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musculoskeletal > Inflammatory Arthritis > Flashcards

Inflammatory Arthritis Flashcards

1
Q

signs that arthritis is inflammatory

A

> 30 mins of morning stiffness
responds to NSAIDs
acute

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2
Q

signs that back pain is mechanical

A

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

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3
Q

signs that back pain is inflammatory

A

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

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4
Q

what is rheumatoid arthritis

A

chronic inflammatory autoimmune disorder of unknown aetiology

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5
Q

name a gene linked to RA

A

HLA DR4

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6
Q

who is RA more common in

A

females

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7
Q

when does prevalence of RA peak

A

35-50

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8
Q

what is the most sensitive autoantibody for RA

A

anti-CCP

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9
Q

describe the pattern of RA

A

symmetrical polyarthritis

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10
Q

name another autoantibody found in RA

A

rheumatoid factor

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11
Q

role of rheumatoid factor

A

targets the Fc portion of IgG resulting in systemic inflammation

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12
Q

what is rheumatoid factor most commonly

A

IgM

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13
Q

what can anti-CCP often be associated with

A

current/previous smoking history

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14
Q

what is a negative of anti-CCP

A

remains positive with treatment so cannot be used to track disease

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15
Q

clinical presentation of RA

A

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

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16
Q

what type of arthritis can affect C1/2

A

RA

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17
Q

which joint does RA never affect

A

DIP joints

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18
Q

what is one of the most common first signs of RA

A

reduced grip strength

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19
Q

joint deformities associated with RA

A

swan neck deformity
boutonniere deformity

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20
Q

what is swan neck deformity

A

PIP hyperextension and DIP flexion

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21
Q

what is boutonniere deformity

A

PIP flexion and DIP hyperextension

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22
Q

clinical signs of RA

A

swelling of affected joints
bouchards nodes

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23
Q

what are bouchards nodes

A

bony swellings of proximal IPJ

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24
Q

bloods in RA

A

raised inflammatory markers
autoantibodies

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25
Q

what causes osteopenia

A

hyperaemia

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26
Q

imaging of RA

A

XR of hands and feet

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27
Q

signs of early disease of RA on XR

A

soft tissue swelling and periarticular osteopenia

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28
Q

signs of late disease of RA on XR

A

erosions and subluxation

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29
Q

what can be useful in detecting synovial inflammation

A

USS

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30
Q

what is used to score disease activity of RA

A

das28

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31
Q

what can be used for short term symptomatic relief of RA

A

analgesia, NSAIDs, steroids

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32
Q

first line management of RA

A

methotrexate

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33
Q

DMARDs that are safe in pregnancy

A

sulfasalazine
hydroxychloroquine

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34
Q

name some side effects of DMARDs

A

bone marrow suppression, infection, liver function derangement, nausea

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35
Q

when would you try a different type of drug for RA

A

tried 2 DMARDs and patient still has a das28 >3.2

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36
Q

give an example of a second line drug in RA

A

infliximab

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37
Q

what gene are spondyloarthropathies positive for

A

HLA B27

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38
Q

name the 4 spondyloarthropathies

A

ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis

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39
Q

main features of spondyloarthropathies

A

synovitis
enthesitis
dactylitis

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40
Q

name some extra-articular features of spondyloarthropathies

A

ocular inflammation
mucocutaneous lesions
no rheumatoid nodules

41
Q

what is ankylosing spondylitis

A

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

42
Q

who is more likely to get ankylosing spondylitis

A

men

43
Q

when does ankylosing spondylitis usually onset

A

late adolescence or early adulthood

44
Q

clinical presentation of ankylosing spondylitis

A

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

45
Q

what is a sign of late ankylosing spondylitis

A

loss of lumbar kyphosis with pronounced cervical lordosis

46
Q

examination test for ankylosing spondylitis

A

schobers test

47
Q

extra-articular features of ankylosing spondylitis

A

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

48
Q

bloods in ankylosing spondylitis

A

raised inflammatory markers
HLA B27

49
Q

XR finding on ankylosing spondylitis

A

bamboo spine

50
Q

first line management of ankylosing spondylitis

A

NSAIDs

51
Q

second line management of ankylosing spondylitis

A

anti-TNF

52
Q

pencil cup deformity on XR

A

psoriatic arthritis

53
Q

what does asymmetrical oligoarthritis affect

A

1-4 joints on the same side of the body

54
Q

where does psoriatic arthritis tend to affect

A

distal interphalangeal joints and axial skeleton

55
Q

clinical signs of psoriatic arthritis

A

plaques
nail pitting
onycholitis

56
Q

what is used for screening for arthritis in patients with psoriasis

A

PEST

57
Q

characteristic XR changes in psoriatic arthritis

A

periostitis
ankylosis
osteolysis
dactylitis

58
Q

what is ankylosis

A

fixation/fusion of the bones at the joint

59
Q

first line management of psoriatic arthritis

A

NSAIDs

60
Q

who gets enteropathic arthritis

A

patients with IBD

61
Q

pathophysiology of enteropathic arthritis

A

organisms with high lipopolysaccharides in cell wall trigger immune reaction

62
Q

investigations for enteropathic arthritis

A

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

63
Q

what is reactive arthritis

A

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

64
Q

most common preceding infections for reactive arthritis

A

urogenital or enterogenic

65
Q

who usually presents with reactive arthritis

A

20-40

66
Q

pathophysiology of reactive arthritis

A

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

67
Q

clinical presentation of reactive arthritis

A

acute monoarthritis

68
Q

bloods in reactive arthritis

A

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

69
Q

management of reactive arthritis

A

symptomatic relief, most cases are self-limiting

70
Q

what is reiters syndrome

A

a form of reactive arthritis

71
Q

clinical presentation of reiters syndrome

A

triad of symptoms: urethritis, conjunctivitis, arthritis

72
Q

what is gout

A

crystal arthropathy associated with high blood uric acid levels

73
Q

what are the 2 main causes of gout

A

increased urate production
reduced urate excretion

74
Q

name some causes of increased urate production

A

high dietary purine intake
alcohol
psoriasis
haemolytic disorders

75
Q

name some causes of reduced urate excretion

A

chronic renal impairment
hypothyroidism
diuretics
cytotoxics e.g. cyclosporin

76
Q

who is gout more common in

A

men

77
Q

histology of gout

A

gouty tophi

78
Q

what are gouty tophi

A

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

79
Q

classic presentation of acute gout

A

monoarthropathy of the first metatarsalphalangeal joint
abrupt onset - overnight

80
Q

bloods in gout

A

raised serum uric acid
raised inflammatory markers

81
Q

aspiration of synovial fluid in gout

A

needle shaped, negative birefringent crystals

82
Q

first line management of acute gout

A

NSAIDs

83
Q

what is an alternative management of gout

A

colchicine

84
Q

prophylaxis of gout

A

allopurinol

85
Q

what is pseudogout

A

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

86
Q

who is pseudogout more common in

A

elderly

87
Q

what is another name for pseudogout

A

chondrocalcinosis

88
Q

what joint is most commonly affected by pseudogout

A

knee

89
Q

usual presentation of pseudogout

A

incidental finding on x-ray

90
Q

clinical presentation of symptomatic pseudogout

A

painful, hot, swollen joint

91
Q

investigation for pseudogout

A

aspiration of synovial fluid

92
Q

aspiration of pseudogout

A

calcium pyrophosphate crystals are envelope shaped, mild positively birefringent

93
Q

management of acute episodes of pseudogout

A

NSAIDs, colchicine, steroids, rehydration

94
Q

who usually presents with acute calcific tendonitis

A

females, 50-60

95
Q

pathophysiology of acute calcific tendonitis

A

hydroxyapatite crystal deposition in the supraspinatus tendon

96
Q

clinical presentation of acute calcific tendonitis

A

acute onset severe shoulder pain

97
Q

x-ray finding of acute calcific tendonitis

A

calcification proximal to the greater tuberosity

98
Q

management of acute calcific tendonitis

A

NSAIDs, subacromial steroid and local anaesthetic injections

musculoskeletal (30 decks)

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