arthritis Flashcards
multisystem inflammatory disorders that cause arthritis
when there is an appropriate innate or adaptive response
either connective tissue disease or vasculitis
infection that can cause arthritis
septic arthritis
parvovirus, HBV, GCV, lyme arthritis, rheumatic fever - for these immune response that cause effect rather than infection
what does OA effect
nodal OA - small joint in hands
large joints - hips and knees
what does RA effect
inflammatory polyarthritis affecting lots of joints: wrist, MCP and PIP
types of OA
nodal OA
large joint arthritis
forefoot arthritis
types of crystal arthritis
gout - uric acid
pseudogout - calcium pyrophosphate
types of spondyloarthritis
axial spondyloarthritis - ankylosing spondylitis
psoriatic arthritis
IBD
reactive arthritis following GU or GI infection
things in a joint history
age - young unlikely to be OA
Autoimmune much more common in females
Which joints involved – large OA or spondylo, small = RA
Does it affect the spine and sacroiliac
Length of history – cartilage degeration in oA. Sudden – sudden onset of inflammatory condition
Is pain better or worse when use joint – better in inflame when use. In OA worse when use
Inflame stiff after rest and persist for longer. In OA stiffness a lot more transient
Swelling – persistent/variable
FH - genetic predisposition to all of them
SH - smoking predispose to RA
things in a joint examination
Look
- Pattern of joints
- Swelking
- Rash – psoriasis
- Nail change- pitting/onycholysis – psoriasis
- Vasculitic rash – SLE
Temp – warm = inflamed
Swelling – osteophytes ie bony, or boggy and fluctuant – inflammation
Move
- Range of movement
- Pain on movement
- Crepitus on movement
Passive movement focused on joint
Active – tests muscles/tendons and neurology
autiology of inflammatory arthritis
Genetic predisposition for enhanced innate or adaptive immune response, no current infection
- polymorphism in gene for protein in innate immune response = innate immune response = auto-inflammatory disease eg spondyloarthropathies
- Polymorphism in adaptive = autoimmune (auto-Ab) eg RA
- can get mixed
Env triggers
common features of spondyloarthritis
HLA B27+ve
enthesitis
arthritis (synovitis) - large/small
sacroilitis
dactylitis - swelling of the whole digit
iritis
(psoriaform rash)
what are the spondyloarthritis
psoriatic arthritis
axial spondyloarthrits (inc ankylosing spondylitis)
enteropathic arthritis
reactive arthritis
genetic polymorphisms for spondyloarthritis
HLA-B27
- presents peptide to TCR
- ligand for NK cell receptors
- dimeric forms
ERAP 1 and 2 - endoplasmic reticulum aminopeptidase – effect trimming of peptides presented by HLA – adaptive immune response
IL-23 receptor in T and NK cells - effect production of IL17
MEFV - pyrin marenostrim - involved in familial Mediterranean fever
enthesitis in spondyloarthritis
fascia insertions - plantar fascitis
ligament insertions - sacroiliac joints
tendon insertions - achilles tendonitis
- Atypical T cells express IL23 and produce IL17 IL22 and TNF-a
synovitis in spondyloarthritis
oligoarthritis
large and small joints
sacroilitis in spondyloarthritis
sacroiliac joint - synovial joint, stability is maintained by ligaments
- Inflame in these joints
- See the enthesitis in MRI
- Can get synovial proliferation
- Then get erosions on CT
- Then overtime see on XR then fuse
dactylitis in spondyloarthritis
enthesitis, synovitis nad tenosynovitis
swelling of whole digit
very painful and limiting
psoriaform rashes in spondyloarthritis
psoriasis in psoriatic
keratoderman blenorrhagica in reactive arthritis - palms and soles
iritis in spondyloarthritis
red
painful
photphobia
unilateral
pupil abnormalitis
refer for same day review in opthalmology ED
