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Exam - M - MSK + Rheumatology Pathologies (Meg & Rach) > arthriTITs > Flashcards

arthriTITs Flashcards

1
Q

what is osteoarthritis

A

wear tear repair
the cartilage in the bone is damaged by microtrauma over time
this triggers inflammation and pain
chondrocytes lay down new cartilage but eventually the damage overtakes the repair
joint is invaded by immune cells and degenerative change occurs
cartilage cannot protect the bones from directly rubbing against each other
osteophytes form

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2
Q

what causes osteoarthritis

A

abnormal anatomy
inter-articular fractures
meniscal injury

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3
Q

what are symptoms of osteoarthritis

A

pain and stiffness in joint - sharp ache/burn
stiffness in the morning
pain and stiffness that worsen on activity
start up pain

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4
Q

what investigations could you do for osteoarthritis

A

X-ray - visualise extent of deformity, osteophytes, joint space, cysts
MRI

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5
Q

how could you manage osteoarthritis

A

lifestyle - weight loss, physio, acupuncture etc
NSAIDs
interarticular steroid injections - hyaluronic acid
topical NSAODs or capsaicin
joint replacement surgery
braces

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6
Q

what is septic arthritis

A

infection of the joint space causing synovitis

bone and cartilage are damaged, pressure in joint increases and can cut off blood supply causing avascular necrosis

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7
Q

what can cause septic arthritis

A

haematogenous spread
penetrating injuries
arthroscopy
infected joint replacement
bone abscesses can erupt into joint cavity
usually staph A, H influenza, E.coli, strep P

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8
Q

how does septic arthritis present

A 
reluctance to move joint 
pain 
redness
swelling 
heat
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9
Q

what investigations could you do in septic arthritis

A 
US
septic screen in kids
WBC count 
CRP
blood culture
MRI
aspiration and culture
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10
Q

how could you treat septic arthritis

A

antibiotics
fluid balance
drainage
joint replacement if severe

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11
Q

what is rheumatoid arthritis

A

autoimmune response causing synovitis, inflammation of tendon sheath, bursa, joints and leading to hypertrophy of membrane
immunologically susceptible person + environmental trigger = immune complex formation, rheumatoid factor formation, ANCA release, RANKL on T cells that bind to RANK on osteoclasts to activate them

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12
Q

what can cause RA

A

environmental factors like smoking and infection

genetics

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13
Q

what are risk factors for RA

A 
smoking 
family history 
female 
4th/5th decade of life 
periodontal disease or other low grade chronic infection
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14
Q

what are symptoms of RA

A 
morning stiffness 
multiple joints effected 
poor mobility and function 
fatigue 
weight loss 
anaemia 
muscle aches 
scleritis if severe
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15
Q

what are clinical signs of RA

A 
multiple joints effected 
swelling 
nodules 
Z shaped thumb 
ulnar deviation of fingers 
hyperextended PIP, flexed DIP
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16
Q

what investigations could you do for RA

A 
X-ray
bloods - RF, CRP, ESR
ACPA, anti-CCP antibodies
MRI
DAS score to assess severity
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17
Q

how could you manage RA

A

NSAIDs + COX-2 inhibitors + PPIs to settle disease
DMARDs by injection/perfusion
methotrexate (+ folic acid) - others are leflunimide, sulfasalazine and hydroxychloroquine
hydroxychloroquine if mild
biologics if DAS > 5.1
fourth line = methotrexate + rituximab + DMARDs
surgery

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18
Q

what is psoriatic arthritis

A

chronic inflammation of skin and joints

can be arthritis mulitas which is a severe form

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19
Q

how does psoriatic arthritis present

A 
psoriasis often presents first 
swollen DIP
lifting of nails
pitting
palmar plantar pustulosis
DActylitis - inflammation of the full finger or toe.
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20
Q

what investigation can you do for psoriatic arthritis

A

X-ray

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21
Q

how can you treat psoriatic arthritis

A 
methotrexate
steroids
cyclosporine 
leflunomide  
physio 
Anti-TNF
anti-IL-17 and 23
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22
Q

what is reactive arthritis

A

inflammatory arthritis triggered by pathogens elsewhere in the body

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23
Q

what can cause reactive arthritis

A 
Most common - chlamydia 
salmonella 
chlamydia 
streptococci 
neisseria 
campylobacter
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24
Q

how does reactive arthritis present

A

usually only one joint is affected
dactylitis
Enthesitis
urethritis

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25
Q

what is reiter’s syndrome

A

dactylitis + Enthesitis + urethritis

26
Q

what tests can you do for reactive arthritis

A

ESR
CRP
stool culture if diarrhoea
aspirate

27
Q

how can you manage reactive arthritis

A 
antibiotics if needed
NSAIDs 
steroid injection 
DMARDs if chronic 
methotrexate if still have symptoms after 6 months
28
Q

what is enteropathic arthritis

A

arthritis associated with IBD
may need bowel resection
otherwise treat like arthritis

29
Q

What are the common hand signs seen in rheumatoid arthritis?

A

Swann neck fingers (flexion of the proximal interphalangeal joints and extension of the distal interphalangeal joints), ulnar deviation and body swelling of joints.

30
Q

What is the difference between inflammatory arthritis and osteoarthritis?

A

Inflammatory arthritis is worse at rest and improves with activity.
Osteoarthritis is better at rest and gets worse with activity.

31
Q

What joints are never affected in rheumatoid arthritis?

A

The back (back pain is never a symptom) and the distal interphalangeal joints.

32
Q

Which genes are associated with rheumatoid arthritis?

A

HLA-DR4 and HLA-DR1.

33
Q

What DAS28 score n rheumatoid arthritis shows remission?

A 
<2.4 = remission.
>5.1 = eligible for biological therapy
34
Q

Whats the difference between seropositive and seronegative rheumatoid arthritis?

A

Seropositive - RF and Anti CPPA - one to both are positive.
seronegative - both are negative.
Seropositive patients have a poorer prognosis.

35
Q

What is the side effect of methotrexate?

A

Its teratogenic, for both males and females.

36
Q

What is retire syndrome?

A

When all 3 - joint inflammation, conjunctiva inflammation and urethra inflammation occur.

37
Q

What is the difference between reactive arthritis and septic arthritis?

A

Reactive arthritis - is just an autoimmune condition, unlike septic arthritis the pathogens don’t infect the joint.

38
Q

How soon after infection does reactive arthritis occur?

A

2-3 weeks.

39
Q

What are the main parts of the body attacked in reactive arthritis?

A

The tissue linings, conjunctiva and urethra.

40
Q

What is the most common joint which is affected by reactive arthritis?

A

The knee.

41
Q

What are common types of seronegative arthritis?

A

Reactive arthritis
ankylosing spondylitis
psoriatic arthritis.

42
Q

What is the ‘common hot joint policy’?

A

Treat a hot joint as septic arthritis - with antibiotics, until septic arthritis is excluded.

43
Q

What is a common cause of septic arthritis?

A

Gonorrhoea.

44
Q

What common joints are affected in osteoarthritis?

A

Distal interphalangeal joints, hips, knees, wrists, MCP at the base of the thumb.

45
Q

What are the x-ray changes seen in osteoarthritis?

A 
LOSS
L - loss of joint space
O - osteophytes
S- subarticular sclerosis (increased density)
subchondral cysts.
46
Q

What sign is seen in hands of patients with osteoarthritis?

A

Haberden’s nodes - swelling of the distal interphalangeal joints.
Bouchards nodes - Proximal interphalangeal joints.
Squaring of base of thumb.

47
Q

what is the treatment for acute osteomyelitis?

A

rest and splint
antibiotics if cause unknown - benzylpenicillin and Flucloxacillin
Antibiotics usually IV then oral, given for 4-6 weeks

Usually surgery is required - drainage and debridement

48
Q

What is a common complication of acute osteomyelitis?

A

Septic arthritis.

Chronic osteomyelitis.

49
Q

What is the most common organism causing osteomyelitis?

A

Staph aureus.

50
Q

What is chronic osteomyelitis?

A

usually due to recurrent acute osteomyelitis.

51
Q

What is the treatment for chronic osteomyelitis?

A

Usually long term antibiotics (for 6 months) and surgical.

52
Q

How many people with arthritis develop psoriatic arthritis?

A

10-20%.

53
Q

What is the most common subtype of psoriatic arthritis?

A

oligoarticular arthritis - less severe, sometimes asymptomatic with <5 joints involved.

54
Q

What type of arthritis does psoriatic arthritis often mimic?

A

Rheumatoid arthritis

55
Q

What is arthritis mutilans?

A

a severe form of psoriatic arthritis - damaging the. phalanxes. shortening of the fingers.

56
Q

Who/where does pagets disease usually attack?

A

Elderly adults.

Thee axial. skeleton - bones of the head and the spine.

57
Q

What is the key finding of Paget’s disease?

A

Increased ALP, normal calcium and phosphate.

58
Q

What are pagets disease complications?

A

Osteosarcoma - bone cancer.

Spinal stenosis.

59
Q

How long is morning stiffness for osteoarthritis and rheumatoid arthritis?

A

Osteoarthritis < 30 mins.

Rheumatoid arthritis > 45 mins.

60
Q

What is the treatment for gout?

A

acute - 1st line is NSAIDs, 2nd Line is colchicine, 3rd line is steroids.
Prophylaxis - allopurinol (decreases uric acid) - if prescribing wait until the acute gout is resolved after this it can be continued through acute phases.

Exam - M - MSK + Rheumatology Pathologies (Meg & Rach) (13 decks)

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