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MSK > Arthritis- rheumatology > Flashcards

Arthritis- rheumatology Flashcards

1
Q

most common arthritis

A

OA

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2
Q

how does OA happen?

A

wear and tear of cartilage within joints

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3
Q

what do you see on x ray with OA?

A 
LOSS!!
Loss of joint space
osteophytes
sclerosis
subchondral bone cysts
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4
Q

pain worse on activity and relieved by rest. stiffness (and morning stiffness)

A

OA

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5
Q

what might you find on examining an OA joint?

A

crepitus
bone enlargements
joint tenderness
joint effusion

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6
Q

what can cause secondary OA?

A 
congenital hip dislocation
hyaline cartilage injury
meniscal tears
crystal arthropathy
inflammatory arthritis
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7
Q

how is OA managed?

A 
analgesia- pararcetamol
NSAIDS
pain modulators-tricyclics
anticonvulsants- gabepentin
steroids
joint replacement
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8
Q

name some features of inflammatory arthritis?

A 
joint pain and swelling
morning stiffness
improvement with exercise
synovitis on examination
raised inflammatory markers
extra articliuar symptoms
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9
Q

describe RA

A

a chronic systemic inflammatory disease characterised by potentially deforming symmetrical polyarthritis and systemic disease

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10
Q

who is most affected by RA?

A

females

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11
Q

where does RA affect most people?

A

small joints in hands and feet are most commonly affected.

knees, shoulders and elbows can be affected as the disease progresses

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12
Q

pathogenisis of RA?

A

immune response against the synovium

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13
Q 
symmetrical synovitis (swelling)
pain which can improve on activity
morning stiffness
tenderness
reduced range of movement
disturbed sleep
deformities
A

RA

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14
Q

name some extra-articular manifestations of RA?

A 
rheumatoid nodules
pleural effusions
CV problems increased
anaemia
uveitis
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15
Q

antibody tests for RA

A

anti-CCP and Rheumatoid factor (RF)

RF is not as sensitive

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16
Q

first line treatment for RA?

A

DMARDS. methotrexate first

17
Q

what do you need to monitor if on methotrexate?

A

FBC and LFTs

18
Q

if patient with RA is not responding to DMARDs what can you give them?

A

biological therapy e.g anti TNF

19
Q

what can you give for short term relief of RA?

A

simple analgesia
NSAIDS
steroids

20
Q

Name the 4 spondyloarthropathies

A

ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis

21
Q

what is ankylosing spondylitis?

A

chronic inflammatory disease of spine and sacroiliac joints

22
Q

what age and gender is more commonly affected by ankylosing spondylitis?

A

20-40 years

males

23
Q

name some things a patient with ankylosing spondylitis might present with?

A 
back pain and stiffness
may develop hip and knee arthritis
spinal morning stiffness
improves with exercise
over time there is loss of spinal movement and development of question mark sign
loss of lumbar lordosis
increased thoracic kyphosis
24
Q

what diseases are associated with ankylosing spondylitis? (the A disease)

A 
axial arthritis
anterior uveitis
aortic regurgitation
apical fibrosis
amyloidosis
achillies tendonitis
plantar fasciitis
25
Q

what is HLA-B27 associated with?

A

spondyloarthropathies

26
Q

investigations for ankylosing spondylitis?

A

inflammatory markers
HLA-B27
X rays
MRI

27
Q

treatment for ankylosing spondylitis?

A

physio and exercise
NSAIDS
Anti TNF inhibitors

28
Q

what dont DMARDS work on?

A

spinal disease

29
Q

arthritis in patients with IBD

A

enteropathic arthritis

30
Q

what is enteropathic artheritis?

A

inflammatory arthritis involving peripheral joint and sometimes spine…usually people with IBD have this

31
Q

treatment for enteropathic arthritis?

A

find something to treat the underlying condition (and teh arthritis)
NSAIDS are not good because they make bowel problems worse
normal analgesia
DMARDS
steroids
anti TNF

32
Q

when does reactive arthritis occur?

A

in response to infection in another part of the body (usually salmonella, campylobacter, chlamydia, Neisserie)

33
Q

arthrits, uveitis and urethritis

cant see cant pee cant bend the knee

A

reiter’s syndrome

34
Q

is reactive arthrits HLA-B27 positive?

A

yes

35
Q

investigations for reactive arthritis?

A 
CRP/ESR
FBC
U&E
cultures-blood, stool and urine
joint fluid analysis to rule out infection
x-ray of affected joint
36
Q

what is the pattern in psoriatic arthritis like?

A

asymmetrical ologoarthrits but can affect hands similar way to RA

37
Q 
nail changes-onycholysis and pitting
sausage fingers
inflammation
dactylitis
may have plantar fasciitis or achilles tendonitis
A

psoriatic arthritis

38
Q

treatment for psoriatic arthritis?

A

DMARDS-methotrexate
NSAIDS
steroids
anti TNF

MSK (15 decks)

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