Arthritis/Bone Disease Flashcards
What is REACTIVE ARTHRITIS?
HLA-B27 associated seronegative spondyloarthropathies.
‘Can’t see, pee or climb a tree’
Defined as arthritis that develops following an infection where the organism cannot be recovered from the joint
What are the features of REACTIVE ARTHRITIS (REITER’S SYNDROME)?
- Typically develops within 4 weeks of initial infection - typically lasts around 4-6months
- Can affect spine/sacroiliac joints
- Typically asymmetrical oligoarthritis of lower limbs
- Painless vesicles on the skin
- Waxy yellow/brown papules on palms and soles
- Circinate Balanitis (ring-shaped dermatitis of he glans penis
Managed with analgesia, sulfasalazine/methotrexate for persistent disease.
- Circinate Balanitis (ring-shaped dermatitis of he glans penis
What are the features of RHEUMATOID ARTHRITIS?
- Swollen, painful joints on hands and feet (worse in the morning)
- Positive ‘squeeze test’
- Acute onset with marked systemic disturbance
- Relapsing/remitting monoarthritis of different large joints
- Swan neck/boutonniere deformities as late features - Z-line deformities
X-RAY Findings:
- Loss of joint space
- Juxta-articular osteoporosis
- Soft-tissue swelling
- Periarticular erosions
- Subluxation
What is the diagnostic criteria for RHEUMATOID ARTHRITIS?
- Joint involvement (how many small joints)
- Serology (High positive RF or ACPA)
- Acute-phase reactants (Abnormal CRP/ESR)
- Duration of symptoms (>6 weeks)
What are the prognostic factors for RHEUMATOID ARTHRITIS?
- RF Positive
- Poor functional status at presentation
- Early erosions (<2y) on X-Ray
- Extra articular features e.g. nodules
- Insidious onset
- anti-CCP antibodies
What is the management for RHEUMATOID ARTHRITIS?
Initial:
DMARD Monotherapy - monitor using a combination of CRP and disease activity
Flares:
- Corticosteroids
Use TNF-inhibitors if there is inadequate response to at least 2 DMARDs
What are the features of OSTEOGENESIS IMPERFECTA?
Aka ‘Brittle Bone Disease’ - an autosomal dominant disorder due to abnormality in type 1 collagen
- Presents in childhood
- Fractures following minor trauma
- Blue sclera
- Deafness secondary to otosclerosis
- Dental imperfections
What is PAGET’S DISEASE OF THE BONE?
Uncontrolled increased bone turnover, most commonly affects the skull, spine/pelvis, long bones etc.
Can cause complications such as deafness, sarcomas, fractures, and cardiac failure
Predisposing factors: Increasing age, male, family history
Can cause bone pain, bowing of tibia, isolated raised ALP
What is PSORIATIC ARTHROPATHY?
Psoriatic skin lesions with various types of arthritic presentations. Include:
- Rheumatoid-like polyarthritis
- Asymmetrical oligoarthritis
- Sacroilitis
- DIP joint disease
- Arthritis mutilans
Should be managed like RA
What are the features of SEPTIC ARTHRITIS?
The most common organism is Staph. aureus, or Neisseria gonorrhoeae in young adults
Shows acute, swollen joint with fever. Sample synovial fluid and blood cultures
Managed with IV antibiotics, needle aspiration to decompress the joint
What is DISH?
Diffuse Idiopathic Skeletal Hyperostosis
A type of arthritis that affects tendons and ligaments, mainly around the spine. Causes band of tissue to become calcified and cause bony spurs, causing stiffness and pain.
