Inflammatory Arthritis Flashcards
What is rheumatoid arthritis (RA)?
- Systemic inflammatory disease
- Triggered by gene & virus
- Autoimmune - failure to recognise synovial lining, body begins to destroy it
What are the articular characteristics of RA?
- Palpation tenderness
- Synovial thickening/fibrosis
- Effusion
- Erythema (redness)
- Decreased ROM
- Ankylosis (bony fusion)
- Subluxation
Where does RA commonly occur?
- Symmetrical
- Distal more common than proximal
- PIP
- MCP/MTP
- Wrist/ankle
- Less common elbow, knee, shoulder, hip
What does TNF-alpha trigger in RA?
- Macrophages: Increased inflammation
- Endothelium: Increased cell infiltration/angiogenesis
- Hepatocytes: Increased CRP in serum
- Synoviocytes: Articular cartilage degradation
What occurs in RA synovial inflammation?
- Congestion of synovium
- Oedema
- Fibrin exudation
What are the consequences of chronic inflammation?
- Hypertrophic synovium
- Proliferation of blood vessels
- Proliferation of synovial fibroblasts (scarring of synovium)
- Granulation tissue grows across articular cartilage (pannus)
What are the extra-articular features of RA?
- Rheumatoid nodules
- Tenosynovitis (inflammation of tendon sheaths) & nodules on tendons
- Pleurisy (inflammation in pleural space)
- Pericarditis (inflammation of pericardium)
- Inflammation of arterial lining (endarteritis)
What are the clinical features of RA?
- 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)
What are some of the tests for RA?
- RF factor
- ESR
- C-reactive protein
What are the principles of treatment for RA?
- Decrease pain (EPAs, rest)
- Decrease swelling (EPAs, bandage)
- Decrease contractors (splinting, Xs, mobs)
- Increase ROM (Xs, hydrotherapy)
- Increase strength (Xs, hydrotherapy)
What are seronegative spondyloarthropathies?
Serongative = blood test negative, no RA
Spondylo = spine
Arthropathies: inflammation of joint
What are 3 types of seronegative spondyloarthropathies?
- Ankylosing spondylitis
- Reactive arthritis
- Enteropathic arthritis
What is reactive arthritis?
- “Reiter’s syndrome”
- Follows 2/52 after venereal (STD)/gastroenteric infection (e.g. salmonella)
- Knees, ankles, feet, toes, entheses
- Most commonly sacroiliitis
What is enteropathic arthritis?
- Joints painful when IBD active
- Knees, hips, ankles (symmetrical)
- 10-20% people with Crohn’s disease
What is ankylosing spondylitis?
- Chronic systemic inflammatory disease of axial skeleton
- Commonly 17-19yo boys
- Enthesitis, knees, heels, sacroiliac joints
What are the symptoms of ankylosing spondylitis?
- Back pain (75% of cases)
- Worse at night, wake frequently
- Morning stiffness, difficulty getting out of bed
- Eased by heat/exercise
- Family history
What is the natural history of ankylosing spondylitis?
- Teenage/juvenile onset
- Flares & remissions in early stages
- First 10 years the worst
- Usually managed by physio & NSAIDs
What is the end stage of ankylosing spondylitis?
Bony ankylosis of spine & affected joints (bony fusion)
What are the principles of treatment for ankylosing spondylitis?
- Education
- Early diagnosis
- NSAIDs
- Daily exercises
- Counselling
- More exercises
What are some of the measurements for ankylosing spondylitis?
- Height
- Tragus to wall
- Chest expansion
- Vital capacity
- Fingertips to floor distance
What happens if there is no intervention for ankylosing spondylitis?
Bony ankylosis in flexion
What is psoriatic arthritis?
Skin inflammatory disease
- Redness
- Flaking
- Hailstone pitting of nails
- Inflammation of joints
What is gout?
- A grouping of problems associated with uric acid
- Causes tophi (painful crystallised uric acid)
What are the 4 type of gout?
- Gouty arthritis
- Soft tissues
- Urinary tract
- Gouty nephropathy
What are DMARDs?
Disease modifying anti-rheumatic drugs - immune suppression
What are 3 types of DMARDs?
- Methotrexate (1st line)
- Sulphasalzine (1st line)
- Leflunomide (2nd line)
What are the pros and cons of corticosteroids?
Pros:
- Short-term relief
- Greatly improves ROM/stiffness
Cons:
- Osteoporosis
- Androgyny
- Weight gain (cushing’s syndrome)
When are corticosteroids used?
- 2nd line
- Flare-ups only
- Never more than 3 weeks
What are the types of anti-inflammatory drugs?
- NSAIDs
- Immunosuppressants
- Steroids
- Biologics (cytokine blockers)
