Inflammatory Arthritis Flashcards
1
Q
What is rheumatoid arthritis (RA)?
A
- Systemic inflammatory disease
- Triggered by gene & virus
- Autoimmune - failure to recognise synovial lining, body begins to destroy it
2
Q
What are the articular characteristics of RA?
A
- Palpation tenderness
- Synovial thickening/fibrosis
- Effusion
- Erythema (redness)
- Decreased ROM
- Ankylosis (bony fusion)
- Subluxation
3
Q
Where does RA commonly occur?
A
- Symmetrical
- Distal more common than proximal
- PIP
- MCP/MTP
- Wrist/ankle
- Less common elbow, knee, shoulder, hip
4
Q
What does TNF-alpha trigger in RA?
A
- Macrophages: Increased inflammation
- Endothelium: Increased cell infiltration/angiogenesis
- Hepatocytes: Increased CRP in serum
- Synoviocytes: Articular cartilage degradation
5
Q
What occurs in RA synovial inflammation?
A
- Congestion of synovium
- Oedema
- Fibrin exudation
6
Q
What are the consequences of chronic inflammation?
A
- Hypertrophic synovium
- Proliferation of blood vessels
- Proliferation of synovial fibroblasts (scarring of synovium)
- Granulation tissue grows across articular cartilage (pannus)
7
Q
What are the extra-articular features of RA?
A
- Rheumatoid nodules
- Tenosynovitis (inflammation of tendon sheaths) & nodules on tendons
- Pleurisy (inflammation in pleural space)
- Pericarditis (inflammation of pericardium)
- Inflammation of arterial lining (endarteritis)
8
Q
What are the clinical features of RA?
A
- Insidious onset over several weeks or
- Explosive polyarticular onset (total joint ache) over several days
- Morning stiffness >2hrs
- Synovial inflammation
- Structural damage (cartilage loss, erosion of bone, irreversible)
9
Q
What are some of the tests for RA?
A
- RF factor
- ESR
- C-reactive protein
10
Q
What are the principles of treatment for RA?
A
- Decrease pain (EPAs, rest)
- Decrease swelling (EPAs, bandage)
- Decrease contractors (splinting, Xs, mobs)
- Increase ROM (Xs, hydrotherapy)
- Increase strength (Xs, hydrotherapy)
11
Q
What are seronegative spondyloarthropathies?
A
Serongative = blood test negative, no RA
Spondylo = spine
Arthropathies: inflammation of joint
12
Q
What are 3 types of seronegative spondyloarthropathies?
A
- Ankylosing spondylitis
- Reactive arthritis
- Enteropathic arthritis
13
Q
What is reactive arthritis?
A
- “Reiter’s syndrome”
- Follows 2/52 after venereal (STD)/gastroenteric infection (e.g. salmonella)
- Knees, ankles, feet, toes, entheses
- Most commonly sacroiliitis
14
Q
What is enteropathic arthritis?
A
- Joints painful when IBD active
- Knees, hips, ankles (symmetrical)
- 10-20% people with Crohn’s disease
15
Q
What is ankylosing spondylitis?
A
- Chronic systemic inflammatory disease of axial skeleton
- Commonly 17-19yo boys
- Enthesitis, knees, heels, sacroiliac joints
