Arthritis Flashcards
Describe the differences in presentation between OA and RA?
OA = pain ON movement
= no AM stiffness/stiffness <30mins
RA = more painful after extended periods of rest
= AM stiffness (>30mins)
OA - typically larger joints e.g. hips and knees
RA = typically smaller joints e.g. feet and hands
How does TB present osteologically?
Adults - as secondary disease
Kids - as primary disease
Most common in spine and invades causing caseating granulomas (Pott’s disease)
Will have other common signs of TB - fever, night sweats etc.
How is TB arthritis treated?
9 months of TB drug treatment
Define Septic arthritis/infectious arthritis
Why is it a medical emergency?
Severe acute inflammation of the joint
It can cause permeant destruction of the joint
How is septic arthritis most likely to present?
What is the diagnostic feature?
What other investigation must also be done and why?
Joint aspiration - purulent
Will have severely acutely inflamed joint - most commonly knee
Blood cultures - most commonly bactereamia present
Treatment of septic arthritis
- Wash out infected joint
2. 4-6 weeks of antibiotic treatment starting with IV flucloxicillin
What is the most common cause of joint disease?
Osteoarthritis
What causes osteoarthritis?
Missmatch between collagen breakdown and production
Chondrocytes die and matrix no longer work adequately -> fissured cartilage
Eburation occurs when bone is exposed as cartilage wears away fully
What does eburnation lead to in OA which can cause nerve damage or irriation?
Eburnation leads to osteophytes
Osteophytes are caused by abnormal bone repair and overgrowths
In what conditions would you find pannus and rheumatoid nodules and explain what each are?
RA
Pannus - granulation tissue in joint space
R nodules - NECROTISING granulation tissue in subcutaneous tissue in particular pressure points and organs
What is arthritis in <16 yo called?
Idiopathic juvenile arthritis
What score system is used in RA to establish the level of disease progression and treatment options?
How does it work?
DAS28 (disease activity score)
Test tenderness and swelling of 28 joints
What are the Xray findings you would see in OA?
LOSS
Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis
How do you diagnose OA?
Clinical diagnosis if:
- > 45
- joint pain on movement
- <30mins of AM stiffness
What is the drug management of RA?
- Methotrexate
- Methotrexate + other immunosuppresant (e.g. leflunomide/sulfasalazine)
- Methotrexate + Biological therapy (anti-TNF)
- Methotrexate + rituximab
Describe each of the following deformities that can be found in RA:
- Swan neck deformity
- Bouchard’s nodes
- Ulnar deviation of MCP joints
- Z shaped thumb
- Boutonniere deformity
Swan neck deformity - dip down at PIP joint and high at DIP joint
Bouchard’s nodes - swelling around PIP joints
Ulnar deviation at MCP - full fingers move toward pinky
Z-shaped thumb
Boutonniere deformity - high at PIP joint and low at DIP joint
What antibodies are associated with RA?
What one is most specific?
RF
Anti-CCP
Describe the pattern of distribution of rheumatic arthritis
Bilateral
What radiological features are seen in RA?
periarticular osteopenia and erosions
What defines “primary” OA?
Don’t know cause of OA
What is Felty’s syndrome?
RA
Splenomegaly
Neutropenia
Describe some of the changes seen in the hands of OA patient?
DIP swelling = Haberdens nodes
PIP swelling = Bouchards nodes
Squaring of base of thumb
Remember Haberdens sounds like heberdies -> far away -> DIP joints
What drug management is used for OA?
What is important when giving patients analgesias?
What further lifestyle advice is given?
What other management can be used?
- Oral paracetamol w/ topical NSAID/capsicum
- Oral NSAID (remember PPI)
- Oral opioids (co-codamol/codiene) - v rare
Take when you need but as little as often - try to limit reliance on drugs
Weight loss
Physio
Intra-articular steroid injections
Joint replacement
Is psoriatic arthritis likely to present at the same time as psoriasis?
No - not in young and fit individuals
Common side effect of hydroxychloroquine?
Retinopathy and corneal deposits
How can RA present:
- ocularly
- dermatological
- respiratory
- renal
- cardiovascular
Ocular - Sjorgen's syndrome Derm. - rheumatoid nodules Resp - pulmonary fibrosis + rheumatoid nodules Renal - chronic renal failure Cardiovascular - pericarditis
Describe how rheumatoid nodules would appear?
Hard
Painless
Often numerous
RA is caused by a self response to synovial fluid produced by the synovial membrane in joints.
The synovial membrane covers the articular surfaces of the joints. T/F?
F - synovial membrane only extends from the margins of one articular surface to the next within the synovial cavity
See diagram in lower limb anatomy
What is the radiological sign of psoriatic arthritis?
Pencil in cup
What is a severe form of psoriatic arthritis presentation?
Arthritis mutilans - hands all muddled up and weird
An inflammatory arthritis with dactylitis and DIP involvement?
Psoriatic arthritits
Dactylitis = digit swelling
