Inflammatory Arthropathies Flashcards

1
Q

What is meant by spondyloarthropathy?

A

Inflammatory arthritis affecting both spine and joints

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

What is enthesitis?

A

Inflammation at the site where tendon joins to bone

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

What is dactylitis?

A

Inflammation of an entire digit

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

What is ankylosing spondylitis?

A

Inflammatory spinal arthritis, usually affecting sacroiliac joint too

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

Is ankylosing spondylitis more common in males or females?

A

Males

Late adolescence

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

What are the 4 main extra-articular feature of ank. spond.?

A
4 As:
Anterior uveitis
Peripheral arthiritis
Aortic regurgitation
Apical fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What examinations can be used to diagnose ank. spond?

A

Schober’s test
Occiput-to-wall test
Chest expansion

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

List treatment for ankylosing spondylitis

A

Exercise, physiotherapy
NSAID
Anti-TNF (infliximab)
Surgery

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

What are the 2 typical nail changes that occur in psoriatic arthritis? What are the other features?

A
Nail pitting
Onycholysis
Oligoarthiritis (typically DIPJs)
Spondylitis
Dactylitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Rheumatoid factor is positive in psoriatic arthritis. True/False?

A

False

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

What is the source of reactive arthritis?

A

Infection, leading to inflammatory synovitis

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

Symptoms of reactive arthritis come on at the start of infection. True/False?

A

False

Typically up to 4wks after infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Reiter’s syndrome is a form of reactive arthritis made up of which disease triad?

A

Urethritis (‘cant pee’)
Conjunctivitis/uveitis/iritis (‘cant see’)
Arthritis (‘cant climb tree’)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List features suggestive of joint inflammation

A
Joint pain
Swelling
Morning stiffness
Improvement with exercise
Synovitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the most prevalent seropositive arthropathy?

A

Rheumatoid arthritis

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

List the main seronegative arthropathies

A

Ankylosing spondilitis
Psoriatic arthritis
IBD arthritis
Reactive arthritis

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

Which HLA is often associated with seronegative arthropathies?

A

HLA-B27

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

Where does ankylosing spondilitis usually affect?

A

Spine

Sacroiliac joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Who is more affected by AS - males or females?

A

Males 3:1 females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the age of onset of AS?

A

20-40yrs

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

List clinical features of AS

A

Spinal pain/stiffness (longer than 3 months)
Improvement with exercise
Loss of lumbar lordosis
Increased thoracic kyphosis

22
Q

Which test is used to assess lumbar spine flexion?

A

Schobers test

23
Q

What does AS show on XR?

A

Sclerosis/fusion of sacroiliac joints
Syndesmophytes (bony spurs)
“Bamboo spine”

24
Q

Psoriatic arthritis is usually symmetrical. True/False?

25
Which GU infections can typically cause reactive arthritis?
Chlamydia | Neisseria
26
Which GI infections can typically cause reactive arthritis?
Salmonella | Campylobacter
27
What causes gout?
High levels of uric acid, causing deposition of urate crystals within a joint
28
What is uric acid a product of?
The breakdown of purines in DNA metabolism (adenine, guanine)
29
What are gout tophi?
Painless white accumulations of uric acid that can erupt through the skin
30
How do gout crystals appear on polarised microscopy?
Negatively birefringent needle-shaped crystals
31
Outline treatment of acute gout
NSAID/colchicine (for those intolerant of NSAID) Steroid Analgesia (opiates, paracetamol) Lifestyle changes (reduce purine rich foods, reduce alcohol, weight loss, fluids)
32
What is the drug of choice for sufferers of recurrent gout? When should this be administered?
Allopurinol (or feboxustat) | 2-4 weeks after acute attack
33
What causes pseudogout?
Deposition of calcium pyrophosphate crystals
34
What does chondocalcinosis mean?
Deposition of calcium pyrophosphate crystals in cartilage in the absence of acute inflammation
35
Define inflammatory arthritis
Significant early morning stiffness, usually asymmetric, which improves throughout the day
36
What is the characteristic sign on XR suggestive of psoriatic arthritis?
Pencil in cup deformity
37
Outline the treatment for psoriatic arthiritis
``` NSAIDs DMARDs Anti-TNF Surgery Physiotherapy ```
38
Which investigation should be carried out in reactive arthritis to rule out infection?
Joint fluid analysis
39
Reactive arthritis is self-limiting. True/ False?
True | Resolves in 6 months
40
Outline the treatment for reactive arthritis
CCS IM Antibiotics Physiotherapy NSAIDs
41
Enteropathic arthritis is associated with flare-ups of which long-term clinical condition?
Inflammatory Bowel Disease
42
Outline the treatment for IBD arthritis
``` Treat IBD Analgesia Steroids DMARDs Anti-TNF ```
43
What is clinically defined as hyperuricaemia? Is this indicative of gout?
>7mg/dl | No - lots of population have increased uric acid levels but not gout
44
List some causes of overproduction of uric acid
Bleeding | Increased purine rich foods (red meat, shellfish, offal, sardines, legumes)
45
List some causes of underexcretion of uric acid
Renal insufficiency Dehydration Diuretics Alcohol abuse
46
List three differential diagnoses for gout
Septic arthritis Trauma Seronegative arthritis
47
List some clinical features of gout
Rapid onset Red, hot, severe pain at joint (commonly big toe) Gout tophi
48
What is the main investigation used to diagnose gout?
Joint aspirate
49
How do pseudogout crystals appear on polarised microscopy?
Positive birefringent rhomboid (envelope) shaped crystals
50
Outline treatment for pseudogout
NSAIDs/colchicine (for those intolerant of NSAID) Steroids Rehydration
51
Hydroxyapitate deposition disease is characterised by what clinical sign?
Milwaukee shoulder
52
What is the microscopic appearance of hydroxyapitate deposition disease?
Alzarin stain-red clumps