arthriTITs Flashcards
what is osteoarthritis
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
what causes osteoarthritis
abnormal anatomy
inter-articular fractures
meniscal injury
what are symptoms of osteoarthritis
pain and stiffness in joint - sharp ache/burn
stiffness in the morning
pain and stiffness that worsen on activity
start up pain
what investigations could you do for osteoarthritis
X-ray - visualise extent of deformity, osteophytes, joint space, cysts
MRI
how could you manage osteoarthritis
lifestyle - weight loss, physio, acupuncture etc
NSAIDs
interarticular steroid injections - hyaluronic acid
topical NSAODs or capsaicin
joint replacement surgery
braces
what is septic arthritis
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
what can cause septic arthritis
haematogenous spread
penetrating injuries
arthroscopy
infected joint replacement
bone abscesses can erupt into joint cavity
usually staph A, H influenza, E.coli, strep P
how does septic arthritis present
reluctance to move joint pain redness swelling heat
what investigations could you do in septic arthritis
US septic screen in kids WBC count CRP blood culture MRI aspiration and culture
how could you treat septic arthritis
antibiotics
fluid balance
drainage
joint replacement if severe
what is rheumatoid arthritis
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
what can cause RA
environmental factors like smoking and infection
genetics
what are risk factors for RA
smoking family history female 4th/5th decade of life periodontal disease or other low grade chronic infection
what are symptoms of RA
morning stiffness multiple joints effected poor mobility and function fatigue weight loss anaemia muscle aches scleritis if severe
what are clinical signs of RA
multiple joints effected swelling nodules Z shaped thumb ulnar deviation of fingers hyperextended PIP, flexed DIP
what investigations could you do for RA
X-ray bloods - RF, CRP, ESR ACPA, anti-CCP antibodies MRI DAS score to assess severity
how could you manage RA
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
what is psoriatic arthritis
chronic inflammation of skin and joints
can be arthritis mulitas which is a severe form
how does psoriatic arthritis present
psoriasis often presents first swollen DIP lifting of nails pitting palmar plantar pustulosis DActylitis - inflammation of the full finger or toe.
what investigation can you do for psoriatic arthritis
X-ray
how can you treat psoriatic arthritis
methotrexate steroids cyclosporine leflunomide physio Anti-TNF anti-IL-17 and 23
what is reactive arthritis
inflammatory arthritis triggered by pathogens elsewhere in the body
what can cause reactive arthritis
Most common - chlamydia salmonella chlamydia streptococci neisseria campylobacter
how does reactive arthritis present
usually only one joint is affected
dactylitis
Enthesitis
urethritis
what is reiter’s syndrome
dactylitis + Enthesitis + urethritis
what tests can you do for reactive arthritis
ESR
CRP
stool culture if diarrhoea
aspirate
how can you manage reactive arthritis
antibiotics if needed NSAIDs steroid injection DMARDs if chronic methotrexate if still have symptoms after 6 months
what is enteropathic arthritis
arthritis associated with IBD
may need bowel resection
otherwise treat like arthritis
What are the common hand signs seen in rheumatoid arthritis?
Swann neck fingers (flexion of the proximal interphalangeal joints and extension of the distal interphalangeal joints), ulnar deviation and body swelling of joints.
What is the difference between inflammatory arthritis and osteoarthritis?
Inflammatory arthritis is worse at rest and improves with activity.
Osteoarthritis is better at rest and gets worse with activity.
What joints are never affected in rheumatoid arthritis?
The back (back pain is never a symptom) and the distal interphalangeal joints.
Which genes are associated with rheumatoid arthritis?
HLA-DR4 and HLA-DR1.
What DAS28 score n rheumatoid arthritis shows remission?
<2.4 = remission. >5.1 = eligible for biological therapy
Whats the difference between seropositive and seronegative rheumatoid arthritis?
Seropositive - RF and Anti CPPA - one to both are positive.
seronegative - both are negative.
Seropositive patients have a poorer prognosis.
What is the side effect of methotrexate?
Its teratogenic, for both males and females.
What is retire syndrome?
When all 3 - joint inflammation, conjunctiva inflammation and urethra inflammation occur.
What is the difference between reactive arthritis and septic arthritis?
Reactive arthritis - is just an autoimmune condition, unlike septic arthritis the pathogens don’t infect the joint.
How soon after infection does reactive arthritis occur?
2-3 weeks.
What are the main parts of the body attacked in reactive arthritis?
The tissue linings, conjunctiva and urethra.
What is the most common joint which is affected by reactive arthritis?
The knee.
What are common types of seronegative arthritis?
Reactive arthritis
ankylosing spondylitis
psoriatic arthritis.
What is the ‘common hot joint policy’?
Treat a hot joint as septic arthritis - with antibiotics, until septic arthritis is excluded.
What is a common cause of septic arthritis?
Gonorrhoea.
What common joints are affected in osteoarthritis?
Distal interphalangeal joints, hips, knees, wrists, MCP at the base of the thumb.
What are the x-ray changes seen in osteoarthritis?
LOSS L - loss of joint space O - osteophytes S- subarticular sclerosis (increased density) subchondral cysts.
What sign is seen in hands of patients with osteoarthritis?
Haberden’s nodes - swelling of the distal interphalangeal joints.
Bouchards nodes - Proximal interphalangeal joints.
Squaring of base of thumb.
what is the treatment for acute osteomyelitis?
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
What is a common complication of acute osteomyelitis?
Septic arthritis.
Chronic osteomyelitis.
What is the most common organism causing osteomyelitis?
Staph aureus.
What is chronic osteomyelitis?
usually due to recurrent acute osteomyelitis.
What is the treatment for chronic osteomyelitis?
Usually long term antibiotics (for 6 months) and surgical.
How many people with arthritis develop psoriatic arthritis?
10-20%.
What is the most common subtype of psoriatic arthritis?
oligoarticular arthritis - less severe, sometimes asymptomatic with <5 joints involved.
What type of arthritis does psoriatic arthritis often mimic?
Rheumatoid arthritis
What is arthritis mutilans?
a severe form of psoriatic arthritis - damaging the. phalanxes. shortening of the fingers.
Who/where does pagets disease usually attack?
Elderly adults.
Thee axial. skeleton - bones of the head and the spine.
What is the key finding of Paget’s disease?
Increased ALP, normal calcium and phosphate.
What are pagets disease complications?
Osteosarcoma - bone cancer.
Spinal stenosis.
How long is morning stiffness for osteoarthritis and rheumatoid arthritis?
Osteoarthritis < 30 mins.
Rheumatoid arthritis > 45 mins.
What is the treatment for gout?
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.
