Deck 1 Flashcards
Name 4 conditions that present with Monoarthritic presentation
Septic arthritis
Crystal arthritis (gout cppd)
Osteoarthritis
Trauma (haemarthrosis)
Name 5 conditions that present with Oligoarthritis presentation
Crystal arthritis Psoriatic arthritis Reactive arthritis (yersinia, salmonella, campylobacter) Ankylosing spondylitis Osteoarthritis
Name 4 conditions that present with SYMMETRICAL polyarthritis presentation
Rheumatoid
Osteoarthritis
Viruses (hep a/b/c/mumps)
Systemic conditions
Name 2 conditions that present with ASYMMETRICAL polyarthritis presentation
Reactive arthritis
Psoriatic arthritis
How do u assess the locomotor system
Gait Arms Legs Spine Range of movement
Name the Rheumatological Investigations
Joint aspiration (look for blood, pus, crystals)
FBC, ESR, CRP, U+E
Urate
Blood culture for septic arthritis
Radiology: US, MRI – effusions, synovitis, enthesitis, infection, erosions, calcifications, widening/loss of joint space, changes in underlying bone
CXR: RA, vasculitis, TB, sarcoid
X-ray features of osteoarthritis
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts
X-ray ft of rheumatoid arthritis
Juxta-articular osteopenia
Soft tissue swelling
Joint deformity
Loss of joint space
X-ray ft of gout
Periarticular erosions
Normal joint space
Soft tissue swelling
Causes for 15-30yo
Prolapsed disc (MRI), trauma, fractures
Ankylosing spondylitis
Spondylolisthesis
Pregnancy
Causes for 30-50yo
Degenerative spinal disease
Prolapsed disc (MRI)
Ca secondary from lung/breast/prostate/thyroid/kidney
Causes of pain for >50yo
Degenerative Osteoporotic vertebral collapse Paget’s (ALP) Ca (PSA) Myeloma (serum/ urine electrophoresis) Spinal stenosis
Name 4 neurosurgical emergencies
Acute cauda equina compression
Acute cord compression
Immediate urgent treatment
Mets
What is osteoarthritis
Most common joint condition
Usually primary, secondary to joint disease or other conditions
Signs and symptoms of OA
Pain on movement, worse at end of day
Background pain at rest
Stiffness after rest
Joint tenderness/derangement
Rx for OA
Exercise, wt loss if overweight
Regular paracetamol +/- topical NSAIDs
Codeine, short term oral NSAID +PPI
Intra-articular hyaluronic acid injfections
Physio/OT
Heat/cold packs at site of pain/walking aids
Inv for Septic arthritis
Urgent joint aspiration for synovial fluid microscopy + culture
X-ray (may be normal)
CRP (may be normal)
Blood culture to guide ABx
Rx of Septic arthritis
Empirical IV Abx after aspiration Follow local guidelines for ABx choice Flucloxacillin 1g/6h Vancomycin if MRSA Cefotaxime (gonococcal or Gram -ve) Ortho for arthrocentesis, lavage and debridement
Presentation of rheumatoid arthritis
Symmetrical deforming peripheral polyarthritis, swollen painful and stiff small joints of hands and feet – worse in morning
HLADR4/DR1 linked
Increased incidence in females + smokers
Less common presentation of RA
Widespread sudden onset of arthritis
Recurring mono/polyarthritis of various joints
Systemic illness with extra-articular symptoms
Signs of RA
Early - swollen MCP, PIP, wrist or MTP joints (symmetrical) - tenosynovitis or bursitis Late - joint damage + deformity - boutonniere and swan-neck deformities of fingers Extra-articular - vasculitis, lymphadenopathy, fibrosing alveolitis - pleural + pericardial effusion - Raynauds - carpal tunnel syndrome - splenomegaly, episcleritis, scleritis
INV for RA
Rheumatoid factor
Anticyclic citrullinated peptide bodies (ACPA / Anti-CCP)
Inc ESR
Inc CRP
Inc Platelets
X-ray: bony erosions, subluxation, carpal destruction
US + MRI: synovitis
Rx for RA
Refer early to rheumatologist
DAS28 to measure disease activity (reduce score to <3)
DMARDs early use w/ biological agents
Steroids (methylprednisolone)
NSAIDs (paracet + codeine ineffective)
Atherosclerosis accelerate in RA thus manage risk factors + smoking
Criteria for diagnosing RA
Joint involvement
Serology
Acute phase reactants
Duration of symptoms
Biological agents and NICE guidance shows 4 approaches
TNFA-alpha inhibitors
B cell depletion
IL-1 and IL6 inhibition
Disruption of T-cell function
How does gout present
severe acute monoarthropathy of the metatarsophalangeal joint of the big toe
polyarticular including: ankle, foot, small joints of hand, wrist elbow knee
DD of gout
Haemarthrosis, cppd, palindromic RA
Causes of gout
Inc dietary purines Alcohol excess Diuretics Leukaemia Cytotoxics
Inv for gout
Polarised light microscopy of synovial fluid = urate crystals
Serum urate
X-rays: soft tissue swelling
Rx for gout
NSAID or coxib Colchicine Steroids Rest and elevate affected joint Allopurinol to decrease attacks, inc dose every 2w, admin 3w after 1st attack Febuxostat Uricosuric durgs
