Arthritis diseases Flashcards
Rheumatoid arthritis basic pathogenesis / hallmarks
RF, ACPA, females, pannus
Rheumatoid arthritis clinical features
symmetrical, poly, MCP & PIP not DIP
Palindromic arthritis definition
short-lived episodes of acute monoarthritis
RA: Joint involvement hands, wrists, toes
ulnar drift, boutonniere, swan-neck, ulnar styloid, hammer-toe
Management RA
DAS28, NSAIDS in combi with DMARDS, TNF-a blockers
Methotrexate = contraindicated pregnancy
sulfasalazine = can be during pregnancy
leflunomide = not in pregnancy
Ankylosing spondylitis (AS): patho / hallmarks
young adult males, HLA-B27, bamboo spine, bony spurs cause permanent stiffening
AS: clinical features
low back pain, sacroiliac inflammation, pain in 1 or both buttocks, lumbar lordosis
Management AS
preventative exercises, NSAIDs, DMARDS help arthritis not spinal disease, TNF-a blockers if NSAIDs fail
Psoriatic arthritis symptoms
asymmetrical, DIPs, nail pits, dactylitis (hot dog finger), arthritis mutilans (bone shortening), central erosions
Management psoriatic arthritis
NSAIDs (may worsen psoriasis), methotrexate, TNF-a blockers (not rituximab)
Reactive arthritis: hallmarks + some bacteria involved
after infection, man more, salmonella, shigella, chlamydia, respond differently to the infection not more susceptible
Reactive arthritis symptoms
asymmetrical lower-limb arthritis, enthesitis, urethritis, conjunctivitis
Reactive arthritis management
antibiotics, NSAIDs, corticosteroids, DMARDs in relapse
Enterohepatic arthritis associated with IBD
Remission of ulcerative collitis = remission arthritis
Well controled Crohn’s = arthritis can persist
Enterohepatic arthritis treatment
treat IBD, NSAIDs, sulfasalazine, TNF-a blockers
Gout: patho / hallmarks
sodium urate crystals, needle shaped, more man, purine-rich diet, alcohol misuse, impaired excretion or increased production, low-dose aspirin blocks uric acid secretion
Gout symptoms
acute gout followed by asymptomatic intercritical phase
chronic interval gout = acute attacks with superimposed low-grade inflammation + potential joint damage
urate renal stone
Gout management
NSAIDs for pain and no renal impairment
renal impairment use colchicine & corticosteroids
dietary changes
alluprinol with severe frequent attacks, not within month after acute attack
chronic tophaceous gout
smooth white deposits in skin and around joints, can ulcerate, associated with renal impairment, stop diuretics, treat with alluprinol
Pseudogout
calcium pyrophosphate deposition, rhomboidal shaped, more elderly women knee or wrist, same treatment gout
Septic arthritis: patho + symptoms
mostly staph areus, others: streptococci, gonnorrhoea, influenza in children, hot red swollen joints, painful, immobile by muscle spasm, purulent aspiration
Septic arthritis management
antibiotics treat on basis of clinical suspicion
flucloxallin –> if penicillin allergy use erythromycin
teicoplanin if MRSA suspected
types of bacterial arthritis: name bacteria
gonococcal, tuberculous, meningococcal, infective endocarditis, borreliosis (lyme), brucellosis, syphilitic, leprosy
arthritis in viral disease: name viruses
rubella, erythrovirus B19, hepatitis, arbovirus, HIV&AIDS
