Arthropathies Flashcards
What type of infections commonly cause reactive arthritis? How long after the infection does the arthropathy occur?
GU (e.g. chlamydia/gonorrhoea) or GI (e.g. campylobacter/salmonella) - the arthropathy typically occurs 1-3 weeks after the infection
The diagnosis of rheumatoid arthritis is based on what 3 things?
Clinical presentation, serological analysis (inflammatory markers, autoantibodies, routine bloods) and radiographic findings
Name the 4 main symptoms of osteoarthritis?
Mechanical pain, crepitus, joint stiffness (usually < 30 minutes), bony swellings and deformities
How is psoriatic arthritis treated?
Symptomatic relief with painkillers, DMARD/biologic, often physiotherapy
Which joints of the hands are affected by rheumatoid arthritis?
PIPs and MCPs
Pain which is worse on activity, worse by the end of the day and relieved by rest is most likely to be caused by which type of arthropathy?
Non-inflammatory, typically osteoarthritis
Which antibody is specific for rheumatoid arthritis?
Anti-CCP
‘Pencil in cup appearance’ on x-ray is typical of which type of arthritis?
Psoriatic arthritis
Enteropathic arthritis is related to what condition? There may also be skin involvement, this is known as what?
IBD, skin involvement is known as pyoderma gangrenosum
What lifestyle advice should be given to someone suffering from gout?
Restrict alcohol/shellfish/red meat, keep hydrated, weight loss
Rheumatoid arthritis typically affects which joints?
Small joints of the hands and feet
In which joint does septic arthritis most commonly occur?
The knee
Which joints of the hands can be affected by osteoarthritis?
DIPs, PIPs and the first CMC
What are some of the nail changes mostly associated with psoriatic arthritis?
Pitting and onycholysis
Name some examples of extra-articular manifestations of rheumatoid arthritis?
Rheumatoid nodules, lung disease (interstitial fibrosis, pulmonary nodules), increased CV morbidity, eye disease (episcleritis, scleritis, uveitis)
What is the gold standard investigation for septic arthritis?
Joint aspirate for culture and gram stain (this should be taken before treatment is commenced)
How is ankylosing spondylitis treated?
Physiotherapy and NSAIDs for pain relief (anti-TNF biologics may be used in more severe disease)
What type of arthritis could typically be described as ‘asymmetrical oligoarthritis’?
Seronegative inflammatory arthropathies
What is the most common site to be affected by gout? What is this known as?
The first MTP- known as Podagra
When is the best time to measure serum urate?
2 weeks after an acute attack of gout
How is reactive arthritis treated?
Most cases are self-limiting- treat the underlying infectious cause and give symptomatic relief (DMARDs may be required in chronic cases)
How is septic arthritis treated?
IV antibiotics and joint aspiration
Ankylosing spondylitis is an inflammatory disease typically affecting where?
The spine and sacroiliac joints
How is osteoarthritis managed?
Pain control (simple analgesics, mild opioids, IA steroids), physiotherapy and lifestyle factors e.g. weight loss and exercise. Surgery can be used as a last resort.
What makes pseudogout different to gout?
It is caused by calcium pyrophosphate crystal deposition
Pain from osteoarthritis of the hip can be felt where? Hip pain is often actually caused by osteoarthritis of where?
Pain from the hip is typically felt in the groin or radiating to the knee; pain in the hip is often actually coming from the lower back
What is the most common organism causing septic arthritis? In a younger, sexually active individual, what other cause should always be considered?
Staph Aureus is most common overall, Neisseria Gonorrhoeae should always be considered
What are some risk factors for the development of gout?
Renal failure, diuretic use, high alcohol/red meat/seafood intake
What are some features of ankylosing spondylitis which may be seen on examination?
‘Question mark spine’ due to loss of lumbar lordosis and increased thoracic kyphosis, and a decreased Schober’s test
What investigations are used in suspected reactive arthritis, which would not be necessary in the investigation of other seronegative inflammatory arthropathies?
Urine, blood and stool cultures, joint fluid analysis
What are the 4 typical x-ray findings of osteoarthritis?
Loss of joint space, osteophytes, sclerosis, subchondral cysts
Rheumatoid arthritis is an autoimmune disease which is mediated by which HLA type?
HLA-DR4
The seronegative inflammatory arthropathies are related to which HLA type?
HLA-B27
How is osteoarthritis usually diagnosed?
History, examination and typical x-ray findings
Gout usually presents with a hot, tender, red, swollen joint. What is the most important differential of this and what is the gold standard investigation to differentiate the two?
Septic arthritis, requires joint aspirate for cultures, gram stain and polarised microscopy
How is rheumatoid arthritis treated?
Symptomatic relief with painkillers, DMARD/biologic, often physiotherapy
How is pseudogout treated?
NSAIDs, steroids and sometimes colchicine (there is no medication to prevent recurrence)
How would uric acid crystals be described when seen under polarised microscopy?
Needle shaped crystals which display negative birefringence
What are the 4 main features of seronegative inflammatory arthropathies?
Sacroiliitis, dactylitis, uveitis, enthesitis
What triad of symptoms makes up Reiter’s syndrome?
Uveitis/conjunctivitis, reactive arthritis and urethritis
What are the 4 seronegative inflammatory arthropathies?
Ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis, reactive arthritis
What are 3 key features of septic arthritis?
High fever, non-weight bearing, raised inflammatory markers
Bony enlargements can be seen on the hands of people with osteoarthritis. What are these known as and where are each of them found?
Heberden’s nodes (DIPs) and Bouchard’s nodes (PIPs)
‘Peri articular erosions’ is an x-ray finding in which disease?
Rheumatoid arthritis (usually later stage)
If there has been 2 or more attacks of gout in 6 months, a person usually qualifies for urate lowering therapy. What two drugs can be used for this?
Allopurinol or febuxostat
How is enteropathic arthritis treated?
Usually with immunosuppressants which control both conditions at once
Which type of arthritis could be described as an ‘autoimmune symmetric polyarthropathy’?
Rheumatoid arthritis
Which condition will show rhomboid/envelope shaped crystals with weakly positive birefringence on joint aspirate?
Pseudogout
What are the treatments for acute gout?
NSAIDs (usually naproxen) or colchicine if NSAIDs are contraindicated (there may also be a role for IM/IA steroids)
What is Felty’s syndrome?
A triad of rheumatoid arthritis, splenomegaly and neutropenia
How should an acute flare up of rheumatoid arthritis be treated?
Oral or IM steroids (methylprednisolone)
