Inflammatory Arthritis Flashcards
What is the effect of smoking on rheumatoid arthritis?
reduces prognosis
less responsive to treatment
what is rheumatoid arthritis?
a chronic inflammatory disease of the joints- symmetrical polyarthritis
What is the main pathology behind rheumatoid arthritis?
- autoantibodies (usually) causing inflammation of the synovium
- synovium proliferates and releases cytokines into synovial space
- cytokines eat into cartilage and bones causing progressive joint destruction
what are the main 4 symptoms of rheumatoid arthritis?
joint pain stiffness joint swelling general (eg malaise, fatigue) \+ any extra-articular features
what are the main 3 clinical signs of rheumatoid arthritis?
(boggy) swelling
tenderness
reduced range of movement
why can rheumatoid arthritis result in dry eyes?
inflammation and then fibrosis of the lacrimal gland causing reduced tear production
why can rhuematoid arthritis result in a dry mouth?
inflammation and then fibrosis of the salivary gland causing reduced saliva production
compare pulmonary fibrosis caused by rheumatoid arthritis to idiopathic pulmonary fibrosis?
pulmonary fibrosis caused by rheumatoid arthritis is much less aggressive
what cytokine produced in the rheumatoid arthritis process causes osteoporosis?
IL-6
what are the 2 main antibodies involved in rheumatoid arthritis?
anti-CCP
Rheumatoid Factor
(not everyone has both or any of these)
what is the best radiological investigation for rheumatoid arthritis?
ultrasound
what is the main treatment used for rheumatoid arthritis?
methotrexate
what are the 4 biologics that have achieved major impact in rheumatoid arthritis?
- anti-TNF (infliximab)
- B cell depletion (rituximab)
- disruption of T cell co-stimulation (abatacept)
- IL-1 inhibiaiton (anankira) or IL-6 inhibition (tocilizumab)
What is soft tissue rheumatism?
pain caused by inflammation/damage to ligaments, tendons, muscles or nerve near a joint rather than the bone or cartilage
(pain is very localised)
how many joints are affected in polyarthritis?
4+
how does rheumatoid arthritis increase CV risk?
pro-inflammatory conditions increase risk of atheroma
What are spondyloarthropathies?
a family of inflammatory arthritides characterised by involvement of both spine and peripheral joints
what HLA type do genetically predisposed individuals to ankylosing spondylitis commonly have?
HLA B27
what are the 4 disease subgroups of spondyloarthropathies?
ie 4 inflammatory arthritides that can have spinal involvement
ankylosing spondylitis
psoriatic arthritis
reactiv arthritis
enteropathic arthritis
compare mechanical back pain to inflammatory back pain in terms of response to activity?
mechanical back pain: worsened by activity
inflammatory back pain: better with activity
what is an enthesis?
a sit of insertion of a tendon, ligament or articular capsule into the bone
what is enthesitis?
inflammation of an insertion site on a bone
what is dactylitis?
inflamamtion of entire digit
sausage digits
what is the most common type of juvenile inflammatory arthritis?
oligoarticular arthritis
what is the location and distrubution of oligoarticular arthritis?
large limbs in an asymmetrical pattern
what is ankylosing spondylitis?
a chronic systemic inflammatory disorder that primarily affects the spine
(a spondyloarthropathy)
what joint involvement is the hallmark of ankylosing spondylitis?
sacroiliac joint involvement
–> sacroilits
in ankylosing spondylitis, peripheral arthritis is uncommon, but if this were to happen, what joints would typically be affected?
big joints
eg shoulder and hip
who tends to get ankylosing spondylitis?
men in early adulthood
what does exercise do to the pain felt in ankylosing spondylitis?
relieves pain
because ankylosing spondylitis is an inflammatory condition
Ankylosing spondylitis is known as the ‘A’ disease- what are the 7 ‘A’ features?
Axial arthritis Anterior uveitis Aortic regurgitation Apical lung fibrosis Amyloidosis Achilles tendinitis plAntar fasciitis
what test is good for assessing flexion of the lumbar spine?
schober’s test
what are the main differences between ankylosing spondylitis spine and osteoarthritis spine?
AS- bone density reduced in late disease fusion of vertebrae syndesmophytes no subchondral sclerosis or cysts
OA- normal bone density reduced joint space but no fusion osteophytes subchondral sclerosis and cysts
what is a syndesmophyte?
a bony growth originating inside a ligament
what is the treatment of ankylosing spondylitis?
physiotherapy and home exercises NSAIDs immunosuppressants (but only if peripheral involvement) biologics steroids
What is psoriatic arthritis?
an inflammatory arthritis associated with psoriasis
is rheumatoid factor present in psoriatic arthritis?
no
what are the 5 main presentations of psoriatic arthritis?
- sacroilitis (spondyloarthropathy)
- nail involvement (pitting, onycholysis, hyperkeratosis)
- dactlitis
- enthesitis
- extra-artcicular features (eg eye disease)
what are the 5 clinical subgroups of psoriatic arthritis?
- confined to DIP joints in hands and feet
- symmetrical polyarthritis (similar to RA)
- spinal involvement
- asymmetrical oligoarthriis
- arthritis mutilans
what is the treatment of psoriatic arthritis?
physiotherapy NSAIDs steroids joint injections immunosuppresants biologics
What is reactive arthritis?
an infection induced systemic illness characterised by inflammatory synovitis from which micro-organisms cannot be cultures
how long after infection does reactive arthritis symptoms present?
1-4 weeks
what are the 2 classes of infection which most commonly cause reactive arthritis?
urogenital
enterogenic