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MB2 Rheumatology and Orthopaedics > Arthritis, spondyloarthropathies > Flashcards

Arthritis, spondyloarthropathies Flashcards

1
Q

what gene mediates RA

A

HLA-DR4

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2
Q

pathophysiology of RA?

A

synovial inflammation and hypertrophy due to unknown cause
APC presents antigen to T cells, activating macrophages and pro inflammatory mediators. also activates B cells which secrete RF to activate osteoclasts to cause bone erosion, chondrocytes to cause cartilage destruction and synoviocytes for hypertrophy

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3
Q

what is the hypertrophied synovium called?

A

pannus

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4
Q

true/false - smoking has increased risk of RA

A

true

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5
Q

RF/anti-CCPis more specific for RA

A

anti-CCP

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6
Q

why would a patient with RA have a raised alk phos

A

because osteoclast activity causes raised alk phos

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7
Q

what would you see on a typical x ray for RA

A

soft tissue swelling
periarticular osteopaenia
erosion

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8
Q

RA complications in the hands?

A

swan necking of fingers

ulnar deviation of MCPs

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9
Q

DAS 28 score of <2.6 is indicative of

A

remission

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10
Q

DAS 28 score of 2.6-3.2 is indicative of

A

low activity

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11
Q

DAS 28 score of 3.2-5.1 is indicative of

A

moderate activity

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12
Q

DAS 28 score of >5.1 is indicative of

A

active disease

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13
Q

most commonly affected joints of osteoarthritis

A

hands, knees, hips

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14
Q

pathophysiology of osteoarthritis

A

localised loss of hyaline cartilage and remodelling of adjacent bone with osteophyte formation at joint margin
thickening of synovium
may lead to synovial thickening, sclerosis and subchondral cyst

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15
Q

risk factors for osteoarthritis

A 
genetics 
ageing 
females 
obesity 
joint injury 
occupation
joint malalignment 
reduced muscle strength
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16
Q

what joints are affected in localised OA

A

hips, interphalangeal joints, facet joints of lower cervical and lower lumbar spines

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17
Q

what joints are affected in generalised OA

A

spinal/hand joints and at least 2 other regions

DIP, thumb bases, first MTP, lower lumbar and cervical facet, knees and hips

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18
Q

how does OA appear on X ray

A

marginal osteophytes
loss of joint space
subschondral sclerosis
subchondral cysts

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19
Q

complications of cervical OA

A

pain
occipital headaches
impinged nerve roots due to osteophytes

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20
Q

complications of lumbar OA

A

osteophytes can cause spinal stenosis

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21
Q

what mineral causes gout

A

monosodium urate

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22
Q

what mineral causes pseudogout

A

calcium pyrophosphate

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23
Q

what mineral causes hydroxyapatite

A

calcium phosphate

24
Q

what factors may cause increased urate production in gout

A 
inherited enzyme defects 
psoriasis 
haemolytic disorders 
alcohol 
high purine diet - high sugar, red meat, seafood
25
Q

what factors may cause decreased urate excretion in gout

A 
chronic renal impairment 
volume depletion 
hypothroidism 
diuretics 
cyclosporin
26
Q

pathophysiology of gout

A

purines from diet and DNA/RNA converted to xantine, converted to plasma urate and excreted. gout is deposition and precipitation of crystals in joints. causes phagocytosis by monocytes and neurophils. neutrophils rupture to release lysosymes and monocytes secrete pro inflammatory mediators and proteases to cause inflammation/tissue damage

27
Q

gout is usually a mono/polyarthropathy

A

monoarthropathy

28
Q

what is classically seen in chronic gout

A

tophi

29
Q

true/false - in acute gout serum urate is always increased

A

false - not always as it is so sudden onset

30
Q

if you looked at monosodium urate under a microscope, how would it appear

A

negatively birefringent needle shape

31
Q

indications for prophylactic therapy for gout?

A 
2 or more gout attacks in a year 
gouty trophi 
uric acid calculi
chronic renal impairment 
heart failure 
chemotherapy
32
Q

what type of drugs are allopurol, febuxostat

A

xanthine oxidase inhibitors

prevent conversion of purine to xanthine

33
Q

name a few uricosuric drugs and what ypu must always check before prescribing

A

sulfinpyrazone, proenecid, benzbromazone

check kidney function

34
Q

true/false - you must start gout prophylaxis during acute attack

A

no! do it after 2 weeks as if its done too soo it can cause another acute attack

35
Q

you want to reach the serum urate target in a susceptible patient who has had gout before. she is on allopurol. she hasnt yet reached target serum levels. what other drug must she be on

A

an NSAID, until serum target reached

36
Q

what is the serum target for gout

A

300-360umol/L

37
Q

what joints does calcium pyrophosphate deposition disease affect

A

knee, ankle, wrist

38
Q

calcium pyrophosphate- how does it appear under a microscpe

A

positively birefringent with rhomboid shape

39
Q

causes of pseudogout

A 
osteoarthritis 
age 
amyloidosis 
trauma 
hypothyroidism 
hyperparathyroidism 
haemochromatosis
40
Q

hydroxyapatite - what joint does it affect and what happens

A

crystal deposition in and around joint, most commonly shoulder
release of collagenases and proteases
acute, rapid deterioration

41
Q

what is soft tissue rheumatism

A

localised pain and inflammation/damage to ligaments, tendons, muscles or nerves near joint

42
Q

what is the most common area for soft tissue rheumatism

A

shoulder

43
Q

who is joint hypermobility more common in

A 
women 
marfans 
ehlers 
danlos 
children under 14
44
Q

what is modified beighton score

A

extension of 9 joints to look for hyperextension

+ve if 4 or more joints

45
Q

what are spondyloarthropathies

A

inflammatory arthritides with involvement of spine and joints in HLA B27 individuals

46
Q

mechanical vs inflammatory back pain

A

mechanical - relief by rest, worse at end of day, worse with activity
inflammatory - worse on rest, better on activity, morning stiffness

47
Q

shared features of spondyloarthropathies

A 
sacroiliac and spinal involvement 
inflammatory arthritis 
enthesitis 
dactylitis 
uveitis 
mucocutaneous lesions 
no rheumatoid nodules 
rare aortic incompetence or heart block
48
Q

features of AS

A 
axial arthritis 
anterior uveitis 
aortic regurg 
apical fibrosis 
amyloidosis/IgA nephropathy 
achilles tendinitis 
plAntar fasciitis
49
Q

what is tragus to wall

A

patient to stand with back, buttock and heel to wall. Try to push head against wall. Patients with AS will struggle to do so due to spinal fusion

50
Q

what is modified schobers test

A

test for lumbar spinal fusion. Get patient to bend forward without bending knees. Measure 10cm up from dimples of venus and then whilst bending. Should be 15 cm ish

51
Q

what would an x ray of AS reveal

A

sacroiliitis
syndesmophytes
bamboo spine
reduced bone density in later disease

52
Q

what would an x ray of PsA look like

A

marginal erosion/whiskering
pencil in cup deformity
osteolysis
enthesitis

53
Q

most common infections causing reactive arthritis

A

chlamydia

salmonella, shigella, yersina

54
Q

triad in reactive arthritis

A

urethritis
conjunctivitis/uveitis
arthritis

55
Q

what is enteropathic arthritis associated with and where does it occur

A

IBD

knee, ankle, elbow, wrist, spine, hip, shoulder

MB2 Rheumatology and Orthopaedics (22 decks)

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