Anaemia of CD
Felty Syndrome
How should you investigate a suspected case of RA?
Bloods - AoCD, ESR/CRP, Hypoalbuminaemia
X-Ray
RF
Anti-CCP
What might you see on an X-Ray of someone with RA?
Uniform joint space narrowing
Juxta-articular osteopenia
Joint erosions at joint margins
Joint deformity and destruction
What is Amyloidosis?
Condition characterised by the Extracellular Deposition of abnormal Amyloid proteins.
Which conditions is Amyloidosis typically associated with?
Primary - Multiple Myeloma, Lymphoma, Waldenstron’s Macroglobulinaemia
Secondary - RA, IBD, TB
How does Amyloidosis typically present?
Nephrotic Syndrome
Hepatosplenomegaly
Carpal Tunnel Syndrome
Periorbital Purpura
Restrictive Cardiomyopathy
Macroglossia
How is Amyloidosis diagnosed?
Apple-green birefringence under polarised light with Congo-Red stain
What are the main Seronegative Spondyloarthropathies?
PEAR
Psoriatic Arthritis
Enteropathic Arthritis
Ankylosing Spondylitis
Reactive Arthritis
Which features do all Seronegative Spondyloarthropathies present with?
HEADS
HLA B27
Enthesitis
Asymmetrical Oligoarthritis with Axial involvement
Dactylitis
Seronegative
How does Ankylosing Spondylitis typically present?
Gradual onset pain & morning stiffness in the :
Spine (Enthesitis)
Sacroiliac Joints (Arthritis)
Eventually, Bone-fusion and loss of spinal movement.
What are the key extra-articular features in Ankylosing Spondylitis?
Anterior Uveitis
Apical Lung Fibrosis
Aortic Regurgitation
How should you investigate a suspected case of Ankylosing Spondylitis?
Bloods - ACD, ESR/CRP, Albumin
MRI
X-Ray - Sacrolitis, Bamboo Spine, Syndesmophytes
Schober’s Test
What is Reactive Arthritis?
Sterile inflammation 2 weeks after extra-articular infection.
What are the most common infections that lead to the development of Reactive Arthritis?
GU (Chlamydia, Gonorrhoea)
GI (Shigella, Campylobacter)
How does Reactive Arthritis typically present?
Asymmetrical oligoarthritis of the lower limbs and spondylitis
Dactilytis, Achilles Tendonitis, Plantar Fascitis
Reiter’s Syndrome
What is Reiter’s Syndrome?
Can’t see, can’t pee, can’t climb a tree
Conjunctivitis
Urethritis
Arthritis
What is Septic Arthritis?
Emergency that may lead to joint destruction.
Joint inflammation due to direct bacterial inoculation of the joint.
Staph. a most common cause
What are the main Risk Factors for Septic Arthritis?
Joint Damage (RA, Prosthetics, Gout)
Infection (Immunosuppression, Diabetes, IV Drug User)
How does Septic Arthritis typically presenty?
Acute monoarthritis, usually affecting the knee.
Hot, Red, very painful joint.
Fever
What might you see upon Joint Aspiration of a Septic Knee?
Turbid, yellow fluid
Low Viscosity
Neutrophils
What are the main risk factors for gout?
Obesity
Male
Hyperuricaemia
Alcohol
How does Gout present?
Acute Monoarthritis on the 1st MTP, precipitated by trauma dn infection.
How does Pseudogout typically present?
Acute monoarthritis of the large joints (knee) in Elderly women
What would you see upon investigation of a suspected case of Gout?
Uric Acid, Raised WCC/CRP
Turbid, yellow fluid with neutrophils and low viscosity
Needle-Shaped, negatively birefringent crystals of Monosodium Urate when seen under polarising light.
‘Rat Bite erosions’ under X-Ray
What might you see upon investigation of a case of Pseudogout?
Similar to Gout.
Rhomboid-shaped, positively birefringent crystals of Calcium Pyrophosphate.
White Lines of Chondrocalcinosis on X-Ray
What is Osteomyelitis?
Bone infection, usually by Staph aureus
What might increase the risk of developing Osteomyelitis?
Haematogenous
IVDU
Immunosuppression
Diabetes
Sickle Cell (Salmonella)
Contiguous
Cellulitis
Localised Infection
Direct
Penetrating Injury
How does Osteomyelitis typically present?
Inflammation
Fever
Long Bones - Children
Vertebrae - Adults (Think Pott’s)
How should you investigate a suspected case of Osteomyelitis?
Bloods - WCC, CRP, ESR, Cultures
X-Ray
MRI
