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Musculoskeletal > Inflammatory Arthritis > Flashcards

Inflammatory Arthritis Flashcards

1
Q

What is the effect of smoking on rheumatoid arthritis?

A

reduces prognosis

less responsive to treatment

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2
Q

what is rheumatoid arthritis?

A

a chronic inflammatory disease of the joints- symmetrical polyarthritis

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3
Q

What is the main pathology behind rheumatoid arthritis?

A
  1. autoantibodies (usually) causing inflammation of the synovium
  2. synovium proliferates and releases cytokines into synovial space
  3. cytokines eat into cartilage and bones causing progressive joint destruction
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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
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5
Q

what are the main 3 clinical signs of rheumatoid arthritis?

A

(boggy) swelling
tenderness
reduced range of movement

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6
Q

why can rheumatoid arthritis result in dry eyes?

A

inflammation and then fibrosis of the lacrimal gland causing reduced tear production

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7
Q

why can rhuematoid arthritis result in a dry mouth?

A

inflammation and then fibrosis of the salivary gland causing reduced saliva production

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8
Q

compare pulmonary fibrosis caused by rheumatoid arthritis to idiopathic pulmonary fibrosis?

A

pulmonary fibrosis caused by rheumatoid arthritis is much less aggressive

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9
Q

what cytokine produced in the rheumatoid arthritis process causes osteoporosis?

A

IL-6

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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)

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11
Q

what is the best radiological investigation for rheumatoid arthritis?

A

ultrasound

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12
Q

what is the main treatment used for rheumatoid arthritis?

A

methotrexate

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13
Q

what are the 4 biologics that have achieved major impact in rheumatoid arthritis?

A
  1. anti-TNF (infliximab)
  2. B cell depletion (rituximab)
  3. disruption of T cell co-stimulation (abatacept)
  4. IL-1 inhibiaiton (anankira) or IL-6 inhibition (tocilizumab)
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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)

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15
Q

how many joints are affected in polyarthritis?

A

4+

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16
Q

how does rheumatoid arthritis increase CV risk?

A

pro-inflammatory conditions increase risk of atheroma

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17
Q

What are spondyloarthropathies?

A

a family of inflammatory arthritides characterised by involvement of both spine and peripheral joints

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18
Q

what HLA type do genetically predisposed individuals to ankylosing spondylitis commonly have?

A

HLA B27

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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

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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

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21
Q

what is an enthesis?

A

a sit of insertion of a tendon, ligament or articular capsule into the bone

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22
Q

what is enthesitis?

A

inflammation of an insertion site on a bone

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23
Q

what is dactylitis?

A

inflamamtion of entire digit

sausage digits

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24
Q

what is the most common type of juvenile inflammatory arthritis?

A

oligoarticular arthritis

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25
Q

what is the location and distrubution of oligoarticular arthritis?

A

large limbs in an asymmetrical pattern

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26
Q

what is ankylosing spondylitis?

A

a chronic systemic inflammatory disorder that primarily affects the spine
(a spondyloarthropathy)

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27
Q

what joint involvement is the hallmark of ankylosing spondylitis?

A

sacroiliac joint involvement

–> sacroilits

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28
Q

in ankylosing spondylitis, peripheral arthritis is uncommon, but if this were to happen, what joints would typically be affected?

A

big joints

eg shoulder and hip

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29
Q

who tends to get ankylosing spondylitis?

A

men in early adulthood

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30
Q

what does exercise do to the pain felt in ankylosing spondylitis?

A

relieves pain

because ankylosing spondylitis is an inflammatory condition

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31
Q

Ankylosing spondylitis is known as the ‘A’ disease- what are the 7 ‘A’ features?

A 
Axial arthritis
Anterior uveitis
Aortic regurgitation
Apical lung fibrosis
Amyloidosis
Achilles tendinitis
plAntar fasciitis
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32
Q

what test is good for assessing flexion of the lumbar spine?

A

schober’s test

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33
Q

what are the main differences between ankylosing spondylitis spine and osteoarthritis spine?

A 
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
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34
Q

what is a syndesmophyte?

A

a bony growth originating inside a ligament

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35
Q

what is the treatment of ankylosing spondylitis?

A 
physiotherapy and home exercises
NSAIDs
immunosuppressants (but only if peripheral involvement)
biologics
steroids
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36
Q

What is psoriatic arthritis?

A

an inflammatory arthritis associated with psoriasis

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37
Q

is rheumatoid factor present in psoriatic arthritis?

A

no

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38
Q

what are the 5 main presentations of psoriatic arthritis?

A
  1. sacroilitis (spondyloarthropathy)
  2. nail involvement (pitting, onycholysis, hyperkeratosis)
  3. dactlitis
  4. enthesitis
  5. extra-artcicular features (eg eye disease)
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39
Q

what are the 5 clinical subgroups of psoriatic arthritis?

A
  1. confined to DIP joints in hands and feet
  2. symmetrical polyarthritis (similar to RA)
  3. spinal involvement
  4. asymmetrical oligoarthriis
  5. arthritis mutilans
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40
Q

what is the treatment of psoriatic arthritis?

A 
physiotherapy
NSAIDs
steroids joint injections
immunosuppresants
biologics
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41
Q

What is reactive arthritis?

A

an infection induced systemic illness characterised by inflammatory synovitis from which micro-organisms cannot be cultures

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42
Q

how long after infection does reactive arthritis symptoms present?

A

1-4 weeks

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43
Q

what are the 2 classes of infection which most commonly cause reactive arthritis?

A

urogenital

enterogenic

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44
Q

what HLA type can predispose to reactive arthritis?

A

HLA B27

45
Q

who tends to get reactive arthritis?

A

20-40 y/o

male and females

46
Q

what is reiter’s syndrome?

A

a form of reactive arthritis with a triad of classical symptoms:

  • UTI
  • conjuntivits/uveitis/iris
  • arthritis
47
Q

what is the treatent of reactive arthritis?

A 
physiotherapy
NSAIDs
steroids
antibiotics for underlying infection
immunosuppressants if chronic
(most resolve spontaneously within 6 months)
48
Q

what condition is enteropathic arthritis associated with?

A

inflammatory bowel disease

typically Crohn’s

49
Q

what happens to the enteropathic arthritis symptoms during a flare up of IBD?

A

joint pain and stiffness becomes worse

50
Q

what is the treatment of enteropathic arthritis?

A

treat underlying inflammatory bowel disease
+
normal analgesia eg paracetamol, cc-codamol

51
Q

why are NSAIDs not a good idea to use in enteropathic arthritis?

A

may exacerbate the inflammatory bowel disease

52
Q

what does arthropathy mean?

A

disease of a joint

53
Q

what does arthralgia mean?

A

pain in a joint

54
Q

what does arthritis mean?

A

inflammation of a joint

55
Q

what are the 4 subtypes of inflammatory arthropathy?

A

seropositive
seronegative
infectious
crystal deposition

56
Q

are spondyloarthropathies seropositive or seronegative?

A

seronegative

57
Q

is SLE seropostive or seronegative inflammatory arthritis?

A

seropositive inflammatory arthritis

58
Q

is enteropathic arthritis seropositive or seronegative inflammatory arthritis?

A

seronegative inflammatory arthritis

59
Q

is ankylosing spondylitis seropositive or seronegative inflammatory arthritis?

A

seronegative

60
Q

is Sjogren’s syndrome seropositve or seronegative inflammatory arthritis?

A

seropositive

61
Q

is reactive arthritis seropositive or seronegative inflammatory arthritis?

A

seronegative

62
Q

is rheumatoid arthritis seropositive or seronegative inflammatory arthritis?

A

seropositive

63
Q

is vasculitis seropositive or seronegative inflammatory arthritis?

A

seropositive

64
Q

what are the main joints affected in rheumatoid arthritis?

A

small joints in hands and feet

as disease progresses: knees, shoulders, elbows and others

65
Q

what does the synovium become after being attacked by auto-antibodies?

A

(inflammatory) pannus

66
Q

which joints in the fingers are typically not involved in rheumatoid arthritis?

A

DIPs

67
Q

which joints in the hands are typically involved in rheumatoid arthritis?

A

MCPs and PIPs

68
Q

what important area of in the spine can be affected by rheumatoid arthritis? and what can this cause?

A

cervical spine causing atlanto-axial sublaxation

this can lead to cervical cord compression

69
Q

where do rheumatoid nodules typically appear?

A

extensor surfaces or sites of frequent mechanical irritation

70
Q

which is more specific for rheumatoid arthritis- anti-CCP or RF?

A

anti-CCP

71
Q

when should a DMARD be commenced?

A

within 3 months of rheumatoid arthritis symptom onset

72
Q

what short term treatments are used for rheumatoid arthritis? (ie for symptom relief)

A 
simple analgesia
NSAIDs
intramuscular steroids
intra-articular steroids
oral steroids
73
Q

when does a patient with rheumatoid arthritis become eligible for biologic therapy?

A

when disease doesn’t respond to standard DMARD therapy

74
Q

what are the most commonly used biologics used in rheumatoid arthritis?

A

anti-TNF drugs

75
Q

in advanced ankylosing spondylitis what shape changes in the spine occur?

A

loss of lumbar lordosis

increased thoracic kyphosis

76
Q

what is a bamboo spine?

A

when the intervertebral discs in the spine fuse together

occurs in ankylosing spondylitis

77
Q

what is the location and distribution of affected joints in enteropathic arthritis?

A 
asymmetrical
large joints (can involve spine)
78
Q

What are the 2 major classes of drugs for inflammatory arthritis?

A

symptom relief
or
disease modifiers

79
Q

what are the 2 major classes of drugs that are disease modifiers for the treatment of inflammatory arthritis?

A

DMARDs (Disease Modifying Anti-Rheumatic Drugs

Biologics

80
Q

what type of NSAIDs reduce the risk of peptic ulceration compared to typical NSAIDs?

A

COX-2 selective inhibitors

81
Q

why should COX-2 inhibitors not be used in patients with high cardiovascular risk?

A

COX-2 inhibitors increase cardiovascular risk

more than COX-1 inhibitors

82
Q

what is Step 1 in the WHO analgesic pathway?

A

non-opioid (eg paracetamol or NSAID)

+/- adjuvant (eg anti-convulsant or anti-depressant

83
Q

what is Step 2 in the WHO analgesic pathway?

A

weak opioid (eg codeine)
+ non-opioid (eg paracetamol or NSAID)
+/- adjuvant (eg anti-convulsant or anti-depressant)

84
Q

what is Step 3 in the WHO analgesic pathway?

A

strong opioid (eg morphine)
+ non-opioid (eg paracetamol or NSAID)
+/- adjuvant (eg anti-convulsant or anti-depressant)

85
Q

if a DMARD is not enough, should you add another DMARD or switch DMARDs?

A

add another

86
Q

what is the first choice DMARD in most patients?

A

methotrexate

87
Q

how is methotrexate administered?

A

orally or subcutaneous injection

88
Q

why is the subcutaneous injection of methotrexate sometimes preferred to the oral form?

A

less nausea

89
Q

why must alcohol intake be limited when on a methotrexate?

A

because methotrexate already increases hepatitis/cirrhosis risk

90
Q

can a patient on methotrexate try to conceive?

A

no
methotrexate is teratogenic
should be switched to sulfasalazine 3 months before conception

91
Q

what are the first line biologics for inflammatory arthritis?

A

anti-TNF therapy

eg etanercept subcut, adalimumab subcut, certolizumab subcut, infliximab IV

92
Q

why are methotrexate and anti-TNF therapy effective in combonation for inflammatory arthritis?

A

methotrexate suppresses the immune system so prevents the development of antibodies forming to neutralise the anti-TNF

93
Q

why should patients about to receive anti-TNF therapy be screened for latent TB?

A

anti-TNF can break down the granulomas that were preventing latent TB infection spreading

94
Q

what is a DAS score?

what does a high DAS score mean?

A

disease activity score
(for inflammatory arthritis)
the higher the score, the worse the disase progression is

95
Q 
is anti-TNF used in:
rheumatoid arthritis?
psoriatic arthritis?
ankylosing spondylitis?
connective tissue disease?
A

RA? yes
PA? yes
AS? yes
CTD? no

96
Q 
is Rituximab used in: 
rheumatoid arthritis?
psoriatic arthritis?
ankylosing spondylitis?
connective tissue disease?
A

RA? yes
PA? no
AS? no
CTD? yes

97
Q

what DAS28 scores shows rheumatoid disease remission?

A
98
Q

what are the 4 main side effects of methotrexate?

DMARD

A

myelosuppression (bone marrow suppression)
liver cirrhosis
pneumonitis
teratogenicity

99
Q

what are the 3 main side effects of sulfasalazine?

DMARD

A

rashes
(reversible) oligospermia
heinz body anaemia

100
Q

what are the 3 main side effects of leflunomide? (DMARD)

A

liver impairment
interstitiual lung disease
hypertension

101
Q

what are the 2 main side effects of hydroxychloroquine? (DMARD)

A

retinopathy

corneal deposits

102
Q

what are the 6 main side effects of prednisolone?

A 
cushingoid features
muscle atrophy
osteoporosis
impaired glucose tolerance
hypertension
cataracts
103
Q

what is the main side effect of gold? (DMARD)

A

proteinuria

104
Q

what are the 2 main side effects of penicillamine? (DMARD)

A

porteinuria

exacerbation of myasthenia gravis

105
Q

what are the 2 main side effects of etanercept? (biologic)

A

demyelination

reactivation of latent TB

106
Q

what is the main side effect of infliximab? (biologic)

A

reactivation of latent TB

107
Q

what is the main side effect of adalimumab? (biologic)

A

reactivation of latent TB

108
Q

what is the main side effect of rituximab? (biologic)

A

infusion reactions

109
Q

what nodes are found in RA- heberdens or bouchards?

A

bouchards

because PIP joints are affected but DIP joints are spared

Musculoskeletal (16 decks)

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