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Y2 MSK > CORTEXT 2 - Rheumatology > Flashcards

CORTEXT 2 - Rheumatology Flashcards

1
Q

Define Arthropathy, Arthritis and Arthralgia

A

Arthropathy - disease of the joint
Arthritis - inflammation of the joint
Arthralgia - painful joint

Use synonymously

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2
Q

What are the two main categories of arthritis?

A

Non-inflammatory

Inflammatory

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3
Q

What are the subtypes of inflammatory arthritis?

A

Seropositive arthritis

Seronegative Inflammatory Arthropathy

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4
Q

What conditions are in the Seropositive arthritis group?

A 
Rheumatoid Arthritis 
Scleroderma 
Lupus
Vasculitis 
Sjogren's
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5
Q

What conditions are in the Seronegative Arthritis group?

A

Ankylosing Spondylitis
Psoriatic arthritis
Reactive Arthritis
IBD Arthritis

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6
Q

What are autoantibodies?

A

antibodies generated by the immune system against the bodies own proteins, usually within cells, by which loss of regulation results in destruction as if it was a foreign threat.

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7
Q

What causes OA?

A

Mismatch of wear and repair of cartilage within joints.

Familial link (no genetic cause) 
Environmental factors 
Hobbies 
Types of work 
Previous injuries (secondary OA)
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8
Q

List some of the common injuries associated with Secondary OA

A 
Congenital hip dislocation 
Perthes 
SUFE 
Previous intra-articular fracture 
Extra-articular fracture with malunion 
Osteochondral/hyaline cartilage injury 
Crystal arthropathy 
Inflammatory arthritis 
Meniscal tears 
Genu Varum or Valgum
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9
Q

What are the radiographical findings of an osteoarthritic joint?

A

LOSS

Loss of joint space
Osteophytes
Sclerosis (bone looks more white)
Subchondral cysts

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10
Q

What are some of the treatment options for OA?

A

Weight loss
Exercise

Analgesia - treat the symptoms
Physio may help strengthen surrounding structures

Intra-articular steroid injections
Joint replacement

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11
Q

What is the mainstay treatment for inflammatory arthropathies?

A

Simple analgesia
Anti-inflammatory (steroids/NSAIDs)
Steroid injections
Diseases Modifying Anti Rheumatic Drugs (DMARDs)

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12
Q

What features are suggestive of joint inflammation?

A 
Pain with swelling 
Morning Stiffness 
Improvement in symptoms with exercise 
Synovitis on examination 
Raised inflammatory markers (CRP and plasma viscosity) 
Extra-articular symptoms
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13
Q

What is the pathogenesis of Rheumatoid Arthritis?

A

Trigger (smoking, infection, trauma)
Immune response against synovium
Inflammatory pannus forms, attacking and denuding articular cartilage, leading to joint destruction
Tendon ruptures, soft tissue damage may occur
Joint instability and subluxation

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14
Q

What are clinical features of RA?

A

Symmetrical synovitis
Pain
Morning stiffness
NB - hands and feet have earliest involvement - MCP, PIPs, wrists, but not DIP.

Extra-articular features:
Rheumatoid nodules (extensor surfaces)
Lung involvement - pleural effusion, interstitial fibrosis, nodules
Increased CV risk
Ocular involvement - keraconjunctivitis sicca, episcleritis, uveitis, nodular scleritis, may lead to scleromalacia

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15
Q

Ix for RA?

A

Rheumatoid Factor and Anti CCP
CRP, ESR and plasma viscosity raised
X-Ray may be normal or show periarticular osteopenia, soft tissue swelling, periarticuar erosions
US may show synovial inflammation

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16
Q

Tx for RA?

A

Aim to commence DMARDs within 3 months of symptom onset.
First line - methotrexate

Analgesia, NSAIDs, IM/IA and oral steroids

If unresponsive to DMARDs - Biologics

Physio, OT, pods and orthotists

Surgical intervention

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17
Q

List types of DMARD

A

Methotrexate
Sulphasalazine
Hydroxychloroquine
Leflunomide

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18
Q

List types of Biologic Treatment

A

Anti-TNF injections
Toclizumab
Rituximab
Abatacept

19
Q

How is disease activity in RA measured?

A

DAS28 Scoring

20
Q

What surgical options are there for RA?

A 
Synovectomy 
Joint replacement 
Joint excision 
Tendon transfers 
Arthrodesis 
Cervical spine stabilisation
21
Q

What is Ankylosing Spondylitis?

A

chronic inflammatory condition of the spine and SI joints. May lead to eventual fusion of the intervertebral joints and SI joints.

22
Q

Presentation of Ankylosing Spondylitis?

A

Spinal pain and stiffness
May develop knee or hip arthritis
Morning stiffness, improvement with exercise

23
Q

What happens to the spine over time in Ankylosing Spondylitis?

A

Loss of movement
Development of ? spine
Loss of lumbar lordosis and increased thoracic kyphosis

24
Q

What test is used for lumbar spine flexion?

A

Schober’s (normal >20cm)

25
Q

What are the associated conditions with ankylosing spondylitis?

A

Anterior uveitis
Aortitis
PF
Amyloidosis

26
Q

What are the treatment options for ankylosing spondylitis?

A

Physio
Excerise
NSAIDs
Anti-TNF inhibitors if aggressive disease

May require surgical intervention if indicated

27
Q

Common clinical features of Psoriatic Arthritis

A 
Asymmetrical oligoarthritis 
Spondylitis 
Dactylitis 
Enthesitis
Nail changes (pitting and onycholysis)
28
Q

Tx for Psoriatic Arthritis?

A

Similar to RA - DMARDs (methotrexate) -> Anti-TNF -> Surgery

29
Q

What types of infection may trigger reactive arthritis?

A

Genitourinary and GI

30
Q

What is Reiter’s Syndrome, and what is the treatment?

A

triad of symptoms - urethritis, uveitis or conjunctivitis, and arthritis

Tx - treat underlying infection and symptoms relief

31
Q

Give examples of Connective Tissue Diseases

A 
Systemic Lupus Erythematosus (SLE) 
Sjogren's 
Systemic Sclerosis 
Mixed Connective Tissue Disease (MCTD)
Anti-phospholipid Syndrome
32
Q

What is the pathology in Sjogren’s Syndrome?

A

Lymphocytic infiltrates in exocrine organs

33
Q

What are the clinical features of Sjogren’s Syndrome?

A

Dryness of the mouth and eyes

Arthralgia
Fatigue
Vaginal Dryness
Parotid gland swelling

34
Q

How is Sjogren’s Syndrome diagnosed?

A

Confirmed ocular dryness (Schirmers test)
Positive Anti-Ro and Anti-La antibodies
Typical features of lip gland biopsy

35
Q

How is Sjogren’s managed?

A

Symptomatic - eyedrops and saliva replacement products (pilocarpine - SE = flushing)
Dental care
Hydroxychloroquine for arthralgia and fatigue

36
Q

Characteristics of Systemic Sclerosis

A

Vasomotor disturbance (Raynauds)
Fibrosis and atrophy of the skin and subcutaneous tissue
Excess collagen deposits causes skin and internal organ changes
Pinching of nose (beaking) and facial changes
Telangiectasia
Calcinosis

Death tends to be due to renal and lung changes - pulmonary HTN = 12% deaths

37
Q

What are the 3 phases of cutaneous involvement of systemic sclerosis?

A
  1. Oedematous

2. Indurai

38
Q

What features of Systemic Sclerosis are considered minor vs major, and when is diagnosis made?

A

Minor - sclerodactyly and atrophy of fingertips and bilateral lung fibrosis

Major - centrally located skin sclerosis of arms, face or neck

Diagnosis - 1 major, 2 minor

39
Q

Give examples of how Systemic Sclerosis may affect different organ systems

A

Resp - Po HTN, Fibrosis
Renal - accelerated HTN leading to renal crisis
GI - dysphagia, malabsorption, bacterial overgrowth of small bowel
MSK - inflammatory arthritis, myositis

40
Q

What is the difference between limited and diffuse systemic sclerosis?

A

Limited - skin involvement confined to hands, face, forearms and feet - ANCA association

Diffuse - skin changed develop rapidly, involve the trunk, early organ involvement - Anti-Scl-70 association

41
Q

What is the management of systemic sclerosis?

A

Manage specific issues:
Reynauds, ulcers - CCBs, iloprost, bosentan

Renal - ACEis
GI - PPIs for reflux
ILD - immunosuppression (cyclophosphamide)

42
Q

Define MCTD

A

Mixed connective tissue disease - condition featuring symptoms seen in other connective tissue diseases (reynauds, arthritis, myositis, sclerodactyly, Po HTN, ILD)

43
Q

Which antibodies are associated with MCTD?

A

Anti-RNP

44
Q

Management of MCTD?

A

Screening for Po HTN (echo) and ILD

Manage symptoms - CCBs etc

Y2 MSK (5 decks)

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