CL2: Arthritis Flashcards
What is osteoarthritis?
Osteoarthritis is seen as inflammation, cartilage loss and some joint swelling leading to weaker muscles. It is not an autoimmune disorder. The bone is not solid but instead has holes. The cartilage flakes off leading to the bone being “jagged” and not smooth. Parts of the cartilage enter the synovial lining cavity causing inflammation and irritation leading to synovitis. The bone reacts to the low grade inflammation by trying to heal itself by thickening. The joint physically becomes bigger and remodelling. This means big cysts form in the subchondral bone (bone beneath the cartilage). We cannot stop this from happening.
Why does muscle weakness occur in osteoarthritis?
Osteoarthritis is the most common type of arthritis. It is the most common reason for knee and hip replacements. Muscle weakness occurs due to patients being less active due to the pain. They therefore do not use the muscles as much and muscle fibres become thin. The bones initially feel painful (and squishy); the joints are inflamed and fingers feel bigger than usual.
Give details of rheumatoid arthritis?
- It is rare. A lot less common than osteoarthritis.
- It is an inflammatory arthritis.
- More common in females
- Can present at any age, most commonly 40-50
- Joint swelling, heat, pain and morning stiffness
- People can feel systemically unwell and can loose weight
- Other organs can be affected also
- Affects most small joints of the hands and feet
How can we test for RA?
- CCP blood test - this is a specific RA blood test
80% positive Rheumatoid factor blood test
How do we treat RA? What is the risk?
Immunosuppression. Due to lots of new drugs only 5% of patients with RA do badly. There is a risk of CVD but this is small as the inflammation is controlled. There is also a risk of osteoporosis but this is small due to treatment with steroids.
Give details of psoriatic arthritis.
This is arthritis associated with psoriasis. Around 4% of the population have psoriasis. Not everyone however is at risk of psoriatic arthritis. 10% of these are at risk of psoriatic arthritis. Psoriasis is also autoimmune. It is genetic. - Can cause swelling in just one joint and inflammation of the spine. It can cause a range of symptoms.
- It can affect there nails also - pitting and lifting of the nail bed.
- Can cause red inflamed eyes (iritis)
Can affect tendon insertion sites (Achilles)
What is dactylitis?
Dactylitis ‘sausage toe’ or ‘sausage finger’ - this is swelling of the whole toe rather than just the joint. It is seen with psoriatic arthritis.
What is Arthritis mutilans?
This is telescoping of the joints. . The whole thumb squashes in and out. It is seen very rarely. It is not painful anymore. Gripping is very hard. There is so much inflammation that there is destruction of the joints and so there is no structure. The skin is still there but the bone has been eaten away.
What is diagnostically different about PA compared to RA?
There is no positive blood test. There is also usually a red rash, characteristic of psoriasis.
What is axial spondylarthritis?
- Inflammatory back pain - wakes you up in the second half of night with stiffnesses in the back
- It commonly affects young people
- Average length of time to diagnose is 8 years
- Pain and stiffness can be treated
- Can cause red inflamed eyes (iritis)
- Can affect tendon insertion sites (Achilles)
In any type of inflammatory disease you feel worse in rest. As you start moving, it gets better. You can get hip arthritis linked to this type of arthritis. There is a no separate vertebral bodies. New bits of bone grow out of the end of the vertebrae leading top spinal fusion and fusion along the facet joints. This individual will be struggling to move their back.
What is crystal arthritis?
Gout
- An inflammatory arthritis caused by too much uric acid. Uric acid is a normal metabolic waste product. It is not an auto-immune disorder.
- It goes into the joints an really hurts.
- It is classically the big toe joint that wakes you up in the night
- Diuretics increase uric acid
- It is very easy to treat with good analgesics and medicines to decrease uric acid levels
- If not treated you get lumps that appear on the hand, toes or on the back of the ankle
It is collections of the crystals - in treatment these can be reabsorbed but it takes a long time
What is rat bite erosion?
Seen in crystal arthritis. You can get bone destruction due to the inflammation. You cannot change this but you can get rid of the swelling and pain from acute flare ups
What is sclerosis?
Sclerosis is the stiffening of a tissue or anatomical feature, usually caused by a replacement of the normal organ-specific tissue with connective tissue.
What is pseudo-gout?
It presents similar to gout but the crystals are not made of uric acid but instead calcium pyrophosphate crystals. It usually affects older women. It leads to red, painful and swollen joints. The only way to test if it is gout or pseudo-gout is to test the liquid. It is not auto-immune but caused by crystals.
