Clinical Aspects of Arthritis

Question 1

What are types of arthritis?

Answer 1

Question 2

What is an important test to do for septic arthritis?

Answer 2

Joint aspiration + blood cultures - to find microorganisms

Question 3

Why is it important not to miss septic arthritis?

Answer 3

Sepsis can spread -> death

Bone and joints can be completely eroded or destroyed (will require joint replacement)

Question 4

What is gout?

Answer 4

Excess of uric acid crystals that precipitate in the joint, on a spectrum.

Question 5

Is raised serum urate level diagnostic of gout?

Answer 5

Hyperuricaemia can lead to acute gout, which can cause chronic tophaceous gout.

Question 6

What is the first line of treatment for acute gout?

Answer 6

Aim is to reduce inflammatory response to crystals:

• NSAIDs
• Colchicine
• (steroids)

Question 7

After an acute attack of gout, following first line of treatment you need to lower the serum uric acid level. What drugs reduce serum uric acid level?

Answer 7

• Xanthine oxidase inhibitors (allopurinol, febuxostat)
• Uricosuric drugs (benzbromarone)
• Synthetic uricase (pegloticase)

Question 8

What are the lifestyle risk factors for gout?

Answer 8

• Diuretics
• Weight (bmi, triglyc, bp)
• Red meat, shellfish
• Alcohol
• Sugary/fructose drinks

Question 9

What lifestyle factors can help to treat gout?

Answer 9

• Cherries
• Vitamin C
• Coffee

Question 10

Does everyone with hyperuricaemia get gout?

Answer 10

No - hyperuricaemia can be associated with genetics (50%) but no history of gout. Improve lifestyle first over drug treatment.

Question 11

What is the target conc for serum uric acid?

Answer 11

< 360 micromols/L

Question 12

What class/type of arthritis is rheumatoid arthritis?

Answer 12

Inflammatory -> poly-symmetrical -> RA

Question 13

What are the aims of RA drug treatment?

Answer 13

• Switch off joint inflammation early
• Prevent bone erosions and joint deformity
• Prevent disability

Question 14

What is RA drug treatment?

Answer 14

Disease modifying drugs (DMARDs)

• Start EARLY - within 3 months
• Oral - methotrexate, sulfasalazine
• Injections - biologics eg. antiTNF drugs

Symptomatic treatment - NSAID, steroids, analgesia
Lifestyle treatment - reduce risk factors eg. smoking

Question 15

What is the difference between inflammatory and non-inflammatory arthritis symptoms?

Answer 15

Inflammatory:​

• Pain worse with rest
• Early morning stiffness > 30 mins
• Systemic symptoms
• Tenderness
• Soft swelling + hot/red joint

Non-inflammatory:

• Pain worse w/ exercise
• Minimal EMS
• No systemic symptoms
• Tenderness
• Hard (bony) swelling

Question 16

Which joints do rheumatoid and osteoarthritis most commonly affect?

Answer 16

• RA - MCP/PIP/wrist joints
• OA - DIP/1^st CMC joint

Question 17

What is the aetiology of osteoarthritis?

Answer 17

• Genetic - eg. nodal OA affecting DIPJs
• Age
• Trauma
• Obesity
• Malalignment
• Other

Question 18

What is the treatment of osteoarthritis?

Answer 18

• Aim = reduce symptoms
• No disease modifying treatment available yet (unlike for RA)
• Analgesia/NSAIDs
• Lifestyle - weight loss, exercise
• Surgery - joint replacement (arthroplasty)

Question 19

What gene gives causes ankylosing spondylitis?

Answer 19

HLA B27