Inflammatory Arthritis Flashcards
(109 cards)
1
Q
What is the effect of smoking on rheumatoid arthritis?
A
reduces prognosis
less responsive to treatment
2
Q
what is rheumatoid arthritis?
A
a chronic inflammatory disease of the joints- symmetrical polyarthritis
3
Q
What is the main pathology behind rheumatoid arthritis?
A
- 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
4
Q
what are the main 4 symptoms of rheumatoid arthritis?
A
joint pain stiffness joint swelling general (eg malaise, fatigue) \+ any extra-articular features
5
Q
what are the main 3 clinical signs of rheumatoid arthritis?
A
(boggy) swelling
tenderness
reduced range of movement
6
Q
why can rheumatoid arthritis result in dry eyes?
A
inflammation and then fibrosis of the lacrimal gland causing reduced tear production
7
Q
why can rhuematoid arthritis result in a dry mouth?
A
inflammation and then fibrosis of the salivary gland causing reduced saliva production
8
Q
compare pulmonary fibrosis caused by rheumatoid arthritis to idiopathic pulmonary fibrosis?
A
pulmonary fibrosis caused by rheumatoid arthritis is much less aggressive
9
Q
what cytokine produced in the rheumatoid arthritis process causes osteoporosis?
A
IL-6
10
Q
what are the 2 main antibodies involved in rheumatoid arthritis?
A
anti-CCP
Rheumatoid Factor
(not everyone has both or any of these)
11
Q
what is the best radiological investigation for rheumatoid arthritis?
A
ultrasound
12
Q
what is the main treatment used for rheumatoid arthritis?
A
methotrexate
13
Q
what are the 4 biologics that have achieved major impact in rheumatoid arthritis?
A
- anti-TNF (infliximab)
- B cell depletion (rituximab)
- disruption of T cell co-stimulation (abatacept)
- IL-1 inhibiaiton (anankira) or IL-6 inhibition (tocilizumab)
14
Q
What is soft tissue rheumatism?
A
pain caused by inflammation/damage to ligaments, tendons, muscles or nerve near a joint rather than the bone or cartilage
(pain is very localised)
15
Q
how many joints are affected in polyarthritis?
A
4+
16
Q
how does rheumatoid arthritis increase CV risk?
A
pro-inflammatory conditions increase risk of atheroma
17
Q
What are spondyloarthropathies?
A
a family of inflammatory arthritides characterised by involvement of both spine and peripheral joints
18
Q
what HLA type do genetically predisposed individuals to ankylosing spondylitis commonly have?
A
HLA B27
19
Q
what are the 4 disease subgroups of spondyloarthropathies?
ie 4 inflammatory arthritides that can have spinal involvement
A
ankylosing spondylitis
psoriatic arthritis
reactiv arthritis
enteropathic arthritis
20
Q
compare mechanical back pain to inflammatory back pain in terms of response to activity?
A
mechanical back pain: worsened by activity
inflammatory back pain: better with activity
21
Q
what is an enthesis?
A
a sit of insertion of a tendon, ligament or articular capsule into the bone
22
Q
what is enthesitis?
A
inflammation of an insertion site on a bone
23
Q
what is dactylitis?
A
inflamamtion of entire digit
sausage digits
24
Q
what is the most common type of juvenile inflammatory arthritis?
A
oligoarticular arthritis
25
what is the location and distrubution of oligoarticular arthritis?
large limbs in an asymmetrical pattern
26
what is ankylosing spondylitis?
a chronic systemic inflammatory disorder that primarily affects the spine
(a spondyloarthropathy)
27
what joint involvement is the hallmark of ankylosing spondylitis?
sacroiliac joint involvement
--> sacroilits
28
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
29
who tends to get ankylosing spondylitis?
men in early adulthood
30
what does exercise do to the pain felt in ankylosing spondylitis?
relieves pain
| because ankylosing spondylitis is an inflammatory condition
31
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
```
32
what test is good for assessing flexion of the lumbar spine?
schober's test
33
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
```
34
what is a syndesmophyte?
a bony growth originating inside a ligament
35
what is the treatment of ankylosing spondylitis?
```
physiotherapy and home exercises
NSAIDs
immunosuppressants (but only if peripheral involvement)
biologics
steroids
```
36
What is psoriatic arthritis?
an inflammatory arthritis associated with psoriasis
37
is rheumatoid factor present in psoriatic arthritis?
no
38
what are the 5 main presentations of psoriatic arthritis?
1. sacroilitis (spondyloarthropathy)
2. nail involvement (pitting, onycholysis, hyperkeratosis)
3. dactlitis
4. enthesitis
5. extra-artcicular features (eg eye disease)
39
what are the 5 clinical subgroups of psoriatic arthritis?
1. confined to DIP joints in hands and feet
2. symmetrical polyarthritis (similar to RA)
3. spinal involvement
4. asymmetrical oligoarthriis
5. arthritis mutilans
40
what is the treatment of psoriatic arthritis?
```
physiotherapy
NSAIDs
steroids joint injections
immunosuppresants
biologics
```
41
What is reactive arthritis?
an infection induced systemic illness characterised by inflammatory synovitis from which micro-organisms cannot be cultures
42
how long after infection does reactive arthritis symptoms present?
1-4 weeks
43
what are the 2 classes of infection which most commonly cause reactive arthritis?
urogenital
| enterogenic
44
what HLA type can predispose to reactive arthritis?
HLA B27
45
who tends to get reactive arthritis?
20-40 y/o
| male and females
46
what is reiter's syndrome?
a form of reactive arthritis with a triad of classical symptoms:
- UTI
- conjuntivits/uveitis/iris
- arthritis
47
what is the treatent of reactive arthritis?
```
physiotherapy
NSAIDs
steroids
antibiotics for underlying infection
immunosuppressants if chronic
(most resolve spontaneously within 6 months)
```
48
what condition is enteropathic arthritis associated with?
inflammatory bowel disease
| typically Crohn's
49
what happens to the enteropathic arthritis symptoms during a flare up of IBD?
joint pain and stiffness becomes worse
50
what is the treatment of enteropathic arthritis?
treat underlying inflammatory bowel disease
+
normal analgesia eg paracetamol, cc-codamol
51
why are NSAIDs not a good idea to use in enteropathic arthritis?
may exacerbate the inflammatory bowel disease
52
what does arthropathy mean?
disease of a joint
53
what does arthralgia mean?
pain in a joint
54
what does arthritis mean?
inflammation of a joint
55
what are the 4 subtypes of inflammatory arthropathy?
seropositive
seronegative
infectious
crystal deposition
56
are spondyloarthropathies seropositive or seronegative?
seronegative
57
is SLE seropostive or seronegative inflammatory arthritis?
seropositive inflammatory arthritis
58
is enteropathic arthritis seropositive or seronegative inflammatory arthritis?
seronegative inflammatory arthritis
59
is ankylosing spondylitis seropositive or seronegative inflammatory arthritis?
seronegative
60
is Sjogren's syndrome seropositve or seronegative inflammatory arthritis?
seropositive
61
is reactive arthritis seropositive or seronegative inflammatory arthritis?
seronegative
62
is rheumatoid arthritis seropositive or seronegative inflammatory arthritis?
seropositive
63
is vasculitis seropositive or seronegative inflammatory arthritis?
seropositive
64
what are the main joints affected in rheumatoid arthritis?
small joints in hands and feet
as disease progresses: knees, shoulders, elbows and others
65
what does the synovium become after being attacked by auto-antibodies?
(inflammatory) pannus
66
which joints in the fingers are typically not involved in rheumatoid arthritis?
DIPs
67
which joints in the hands are typically involved in rheumatoid arthritis?
MCPs and PIPs
68
what important area of in the spine can be affected by rheumatoid arthritis? and what can this cause?
cervical spine causing atlanto-axial sublaxation
this can lead to cervical cord compression
69
where do rheumatoid nodules typically appear?
extensor surfaces or sites of frequent mechanical irritation
70
which is more specific for rheumatoid arthritis- anti-CCP or RF?
anti-CCP
71
when should a DMARD be commenced?
within 3 months of rheumatoid arthritis symptom onset
72
what short term treatments are used for rheumatoid arthritis? (ie for symptom relief)
```
simple analgesia
NSAIDs
intramuscular steroids
intra-articular steroids
oral steroids
```
73
when does a patient with rheumatoid arthritis become eligible for biologic therapy?
when disease doesn't respond to standard DMARD therapy
74
what are the most commonly used biologics used in rheumatoid arthritis?
anti-TNF drugs
75
in advanced ankylosing spondylitis what shape changes in the spine occur?
loss of lumbar lordosis
| increased thoracic kyphosis
76
what is a bamboo spine?
when the intervertebral discs in the spine fuse together
| occurs in ankylosing spondylitis
77
what is the location and distribution of affected joints in enteropathic arthritis?
```
asymmetrical
large joints (can involve spine)
```
78
What are the 2 major classes of drugs for inflammatory arthritis?
symptom relief
or
disease modifiers
79
what are the 2 major classes of drugs that are disease modifiers for the treatment of inflammatory arthritis?
DMARDs (Disease Modifying Anti-Rheumatic Drugs
Biologics
80
what type of NSAIDs reduce the risk of peptic ulceration compared to typical NSAIDs?
COX-2 selective inhibitors
81
why should COX-2 inhibitors not be used in patients with high cardiovascular risk?
COX-2 inhibitors increase cardiovascular risk
| more than COX-1 inhibitors
82
what is Step 1 in the WHO analgesic pathway?
non-opioid (eg paracetamol or NSAID)
| +/- adjuvant (eg anti-convulsant or anti-depressant
83
what is Step 2 in the WHO analgesic pathway?
weak opioid (eg codeine)
+ non-opioid (eg paracetamol or NSAID)
+/- adjuvant (eg anti-convulsant or anti-depressant)
84
what is Step 3 in the WHO analgesic pathway?
strong opioid (eg morphine)
+ non-opioid (eg paracetamol or NSAID)
+/- adjuvant (eg anti-convulsant or anti-depressant)
85
if a DMARD is not enough, should you add another DMARD or switch DMARDs?
add another
86
what is the first choice DMARD in most patients?
methotrexate
87
how is methotrexate administered?
orally or subcutaneous injection
88
why is the subcutaneous injection of methotrexate sometimes preferred to the oral form?
less nausea
89
why must alcohol intake be limited when on a methotrexate?
because methotrexate already increases hepatitis/cirrhosis risk
90
can a patient on methotrexate try to conceive?
no
methotrexate is teratogenic
should be switched to sulfasalazine 3 months before conception
91
what are the first line biologics for inflammatory arthritis?
anti-TNF therapy
| eg etanercept subcut, adalimumab subcut, certolizumab subcut, infliximab IV
92
why are methotrexate and anti-TNF therapy effective in combonation for inflammatory arthritis?
methotrexate suppresses the immune system so prevents the development of antibodies forming to neutralise the anti-TNF
93
why should patients about to receive anti-TNF therapy be screened for latent TB?
anti-TNF can break down the granulomas that were preventing latent TB infection spreading
94
what is a DAS score?
| what does a high DAS score mean?
disease activity score
(for inflammatory arthritis)
the higher the score, the worse the disase progression is
95
```
is anti-TNF used in:
rheumatoid arthritis?
psoriatic arthritis?
ankylosing spondylitis?
connective tissue disease?
```
RA? yes
PA? yes
AS? yes
CTD? no
96
```
is Rituximab used in:
rheumatoid arthritis?
psoriatic arthritis?
ankylosing spondylitis?
connective tissue disease?
```
RA? yes
PA? no
AS? no
CTD? yes
97
what DAS28 scores shows rheumatoid disease remission?
98
what are the 4 main side effects of methotrexate?
| DMARD
myelosuppression (bone marrow suppression)
liver cirrhosis
pneumonitis
teratogenicity
99
what are the 3 main side effects of sulfasalazine?
| DMARD
rashes
(reversible) oligospermia
heinz body anaemia
100
what are the 3 main side effects of leflunomide? (DMARD)
liver impairment
interstitiual lung disease
hypertension
101
what are the 2 main side effects of hydroxychloroquine? (DMARD)
retinopathy
| corneal deposits
102
what are the 6 main side effects of prednisolone?
```
cushingoid features
muscle atrophy
osteoporosis
impaired glucose tolerance
hypertension
cataracts
```
103
what is the main side effect of gold? (DMARD)
proteinuria
104
what are the 2 main side effects of penicillamine? (DMARD)
porteinuria
| exacerbation of myasthenia gravis
105
what are the 2 main side effects of etanercept? (biologic)
demyelination
| reactivation of latent TB
106
what is the main side effect of infliximab? (biologic)
reactivation of latent TB
107
what is the main side effect of adalimumab? (biologic)
reactivation of latent TB
108
what is the main side effect of rituximab? (biologic)
infusion reactions
109
what nodes are found in RA- heberdens or bouchards?
bouchards
| because PIP joints are affected but DIP joints are spared
