Arthritis and Rheumatology

Question 1

what is rheumatic disease ?

Answer 1

pain affecting the joints and/or connective tissue

Question 2

what are the types of rheumatic disease ?

Answer 2

degenerative, inflammatory, soft tissue

Question 3

which rheumatic diseases are degenerative ?

Answer 3

ostoeoarthritis, cervical spondylosis

Question 4

which rheumatic diseases are inflammatory ?

Answer 4

rheumatoid arthritis, seronegative SpA, crystal arthropathies, connective tissue disease, septic arthritis

Question 5

which rheumatic diseases are soft tissue ?

Answer 5

tennis elbow, golfers elbow, mechanical back pain, repetitive strain

Question 6

what are examples of other rheumatic diseases ?

Answer 6

fibromyalgia, osteoporosis

Question 7

what are the types of seronegative spondyloarthropathies ?

Answer 7

ankylosing spondylitis,
reactive arthritis,
psoriatic arthritis,
enteropathic arthritis

Question 8

what are the types of connective tissue disorders ?

Answer 8

SLE,
Sjogren's, 
scleroderma, 
polymyositis,
dermatomyositis,
vasculitis - 
giant cell arthritis, PMR, takayasu's arteritis, polyarteritis nodosa, wagerer's granulomatisis, bechet's syndrome

Question 9

what is osteoarthritis caused by ?

Answer 9

cartilage death

Question 10

what is rheumatoid arthritis caused by ?

Answer 10

synovial fluid inflammation and overgrowth

Question 11

what causes ankylosing spondylitis ?

Answer 11

inflammation and be bone formation at entheses (sites where ligaments and tendons join to bone)

Question 12

what causes gout ?

Answer 12

crystals in synovial fluid

Question 13

what causes septic arthritis ?

Answer 13

infection

Question 14

how do joints react to osteoarthritis ?

Answer 14

the subchondral bone (just under cartilage) becomes sclerotic,
the bone at the edges of the joint grows out forming osteophytes,
capsule becomes thickened and fibrotic,
synovium may become inflamed,
additional synovial fluid may be produced

Question 15

describe the epidemiology of OA

Answer 15

more in women, more common in elderly after age 50

Question 16

how do joints react to rheumatoid arthritis ?

Answer 16

generalised cartilage loss, joint space narrowing, juxta - articular osteoporosis, overgrown and invasive synovial cells, deformed joint and joint capsule

Question 17

describe the epidemiology of RA

Answer 17

more in women, 30-50 years

Question 18

what is ankylosing spondylitis ?

Answer 18

inflammation and new bone formation at entheses

Question 19

at which site does ankylosing spondylitis most commonly occur ?

Answer 19

spine

Question 20

describe the pathogenesis of ankylosing spondylitis

Answer 20

syndesmophytes (new bone spurs) forms in the spine as a result of inflammation,
bone grows out into the area of the ligaments,
spurs lengthen from recurrent attacks,
discs usually undamaged,
progressive loss of range of motion,
entire spine may become ankylosed and immovable,
synovitis in larger peripheral joints

Question 21

describe the epidemiology of ankylosing spondylitis

Answer 21

more in men, 15-30 years

Question 22

describe the processes in gout

Answer 22

sodium urate crystals form in the synovial fluid,

PMN’s migrate to the joint and cause a severe acute inflammatory response

Question 23

what is urate ?

Answer 23

a normal product of purine metabolism

Question 24

which joint is affected first in half of patients with gout ?

Answer 24

proximal interpharyngeal joint of the big toe (podagra)

Question 25

describe the epidemiology of gout

Answer 25

more in men, over 40 years old, no children or women before menopause

Question 26

which organisms cause most joint infections in the UK ?

Answer 26

staphylococci or streptococci

Question 27

which drug is commonly used to treat all types arthritis ?

Answer 27

NSAIDs

Question 28

which drugs are used to treat inflammatory arthritis ?

Answer 28

corticosteroids, disease modifying agents e.g. methotrexate, sulphasalazine, leflunamide, anti TNF, bisphosphonates

Question 29

which drugs are used to treat gout ?

Answer 29

colchicine | xanthine oxidase inhibitors

Question 30

what are the side effects of NSAIDs ?

Answer 30

upper GI effects, gastric/duodenal ulceration

Question 31

what are the side effects of disease methotrexate ?

Answer 31

hepatotoxicity, pulmonary toxicity, stomatitis

Question 32

what are the side effects of sulphasalazine?

Answer 32

skin reactions, diarrhoea

Question 33

what re the side effects of leflunomide ?

Answer 33

hypertension

Question 34

what are the side effects of anti TNF agents ?

Answer 34

increased risk of serious infection

Question 35

what are the side effects of bisphosphonates ?

Answer 35

osteonecrosis of the jaw

Question 36

what are the symptoms of stomatitis ?

Answer 36

``` red patches, mouth ulcers, peeling, swelling, oral dysaesthesia, burning mouth syndrome ```