Inflammatory Arthritis Flashcards by Evie Mander

signs that arthritis is inflammatory

> 30 mins of morning stiffness
responds to NSAIDs
acute

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signs that back pain is mechanical

worsened by activity, typically worst at the end of the day, better with rest

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signs that back pain is inflammatory

worse with rest, better with activity, significant early morning stiffness

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what is rheumatoid arthritis

chronic inflammatory autoimmune disorder of unknown aetiology

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name a gene linked to RA

HLA DR4

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who is RA more common in

females

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when does prevalence of RA peak

35-50

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what is the most sensitive autoantibody for RA

anti-CCP

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describe the pattern of RA

symmetrical polyarthritis

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name another autoantibody found in RA

rheumatoid factor

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role of rheumatoid factor

targets the Fc portion of IgG resulting in systemic inflammation

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what is rheumatoid factor most commonly

IgM

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what can anti-CCP often be associated with

current/previous smoking history

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what is a negative of anti-CCP

remains positive with treatment so cannot be used to track disease

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clinical presentation of RA

symmetrical pain and swelling of (most commonly) the small joints of the hands
early morning stiffness

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what type of arthritis can affect C1/2

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which joint does RA never affect

DIP joints

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what is one of the most common first signs of RA

reduced grip strength

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joint deformities associated with RA

swan neck deformity
boutonniere deformity

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what is swan neck deformity

PIP hyperextension and DIP flexion

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what is boutonniere deformity

PIP flexion and DIP hyperextension

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clinical signs of RA

swelling of affected joints
bouchards nodes

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what are bouchards nodes

bony swellings of proximal IPJ

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bloods in RA

raised inflammatory markers
autoantibodies

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what causes osteopenia

hyperaemia

imaging of RA

XR of hands and feet

signs of early disease of RA on XR

soft tissue swelling and periarticular osteopenia

signs of late disease of RA on XR

erosions and subluxation

what can be useful in detecting synovial inflammation

USS

what is used to score disease activity of RA

das28

what can be used for short term symptomatic relief of RA

analgesia, NSAIDs, steroids

first line management of RA

methotrexate

DMARDs that are safe in pregnancy

sulfasalazine hydroxychloroquine

name some side effects of DMARDs

bone marrow suppression, infection, liver function derangement, nausea

when would you try a different type of drug for RA

tried 2 DMARDs and patient still has a das28 >3.2

give an example of a second line drug in RA

infliximab

what gene are spondyloarthropathies positive for

HLA B27

name the 4 spondyloarthropathies

ankylosing spondylitis psoriatic arthritis reactive arthritis enteropathic arthritis

main features of spondyloarthropathies

synovitis enthesitis dactylitis

name some extra-articular features of spondyloarthropathies

ocular inflammation mucocutaneous lesions no rheumatoid nodules

what is ankylosing spondylitis

chronic inflammatory disease of the axial skeleton that leads to partial or even complete fusion and rigidity of the spine

who is more likely to get ankylosing spondylitis

men

when does ankylosing spondylitis usually onset

late adolescence or early adulthood

clinical presentation of ankylosing spondylitis

gradual onset spine/neck pain morning stiffness lower back pain improves with exercise

what is a sign of late ankylosing spondylitis

loss of lumbar kyphosis with pronounced cervical lordosis

examination test for ankylosing spondylitis

schobers test

extra-articular features of ankylosing spondylitis

5As A – Anterior uveitis A – Aortic regurgitation A – Atrioventricular block (heart block) A – Apical lung fibrosis (fibrosis of the upper lobes of the lungs) A – Anaemia of chronic disease

bloods in ankylosing spondylitis

raised inflammatory markers HLA B27

XR finding on ankylosing spondylitis

bamboo spine

first line management of ankylosing spondylitis

NSAIDs

second line management of ankylosing spondylitis

anti-TNF

pencil cup deformity on XR

psoriatic arthritis

what does asymmetrical oligoarthritis affect

1-4 joints on the same side of the body

where does psoriatic arthritis tend to affect

distal interphalangeal joints and axial skeleton

clinical signs of psoriatic arthritis

plaques nail pitting onycholitis

what is used for screening for arthritis in patients with psoriasis

PEST

characteristic XR changes in psoriatic arthritis

periostitis ankylosis osteolysis dactylitis

what is ankylosis

fixation/fusion of the bones at the joint

first line management of psoriatic arthritis

NSAIDs

who gets enteropathic arthritis

patients with IBD

pathophysiology of enteropathic arthritis

organisms with high lipopolysaccharides in cell wall trigger immune reaction

investigations for enteropathic arthritis

upper and lower GI endoscopy joint aspirate to rule out septic arthritis and gout ↑ inflammatory markers

what is reactive arthritis

synovitis in one or more joints in response to an infective trigger

most common preceding infections for reactive arthritis

urogenital or enterogenic

who usually presents with reactive arthritis

20-40

pathophysiology of reactive arthritis

large joints e.g. the knee become inflamed around 1‐3 weeks following the infection

clinical presentation of reactive arthritis

acute monoarthritis

bloods in reactive arthritis

↑ inflammatory markers, FBC, U+Es, LFTs, HLA B27

management of reactive arthritis

symptomatic relief, most cases are self-limiting

what is reiters syndrome

a form of reactive arthritis

clinical presentation of reiters syndrome

triad of symptoms: urethritis, conjunctivitis, arthritis

what is gout

crystal arthropathy associated with high blood uric acid levels

what are the 2 main causes of gout

increased urate production reduced urate excretion

name some causes of increased urate production

high dietary purine intake alcohol psoriasis haemolytic disorders

name some causes of reduced urate excretion

chronic renal impairment hypothyroidism diuretics cytotoxics e.g. cyclosporin

who is gout more common in

men

histology of gout

gouty tophi

what are gouty tophi

painless white accumulations of uric acid which can occur in the soft tissues

classic presentation of acute gout

monoarthropathy of the first metatarsalphalangeal joint abrupt onset - overnight

bloods in gout

raised serum uric acid raised inflammatory markers

aspiration of synovial fluid in gout

needle shaped, negative birefringent crystals

first line management of acute gout

NSAIDs

what is an alternative management of gout

colchicine

prophylaxis of gout

allopurinol

what is pseudogout

deposition of calcium pyrophosphate in the joints and soft tissues leads to inflammation

who is pseudogout more common in

elderly

what is another name for pseudogout

chondrocalcinosis

what joint is most commonly affected by pseudogout

knee

usual presentation of pseudogout

incidental finding on x-ray

clinical presentation of symptomatic pseudogout

painful, hot, swollen joint

investigation for pseudogout

aspiration of synovial fluid

aspiration of pseudogout

calcium pyrophosphate crystals are envelope shaped, mild positively birefringent

management of acute episodes of pseudogout

NSAIDs, colchicine, steroids, rehydration

who usually presents with acute calcific tendonitis

females, 50-60

pathophysiology of acute calcific tendonitis

hydroxyapatite crystal deposition in the supraspinatus tendon

clinical presentation of acute calcific tendonitis

acute onset severe shoulder pain

x-ray finding of acute calcific tendonitis

calcification proximal to the greater tuberosity

management of acute calcific tendonitis

NSAIDs, subacromial steroid and local anaesthetic injections