Arthritis and Rheumatology Flashcards
what is rheumatic disease ?
pain affecting the joints and/or connective tissue
what are the types of rheumatic disease ?
degenerative, inflammatory, soft tissue
which rheumatic diseases are degenerative ?
ostoeoarthritis, cervical spondylosis
which rheumatic diseases are inflammatory ?
rheumatoid arthritis, seronegative SpA, crystal arthropathies, connective tissue disease, septic arthritis
which rheumatic diseases are soft tissue ?
tennis elbow, golfers elbow, mechanical back pain, repetitive strain
what are examples of other rheumatic diseases ?
fibromyalgia, osteoporosis
what are the types of seronegative spondyloarthropathies ?
ankylosing spondylitis,
reactive arthritis,
psoriatic arthritis,
enteropathic arthritis
what are the types of connective tissue disorders ?
SLE, Sjogren's, scleroderma, polymyositis, dermatomyositis, vasculitis - giant cell arthritis, PMR, takayasu's arteritis, polyarteritis nodosa, wagerer's granulomatisis, bechet's syndrome
what is osteoarthritis caused by ?
cartilage death
what is rheumatoid arthritis caused by ?
synovial fluid inflammation and overgrowth
what causes ankylosing spondylitis ?
inflammation and be bone formation at entheses (sites where ligaments and tendons join to bone)
what causes gout ?
crystals in synovial fluid
what causes septic arthritis ?
infection
how do joints react to osteoarthritis ?
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
describe the epidemiology of OA
more in women, more common in elderly after age 50
how do joints react to rheumatoid arthritis ?
generalised cartilage loss, joint space narrowing, juxta - articular osteoporosis, overgrown and invasive synovial cells, deformed joint and joint capsule
describe the epidemiology of RA
more in women, 30-50 years
what is ankylosing spondylitis ?
inflammation and new bone formation at entheses
at which site does ankylosing spondylitis most commonly occur ?
spine
describe the pathogenesis of ankylosing spondylitis
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
describe the epidemiology of ankylosing spondylitis
more in men, 15-30 years
describe the processes in gout
sodium urate crystals form in the synovial fluid,
PMN’s migrate to the joint and cause a severe acute inflammatory response
what is urate ?
a normal product of purine metabolism
which joint is affected first in half of patients with gout ?
proximal interpharyngeal joint of the big toe (podagra)
describe the epidemiology of gout
more in men, over 40 years old, no children or women before menopause
which organisms cause most joint infections in the UK ?
staphylococci or streptococci
which drug is commonly used to treat all types arthritis ?
NSAIDs
which drugs are used to treat inflammatory arthritis ?
corticosteroids,
disease modifying agents e.g. methotrexate, sulphasalazine, leflunamide,
anti TNF,
bisphosphonates
which drugs are used to treat gout ?
colchicine
xanthine oxidase inhibitors
what are the side effects of NSAIDs ?
upper GI effects, gastric/duodenal ulceration
what are the side effects of disease methotrexate ?
hepatotoxicity, pulmonary toxicity, stomatitis
what are the side effects of sulphasalazine?
skin reactions, diarrhoea
what re the side effects of leflunomide ?
hypertension
what are the side effects of anti TNF agents ?
increased risk of serious infection
what are the side effects of bisphosphonates ?
osteonecrosis of the jaw
what are the symptoms of stomatitis ?
red patches, mouth ulcers, peeling, swelling, oral dysaesthesia, burning mouth syndrome
