Inflammatory Arthritis Flashcards
signs that arthritis is inflammatory
> 30 mins of morning stiffness
responds to NSAIDs
acute
signs that back pain is mechanical
worsened by activity, typically worst at the end of the day, better with rest
signs that back pain is inflammatory
worse with rest, better with activity, significant early morning stiffness
what is rheumatoid arthritis
chronic inflammatory autoimmune disorder of unknown aetiology
name a gene linked to RA
HLA DR4
who is RA more common in
females
when does prevalence of RA peak
35-50
what is the most sensitive autoantibody for RA
anti-CCP
describe the pattern of RA
symmetrical polyarthritis
name another autoantibody found in RA
rheumatoid factor
role of rheumatoid factor
targets the Fc portion of IgG resulting in systemic inflammation
what is rheumatoid factor most commonly
IgM
what can anti-CCP often be associated with
current/previous smoking history
what is a negative of anti-CCP
remains positive with treatment so cannot be used to track disease
clinical presentation of RA
symmetrical pain and swelling of (most commonly) the small joints of the hands
early morning stiffness
what type of arthritis can affect C1/2
RA
which joint does RA never affect
DIP joints
what is one of the most common first signs of RA
reduced grip strength
joint deformities associated with RA
swan neck deformity
boutonniere deformity
what is swan neck deformity
PIP hyperextension and DIP flexion
what is boutonniere deformity
PIP flexion and DIP hyperextension
clinical signs of RA
swelling of affected joints
bouchards nodes
what are bouchards nodes
bony swellings of proximal IPJ
bloods in RA
raised inflammatory markers
autoantibodies
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
