Arthritis- rheumatology Flashcards
most common arthritis
OA
how does OA happen?
wear and tear of cartilage within joints
what do you see on x ray with OA?
LOSS!! Loss of joint space osteophytes sclerosis subchondral bone cysts
pain worse on activity and relieved by rest. stiffness (and morning stiffness)
OA
what might you find on examining an OA joint?
crepitus
bone enlargements
joint tenderness
joint effusion
what can cause secondary OA?
congenital hip dislocation hyaline cartilage injury meniscal tears crystal arthropathy inflammatory arthritis
how is OA managed?
analgesia- pararcetamol NSAIDS pain modulators-tricyclics anticonvulsants- gabepentin steroids joint replacement
name some features of inflammatory arthritis?
joint pain and swelling morning stiffness improvement with exercise synovitis on examination raised inflammatory markers extra articliuar symptoms
describe RA
a chronic systemic inflammatory disease characterised by potentially deforming symmetrical polyarthritis and systemic disease
who is most affected by RA?
females
where does RA affect most people?
small joints in hands and feet are most commonly affected.
knees, shoulders and elbows can be affected as the disease progresses
pathogenisis of RA?
immune response against the synovium
symmetrical synovitis (swelling) pain which can improve on activity morning stiffness tenderness reduced range of movement disturbed sleep deformities
RA
name some extra-articular manifestations of RA?
rheumatoid nodules pleural effusions CV problems increased anaemia uveitis
antibody tests for RA
anti-CCP and Rheumatoid factor (RF)
RF is not as sensitive
first line treatment for RA?
DMARDS. methotrexate first
what do you need to monitor if on methotrexate?
FBC and LFTs
if patient with RA is not responding to DMARDs what can you give them?
biological therapy e.g anti TNF
what can you give for short term relief of RA?
simple analgesia
NSAIDS
steroids
Name the 4 spondyloarthropathies
ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis
what is ankylosing spondylitis?
chronic inflammatory disease of spine and sacroiliac joints
what age and gender is more commonly affected by ankylosing spondylitis?
20-40 years
males
name some things a patient with ankylosing spondylitis might present with?
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
what diseases are associated with ankylosing spondylitis? (the A disease)
axial arthritis anterior uveitis aortic regurgitation apical fibrosis amyloidosis achillies tendonitis plantar fasciitis
what is HLA-B27 associated with?
spondyloarthropathies
investigations for ankylosing spondylitis?
inflammatory markers
HLA-B27
X rays
MRI
treatment for ankylosing spondylitis?
physio and exercise
NSAIDS
Anti TNF inhibitors
what dont DMARDS work on?
spinal disease
arthritis in patients with IBD
enteropathic arthritis
what is enteropathic artheritis?
inflammatory arthritis involving peripheral joint and sometimes spine…usually people with IBD have this
treatment for enteropathic arthritis?
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
when does reactive arthritis occur?
in response to infection in another part of the body (usually salmonella, campylobacter, chlamydia, Neisserie)
arthrits, uveitis and urethritis
cant see cant pee cant bend the knee
reiter’s syndrome
is reactive arthrits HLA-B27 positive?
yes
investigations for reactive arthritis?
CRP/ESR FBC U&E cultures-blood, stool and urine joint fluid analysis to rule out infection x-ray of affected joint
what is the pattern in psoriatic arthritis like?
asymmetrical ologoarthrits but can affect hands similar way to RA
nail changes-onycholysis and pitting sausage fingers inflammation dactylitis may have plantar fasciitis or achilles tendonitis
psoriatic arthritis
treatment for psoriatic arthritis?
DMARDS-methotrexate
NSAIDS
steroids
anti TNF
