Cortext: Artritis Flashcards
What is the most common form of arthritis?
OA
What causes the periodic flaring of symptoms in OA?
Associated inflammation with the OA
List some causes of secondary OA:
Congenital dislocation of the hip
Perthes
SUFE
Previous intra‐articular fracture
Extra‐articular fracture with malunion
Osteochondral / hyaline cartilage injury
Crystal arthropathy
Inflammatory arthritis (can give rise to mixed pattern arthritis)
Meniscal tears
Genu Varum or Valgum
What four signs on x-ray are associated with osteoarthritis?
Loss of joint space
Osteophytes
Sclerosis
Subchondral cysts
(LOSS)
Inflammatory arthropathies can be classified in which 4 groups?
Seronegative
Seropositive
Infectious
Crystal deposition disorders
What is the mainstay of treatment for inflammatory arthropathies?
(4)
Simple analgesia
Anti‐ inflammatory medications (steroids & NSAIDs)
Steroid injections
Disease Modifying Anti Rheumatic Drugs (DMARDs).
Is the pattern of RA symmetrical bilaterally?
Yes
Is the pattern of OA symmetrical bilaterally?
Yes
Is the pattern of Psoriatic Arthritis symmetrical bilaterally?
No
Is the pattern of Inflammatory Spondylitis symmetrical bilaterally?
No,
shoulder, knee etc may be affected as well as back
Name some features which are suggested of joint INFLAMMATION:
(6)
Joint pain with associated swelling Morning stiffness Improvement in symptoms with exercise Synovitis on examination Raised inflammatory markers (CRP and plasma viscosity) Extra-articular symptoms
What type of arthropathy is RA?
Seropositive inflammatory arthropathy
auto‐immune inflammatory symmetric polyarthropathy which most commonly affects the small joints of the hands and feet
How prevalent is RA compared to other seropositive inflammatory arthropathies
Rheumatoid arthritis is the most prevalent seropositive inflammatory arthropathy
How much more likely are women to be affected by RA than men?
Women are 2‐3 times more commonly affected than men.
What is the approximate prevalence rate of RA and at what age does this rate peak?
The prevalence rate is approximately 1%, increasing with age and peaking between the ages of 35 and 50 years.
To what extent to genetic factors account for the risk of developing RA?
Genetic factors account for 50% of the risk for developing RA.
First degree relatives of individuals with RA are at 2- to 3-fold higher risk for the disease
In the disease process of RA, an immune response is initiated againt what?
The synovium, which lines the synovial joints and some tendons.
(Inflammatory pannus forms which then attacks and denudes articular cartilage leading to joint destruction. Tendon ruptures and soft tissue damage can occur leading to joint instability and subluxation.)
What three factors is the diagnosis of RA based upon?
Clinical Presentation
Radiographic finding
Serological analysis
Which (2) scoring systems assist in the diagnosis of RA?
The ACR and EULAR Rheumatoid Arthritis Criteria scoring systems.
Which clinical features are often present in RA?
Symmetrical synovitis (doughy swelling)
Pain
Morning stiffness
MCP and PIP joints affected, as well as wrists
DIP joints NOT affected
What does “synovitis” mean?
Inflammation of synovial membrane
What can happen to the joints of the cervical spine in longstanding RA?
In RA, over time, larger joints can be affected.
On important area is the cervical spine,
In longstanding disease, there may be atlanto-axial subluxation which can result in cervical cord compression.
(between C1 and C2)
(C1 - atlas, C2 - axis)
Subluxation here
–> Cervical cord compression
Which extra-articular manifestations can be seen in RA?
Rheumatoid nodules
(Occur in approx 25% of patients with RA)
(These lesions are most commonly found on extensor surfaces or sites of frequent mechanical irritation.)
Lung involvement:
Pleural effusions
Interstitial Fibrosis
Pulmonary Nodules
CVS:
Cardiovascular morbidity and mortality increased in patients with RA
Ocular involvement is common in patients with RA, includes:
Keratoconjunctivitis sicca (dry eye)
Episcleritis
Uveitis
Nodular scleritis - that may lead to scleromalacia (degeneration/softening of the sclera)
