Arthritis diseases

Question 1

Rheumatoid arthritis basic pathogenesis / hallmarks

Answer 1

RF, ACPA, females, pannus

Question 2

Rheumatoid arthritis clinical features

Answer 2

symmetrical, poly, MCP & PIP not DIP

Question 3

Palindromic arthritis definition

Answer 3

short-lived episodes of acute monoarthritis

Question 4

RA: Joint involvement hands, wrists, toes

Answer 4

ulnar drift, boutonniere, swan-neck, ulnar styloid, hammer-toe

Question 5

Management RA

Answer 5

DAS28, NSAIDS in combi with DMARDS, TNF-a blockers
Methotrexate = contraindicated pregnancy
sulfasalazine = can be during pregnancy
leflunomide = not in pregnancy

Question 6

Ankylosing spondylitis (AS): patho / hallmarks

Answer 6

young adult males, HLA-B27, bamboo spine, bony spurs cause permanent stiffening

Question 7

AS: clinical features

Answer 7

low back pain, sacroiliac inflammation, pain in 1 or both buttocks, lumbar lordosis

Question 8

Management AS

Answer 8

preventative exercises, NSAIDs, DMARDS help arthritis not spinal disease, TNF-a blockers if NSAIDs fail

Question 9

Psoriatic arthritis symptoms

Answer 9

asymmetrical, DIPs, nail pits, dactylitis (hot dog finger), arthritis mutilans (bone shortening), central erosions

Question 10

Management psoriatic arthritis

Answer 10

NSAIDs (may worsen psoriasis), methotrexate, TNF-a blockers (not rituximab)

Question 11

Reactive arthritis: hallmarks + some bacteria involved

Answer 11

after infection, man more, salmonella, shigella, chlamydia, respond differently to the infection not more susceptible

Question 12

Reactive arthritis symptoms

Answer 12

asymmetrical lower-limb arthritis, enthesitis, urethritis, conjunctivitis

Question 13

Reactive arthritis management

Answer 13

antibiotics, NSAIDs, corticosteroids, DMARDs in relapse

Question 14

Enterohepatic arthritis associated with IBD

Answer 14

Remission of ulcerative collitis = remission arthritis

Well controled Crohn’s = arthritis can persist

Question 15

Enterohepatic arthritis treatment

Answer 15

treat IBD, NSAIDs, sulfasalazine, TNF-a blockers

Question 16

Gout: patho / hallmarks

Answer 16

sodium urate crystals, needle shaped, more man, purine-rich diet, alcohol misuse, impaired excretion or increased production, low-dose aspirin blocks uric acid secretion

Question 17

Gout symptoms

Answer 17

acute gout followed by asymptomatic intercritical phase
chronic interval gout = acute attacks with superimposed low-grade inflammation + potential joint damage
urate renal stone

Question 18

Gout management

Answer 18

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

Question 19

chronic tophaceous gout

Answer 19

smooth white deposits in skin and around joints, can ulcerate, associated with renal impairment, stop diuretics, treat with alluprinol

Question 20

Pseudogout

Answer 20

calcium pyrophosphate deposition, rhomboidal shaped, more elderly women knee or wrist, same treatment gout

Question 21

Septic arthritis: patho + symptoms

Answer 21

mostly staph areus, others: streptococci, gonnorrhoea, influenza in children, hot red swollen joints, painful, immobile by muscle spasm, purulent aspiration

Question 22

Septic arthritis management

Answer 22

antibiotics treat on basis of clinical suspicion
flucloxallin –> if penicillin allergy use erythromycin
teicoplanin if MRSA suspected

Question 23

types of bacterial arthritis: name bacteria

Answer 23

gonococcal, tuberculous, meningococcal, infective endocarditis, borreliosis (lyme), brucellosis, syphilitic, leprosy

Question 24

arthritis in viral disease: name viruses

Answer 24

rubella, erythrovirus B19, hepatitis, arbovirus, HIV&AIDS