Inflammatory arthritis Flashcards
What does inflammatory arthritis cover?
Connective tissue disease
Vasculitis
Seropositive
- Rheumatoid arthritis
Seronegative
- Ankylosing spondylitis
- Psoriatic arthritis
- Reactive arthritis
- IBD arthritis
What are the characteristics of RA?
- Symmetrical polyarthritis
- Pain
- Swelling
- Stiffness
- Rapid onset or over months-years
What joints does RA most commonly affect?
Small o Wrist o Ankle o MCP o PIP
Large
o Knees
o Shoulders
o Elbows
DIP = OA
What antibodies are associated with RA?
Rheumatoid factor
- Sensitive
Anti-CCP
- Pre-date development of RA
What are the XR changes in RA?
o Normal in most cases o Loss of joint space o Soft tissue swelling o Periarticular erosions o Subluxation
What examination findings might you find in the hands for RA?
o Joint palpation – boggy
o Z shaped deformity of the thumb
o Swan neck deformity (hyperextended PIP with flexed DIP)
o Boutonnieres deformity (hyperextended DIP with flexed PIP)
o Ulnar deviation of the fingers at the knuckle (MCP joints)
What are the extra-articular findings of RA?
General
o Rheumatoid nodules
o Palmar erythema; nailfold infarcts; ulceration
Cardiorespiratory
o Pulmonary fibrosis with pulmonary nodules (Caplan’s syndrome)
o Pleural effusions
o Pericardial effusion; pericarditis
Syndromes
o Felty’s syndrome (RA + splenomegaly + neutropenia)
o Sjogren’s Syndrome
o Amyloidosis
Ophthalmology
o Episcleritis and scleritis; scleromalacia perforans
Haematology
o Anaemia of chronic disease (normochromic normocytic anaemia)
o Lymphadenopathy
Neurological
o Carpal tunnel; peripheral neuropathy; mononeuritis multiplex; atlanto-axial subluxation
How do you monitor RA and response to treatment?
DAS28 score
What is the management for short-term relief of RA symptoms?
- Steroids
- NSAIDs + PPI
What is the long-term management of RA symptoms?
1st = methotrexate, lefunomide, sulfasalzine or hydroxycholorquine (mild disease) 2nd = 2 combines 3rd = methotrexate + biological therapy
What happens in pregnancy and RA?
- Improvement in symptoms due to hormones
Which RA drugs are safe in pregnancy?
- Hydrocychloroquine
- Sulfasalazine
What is the presentation of psoriatic arthritis?
• Insidious onset
Recognised patterns: o Symmetrical polyarthritis - More common in women - Hands, wrists, ankles and DIPJs are affected o Asymmetrical pauciarthritis - Digits and feet o Spondylitic - More common in men - Back stiffness, sacroiliitis, atlanto-axial joint involvement
What are the signs of psoriatic arthritis?
- Scalp psoriasis
- Psoriatic nail changes
- Onycholysis
- Dactylitis
- Enthesitis (tendon inflammation)
What are the XR findings of psoriatic arthritis?
- Periostitis (Thickened and irregular bone outline)
- Ankylosis (Bones join together)
- Osteolysis (Bone destruction)
- Pencil-in-cup
