Arthritis and Crystal Arthropathy Flashcards
Spectrum of inflammatory arthritis
What is the underlying pathophysiology that causes gout?
Elevated serum urate aka hyperuracemia.
How does elevated serum urate cause gout?
As urate levels rise body tissues become supersaturated and monosodium urate crystals form in and around joints.
These trigger white cell response and inflammation = clinical gout.
Risk factors for hyperuraecemia and gout.
Risk factors for acute attacks of gout.
What is the clinical presentation of gout?
What joints are commonly affected by gout?
Most frequently affected joint is the first MTPJ (first metatarsophalangeal joint).
– Mid-foot, ankle, knee, wrist fingers and elbows.
What are tophi?
Treatment of gout.
Reduce inflammation and pain Affected joints should be rested, elevated and exposed in a cool environment. Bed-cages and ice-packs can be effective adjuncts to management.
- Non-steroidal anti-inflammatory drugs
- Colchicine
- Corticosteroids
What are used as urate lowrering drugs?
Xanthine oxidase inhibitors.
Aim for target serum urate <300 µmols/litre
What are the two crystal arthropathy’s?
Gout
Pseudogout
Pseudogout
Calcium pyrophosphate crystals cause what?
Pseudogout
Rheumatoid arthritis
Auto-immune condition more common and severe in women.
How does rheumatoid arthritis link to increased mortality?
Increased cardiovascular mortality due to ischaemic heart disease.
Non-Hodgkin’s Lymphoma
Clinical features of rheumatoid arthritis.
Which joints are commonly affected in RA?
Normal vs arthritic joints
Key signs of inflammation
Tenderness
Swelling
Erythema
Heat
How can the hands be effected in RA?
Swan neck deformitiy due to RA
What are rheumatoid nodules?
How may the organ systems be effected by rheumatoid arthritis?
Ischaemic heart disease
Eyes: Sjorgens syndrome
Scleritis
Skin: Ulceration
Vasculitis
What investigations are carried out in RA patients?
- ESR & CRP
- FBC - RA patients can become anaemic.
- U&E & LFT - testing kidney and liver function.
- Urinalysis
- Rheumatoid factor - diagnose and prognosis
- Anti-CCP antibodies - diagnose and prognosis
- Synovial fluid – yellow colouration – Many polymorphonuclear leucocytes
What are ESR and CRP tests used for?
The erythrocyte sedimentation rate (ESR or sed rate) and C-reactive protein (CRP) are among the oldest laboratory tests still in use. Both bloods tests are used to detect inflammation in the body.
What are the radiological signs of RA?
Juxta-articular osteopenia is the loss of bone around either side of the joint.
Treatment of RA
• Education • Physiotherapy • Occupational therapy • Podiatry • Medication • Surgery.
Summary of Arthritis and Crystal Arthropathy
- Inflammatory arthritis covers a broad spectrum of conditions.
- Chronic joint inflammation can lead to joint damage and loss of function.
- Many possible treatment approaches.
- Early effective treatment improves outcome.
