Clinical Aspects of Arthritis

Question 1

What are the 4 signs of inflammation?

Answer 1

Swelling, redness, heat, pain/tenderness

Question 2

Give some examples of different types of Arthritis

Answer 2

• Non-inflammatory - OA
• Inflammatory, mono = Crystal/Septic arthritis
• Inflammatory, oligo (asymmetrical) = Ankylosing spondylitis
• Inflammatory, poly (symmetrical) = RA

Question 3

What is septic arthritis?

Answer 3

Inflamamtion of a joint caused by infection

• Potentially life threatening
• Results in destructive arthritis quickly
• Often skin commensals (e.g. Staph aureus)

Question 4

What is Gout?

Answer 4

A type of arthritis where crystals form inside and around the joints.

Question 5

What is the two step drug treatment for gout?

Answer 5

• Step 1 - treat acute attack. Aim is to reduce inflammatory response to crystals (NSAIDs, Colchine, Steroids)
• Step 2 - prevent further attacks. Aim to reduce uric acid level below 360umol/L (Xanthine oxidase inhibitors)

Question 6

What lifestyle changes can you make to reduce risk of Gout?

Answer 6

• Stop taking Diuretics
• Weight Loss
• Reduce purine from diet (red meat/shellfish)
• Less alcohol
• Less sugary drinks
• Eat more cherries, Vit C, Coffee

Question 7

What risk factors are there for gout?

Answer 7

High BMI
Hypertension
High TGs
Loop/thiazide diuretics 
Spouse with gout

Question 8

What is RA?

Answer 8

• Long-term, autoimmune

- Immune system attacks and erodes joints - thickening of joint capsule.

Question 9

What are the aims of RA drug treatment?

Answer 9

• To switch off joint inflammation early
• Prevent bone erosion and joint deformity
• prevent disability

Question 10

What are characteristic symptoms of RA?

Answer 10

Deviation of fingers towards the ulnar

• MCP/PIP/ wrist joints
• Symmetrical, poly-joints, inflammatory

Question 11

What are some drugs that can be used for RA Treatment?

Answer 11

• Disease modifying drugs - methotrexate, antiTNF
• Symptomatic treatment - NSAIDs, steroids, analgesia
• Lifestyle - reduce risk factors (smoking)

Question 12

What are characteristic symptoms of OA?

Answer 12

• Non-inflammatory
• DIP/1st CMC joint
• reduced joint space

Question 13

What treatment of OA is available?

Answer 13

• No disease modifying treatment is available yet
• NSAIDS
• Lifestyle - weight loss, exercise
• Surgery - joint replacement - arthroplasty

Question 14

What is ankylosing spondylitis?

Answer 14

Inflammation of the joints of the spine, commonly where the spine meets the pelvis
Cause - genetic (HLA B27), immunological (CD8), environmental?

Question 15

What treatments are available for AS?

Answer 15

NSAIDS
Analgesia
anti-TNF treatment
Exercises to prevent kyphosis
- reduce inflmmation, spine damage, disability.

Question 16

Inflammatory vs Degenerative arthritis

Answer 16

I: Swollen, hot red joints. Rest/night pain, early morning stiffness. Systemic (fever, tired). ESR often raised. Autoantibodies

D: bony swelling, pain and stiffness after use. No systemic symptoms. Normal ESR. No autoantibodies.

Question 17

Inflammatory vs Degenerative arthritis treatment

Answer 17

I: Disease modifying drugs. Analgesia/NSAIDS. Lifestyle (smoking.) Surgery

D: No disease modifying drugs. Analgesia/NSAIDS. Lifestyle (weight loss). Surgery