arthritis Flashcards
what is the pathophysiology of RA?
inflammed synovial lining showing angiogenesis, cellular hyperplasia, inflammatory cell infiltration, changes in adhesion molecules and cytokines excess
TNF-a, IL-1 and Il-6 heavily implicated
synovial lining becomes hyperplastic and there is Pannus formation
what are the S&S of RA in the joints?
symmetrical, swollen, hot, painful and stiff small joints of the hands and feet
- commonly affected PIP, MCP and MTP joints
- painful to touch and ROM reduced
worse in the morning
ulnar deviation of the wrist dorsal wrist subluxation boutonierre deformitiy - look up swan neck deformity - look up Z-thumb deformity - look up
what InV are done in RA?
rheumatoid factor (+ve in 60-70%)
anti-CCP antibody (again 60-70%)
Bloods
- anaemia of chronic disease
- increased CRP and ESR
- increased platelets
X-ray of joints
- soft tissue swelling
- joint space narrowing
- erosions
- juxta-articular osteopenia
US
- synovitis
Disease activity score - DAS28
- guides initial treatment
what are the treatment options for RA?
NSAID
corticosteroid (pred 1-10mg PO OD)
DMARDS
- MTX + folic acid
- Sulfsalazine
- Hydroxychloroquine
- leflunomide
Biologics
- Infliximab (anti-tnf)
- rituximab (anti CD20)
- tocilizumab (anti Il-6)
PT and OT
what are the complications of RA?
CAD
ILD
Felty syndrome - RA, splenomegaly, decreased WBC
Carpal tunnel syndrome
what are the S&S of OA?
mainly affects hands, knee, hip and spine
pain and crepitus on movement
morning stiffness <30 mins and worse at the end of the day
functional difficulties and reduced ROM
Bony deformities
- enlargement of PIPs (Bouchards nodes)
- enlargement of DIPs (Heberdens nodes)
tenderness over joint line
what does X-ray of the joints show in OA?
LOSS
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts
what are the management options for oesteoarthritis?
exercise and PT
Topical anagesia
- capsaicin and diclofenac
Codeine or oral NSAID (+PPI)
intrarticular steriod injections (methylprednisolone)
Intrarticular hyaluronic acid injections
Joint replacement
what is psoriatic arthritis?
Psoriatic arthritis is a seronegative inflammatory arthritis that affects approximately 10-30% of patients with psoriasis. In the majority of cases, the rash precedes the arthropathy. Psoriatic arthritis can present as isolated arthritis of the distal interphalangeal joints, oligoarthritis (predominantly large joint), polyarthritis, spondylitis or arthritis mutilans (severe deformity with joint destruction).
what are the S&S of psoriatric arthritis?
Hx of psoriasis
joint pain and stiffness (prolonged morning stifness). Gets better with use
swelling and tenderness of individual joints (synovitis) during inspection and palpation.
- Psoriatic arthritis frequently presents in a pattern of monoarticular or oligoarticular joint involvement. In patients with multiple joints involved, the pattern lacks the symmetry of rheumatoid arthritis
Dactylitis - Uniform swelling of an entire digit.
how can psoriatric arthritis be distinguished from RA?
lack of symmetry and anti-CCP negative
what investigationsa are done in psoriatric arthritis ?
X-ray of joint
- erosion in DIP
- periarticular new bone formation
- osteolysis
- pencil in cup deformity
ESR and CRP
- normal or elevated
RF and anti-CCP
- occasional RF is positive but anti-CCP is always negative
synovial fluid aspiration
- excludes gout
what is the treatement of psoriatric arthritis?
NSAIDs PT Intraarticular corticosteroid injection DMARDs Biologics (mostly infliximab) joint arthroplasty
what is septic arthritis?
infection of one or more joints caused by pathogenic innoculation of microbes. it occurs either by direct inoculation or haematogenous spread
what are the common pathogen in septic arthritis?
staphylococci or streptococci predominantly. MRSA emerging problem
Gram negative in 15-20% esp in children, eldery, immunocompromised or IVDU
gonococcal arthritis in sexually active
