Inflammatory Arthritis Flashcards

1
Q

What is the effect of smoking on rheumatoid arthritis?

A

reduces prognosis

less responsive to treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is rheumatoid arthritis?

A

a chronic inflammatory disease of the joints- symmetrical polyarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the main 3 clinical signs of rheumatoid arthritis?

A

(boggy) swelling
tenderness
reduced range of movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

why can rheumatoid arthritis result in dry eyes?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

why can rhuematoid arthritis result in a dry mouth?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

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

A

pulmonary fibrosis caused by rheumatoid arthritis is much less aggressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what cytokine produced in the rheumatoid arthritis process causes osteoporosis?

A

IL-6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the best radiological investigation for rheumatoid arthritis?

A

ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the main treatment used for rheumatoid arthritis?

A

methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how many joints are affected in polyarthritis?

A

4+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how does rheumatoid arthritis increase CV risk?

A

pro-inflammatory conditions increase risk of atheroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are spondyloarthropathies?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

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

A

HLA B27

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is an enthesis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is enthesitis?

A

inflammation of an insertion site on a bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is dactylitis?

A

inflamamtion of entire digit

sausage digits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the most common type of juvenile inflammatory arthritis?

A

oligoarticular arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the location and distrubution of oligoarticular arthritis?

A

large limbs in an asymmetrical pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is ankylosing spondylitis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what joint involvement is the hallmark of ankylosing spondylitis?

A

sacroiliac joint involvement

–> sacroilits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

who tends to get ankylosing spondylitis?

A

men in early adulthood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

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

A

relieves pain

because ankylosing spondylitis is an inflammatory condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

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

A

schober’s test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is a syndesmophyte?

A

a bony growth originating inside a ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is the treatment of ankylosing spondylitis?

A
physiotherapy and home exercises
NSAIDs
immunosuppressants (but only if peripheral involvement)
biologics
steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is psoriatic arthritis?

A

an inflammatory arthritis associated with psoriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

is rheumatoid factor present in psoriatic arthritis?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is the treatment of psoriatic arthritis?

A
physiotherapy
NSAIDs
steroids joint injections
immunosuppresants
biologics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is reactive arthritis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

how long after infection does reactive arthritis symptoms present?

A

1-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

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

A

urogenital

enterogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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