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Phase 2 (again) > Arthritis (s) > Flashcards

Arthritis (s) Flashcards

1
Q

Define osteoarthritis

A

Degenerative condition affecting articular cartilage. Loss of cartilage with bone remodelling and inflammation

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2
Q

Epidemiology of osteoarthritis

A
  1. More common in women
  2. More common with increasing age
  3. Most common arthritis
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3
Q

Causes of osteoarthritis

A
  1. Age - cumulative trauma
  2. Gender - female, increased prevalence after menopause
  3. Genetic predisposition - less common in afro-caribbean
  4. Occupation - manual labour, sports, farming
  5. Obesity - low grade inflammatory state
  6. Other: local trauma, RA, abnormal joints - hypermobility, congenital hip dysplasia
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4
Q

Pathology of osteoarthritis

A
  1. Destruction of articular cartilage (reduction of articular space)
  2. Exposed subchondral bone becomes sclerotic, increased vascularity, subchondral cyst formation
  3. Repair causes cartilaginous growth formation which become calcified (osteophytes)
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5
Q

Signs and symptoms of osteoarthritis

A
  1. Joint involvement: early morning stiffness <30min, pain after exercise/end of day, reduced joint function
  2. Most often hips, knees, spine, small joints of the hand (asymmetrical)
  3. Hard swelling, crepitus
  4. Heberden’s nodes (DIPJ), Bouchard’s nodes (PIPJ)
  5. Alteration in gait
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6
Q

Investigations for osteoarthritis

A
  1. XR LOSS - loss of articular space, osteophytes, subchondral cysts, subchondral sclerosis
  2. CRP slightly raised, no autoantibodies
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7
Q

Management of osteoarthritis (non-medical)

A
  1. Lose weight + exercise
  2. OT, PT
  3. Walking aids
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8
Q

Management of osteoarthritis (pharmacological)

A
  1. Analgesics - NSAIDs, paracetamol, opioids, capsaicin
  2. Transdermal analgesic patches - buprenorphine, lignocaine
  3. Intra-articular corticosteroid injections
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9
Q

Management of osteoarthritis (surgical)

A
  1. Joint replacement
  2. Arthroplasty - surgical replacement or reconstruction of a joint
  3. Arthroscopy - keyhole surgery for loose bodies
  4. Osteotomy - cutting the bone for realignment
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10
Q

Define rheumatoid arthritis

A

Chronic systemic autoimmune inflammatory disease characterised by symmetrical, deforming, peripheral polyarthritis

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11
Q

Epidemiology of RA

A
  1. Young - 30-40 onset
  2. 3x more common in women
  3. Familial association
  4. HLA-DR4 association
  5. More common in smokers
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12
Q

Pathology of RA

A

Infiltration of synovium by inflammatory cells -> angiogenic cytokines form new synovial blood vessels -> synovium proliferates and grows over cartilage producing a pannus -> destroys subchondral bone and cartilage -> bony lesions

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13
Q

Signs and symptoms (intra-articular) of RA

A
  1. Joints - early morning stiffness >30min, ease with use
  2. Symmetrical red, swollen, tender, warm joints
  3. Usually wrists and feet
  4. Ulnar deviation
  5. Swan neck deformity
  6. Boutonnière deformity
  7. Rheumatoid nodules (check elbows)
  8. Z thumb
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14
Q

Signs and symptoms (extra-articular) of RA

A
  1. Cardiac disease : IHD, pericarditis
  2. Vascular disease : accelerated atherosclerosis, vasculitis
  3. Haematological disease: anaemia, splenomegaly
  4. Lung disease: pleuritis, pulmonary fibrosis
  5. Skin: rheumatoid nodules, erythema nodosum
  6. Neurological: Peripheral neuropathy, stroke
  7. Eyes: episcleritis, scleritis, sjogren’s
  8. Kidneys : amyloidosis
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15
Q

Investigations of RA

A
  1. RF - positive in 70-80%
  2. Anti-CCP - highly specific
  3. FBC, ESR, CPR
  4. Xray: LESS
    • Loss of joint space
    • Erosion
    • Soft tissue swelling
    • Soft bones (osteopenia)
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16
Q

Management of RA

A
  1. DMARDs - Methotrexate, sulfasalazine 1st line
  2. TNF-a inhibitor - infliximab, rituximab 2nd line
  3. Analgesia - NSAIDs, intra-articular steroid injection
  4. PT, OT
  5. Surgery
17
Q

Types of seronegative spondyloarthropathies

A
  1. Ankylosing spondyloarthritis
  2. Psoriatic arthritis
  3. Enteropathic arthritis
  4. Reactive arthritis
18
Q

Define seronegative spondyloarthropathies

A

A group of inflammatory joint conditions affecting mainly the spinal column and peripheral joints and enthesitis

19
Q

What allele is associated with seronegative spondyloarthropathies

A

HLA B27

20
Q

Shared clinical features of seronegative spondyloarthropathies

A
  1. Seronegative - rheumatoid factor negative
  2. Strong association with HLA B27
  3. Axial arthritis
  4. Asymmetrical peripheral arthritis
  5. Enthesitis - inflammation at insertion of tendons/ligaments to the bone
  6. Dactylitis - inflammation of digit due to soft tissue oedema and tenosynovial and joint inflammation
  7. Extra articular: iritis, psoriaform rashes, oral ulcers, IBD
21
Q

Signs of seronegative spondyloarthropathies (SPINEACHE)

A 
Sausage digits (dactylitis)
Psoriasis
Inflammatory back/buttock pain
NSAIDs responsive
Enthesitis
Arthritis
Crohn's/colitis associated
HLA B27 associated
Eye problems (uveitis)
22
Q

Define ankylosing spondylitis

A

Chronic inflammatory disease of the spine and sacroiliac joints. Unknown aetiology

23
Q

Epidemiology of ankylosing spondylitis

A
  1. More common in young men (<30y)

2. Smokers

24
Q

Pathology of ankylosing spondylitis

A

Inflammation forming syndesmophytes -> fusion of the vertebrae (bamboo spine)

25
Q

Clinical presentation of ankylosing spondylitis (7)

A
  1. Gradual onset lower back pain that radiates to buttocks with morning stiffness that eases with exercise
  2. Waking in the second half of the night due to pain
  3. Loss of movement in low back
  4. Reduced lordosis and increased kyphosis
  5. Enthesitis
  6. Systemic features: fever, malaise, fatigue
  7. Extra articular involvement:achilles tendonitis, apical fibrosis, aortic regurgitation
26
Q

Investigations for ankylosing spondylitis

A
  1. Diagnosis is clinical supported imaging
  2. Xray/MRI - erosion and sclerosis of margins of sacroiliac joints. Bamboo spine
  3. ESR, CRP, HLA B27 +ve (90%), RF -ve
27
Q

Management of ankylosing spondylitis

A
  1. Intense exercise regimen to maintain mobility and posture
  2. NSAIDs followed by TNF-a inhibitors (infliximab)
  3. Surgery - hip/shoulder replacement, correct spinal deformities
28
Q

Define psoriatic arthritis

A

Inflammatory arthritis associated with psoriasis. 10-40% with psoriasis will develop

29
Q

Signs and symptoms of psoriatic arthritis

A
  1. Ranges mild synovitis to severe progressive erosive arthropathy
  2. Symmetrical polyarthritis
  3. DIPJ primarily affected
  4. Psoriatic arthritis mutilans (bone tissue disappears)
  5. Associated with nail changes, synovitis, acneiform rashes, palmo-plantar pustulosis
30
Q

Investigations for psoriatic arthritis

A
  1. Radiology - erosive changes, ‘pencil in cup’ deformity in severe cases
31
Q

Management of psoriatic arthritis

A
  1. NSAIDs followed by DMARDs (methotrexate, sulfasalazine), TNF-a inhibitors also work
  2. Surgery - can correct deformed joints
32
Q

Enteroarthritis

A
  1. Occurs in up to 20% of patients with IBD
  2. Erythema nodosum, pyoderma gangrenosum (skin condition where pustules form and grow into ulcers)
  3. Management like reactive arthritis
33
Q

Define reactive arthritis

A

Arthritis and other clinical manifestations occur as an autoimmune response to infection elsewhere in the body (usually GI or GU). Preceding infection may be resolved or asymptomatic by the time reactive arthritis presents

34
Q

Epidemiology of reactive arthritis

A

Typically young men

35
Q

Causative organisms of reactive arthritis

A

GI: campylobacter, salmonella, shigella
GU: chlamydia trachomatisor

36
Q

Signs and symptoms of reactive arthritis

A
  1. Acute onset: malaise, fever, fatigue
  2. Lower back pain common (also stiffness/pain in knees, ankles, feet)
  3. Asymmetrical, oligoarthritis (no more than 6 joints)
  4. Enthesitis
  5. Keratoderma blenorrhagica (brown raised plaques on soles and palms)
  6. Reiter’s - conjunctivitis, urethritis, arthritis
37
Q

Investigations for reactive arthritis

A
  1. Raised CRP, ESR
  2. Culture stool if diarrhoea
  3. Serum antibodies/infectious serology
  4. STI screening
  5. X-ray - enthesitis with periosteal reaction
38
Q

Management of reactive arthritis

A
  1. Splint affected joints, PT, aspirate synovial effusions
  2. Drugs: NSAIDs/local steroid injection, methotrexate if >6 months
  3. Treating original infection may have very little affect

Phase 2 (again) (24 decks)

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