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Y2 MSK > Inflammatory Arthropathies > Flashcards

Inflammatory Arthropathies Flashcards

1
Q

What is meant by spondyloarthropathy?

A

Inflammatory arthritis affecting both spine and joints

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2
Q

What is enthesitis?

A

Inflammation at the site where tendon joins to bone

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3
Q

What is dactylitis?

A

Inflammation of an entire digit

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4
Q

What is ankylosing spondylitis?

A

Inflammatory spinal arthritis, usually affecting sacroiliac joint too

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5
Q

Is ankylosing spondylitis more common in males or females?

A

Males

Late adolescence

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6
Q

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

A 
4 As:
Anterior uveitis
Peripheral arthiritis
Aortic regurgitation
Apical fibrosis
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7
Q

What examinations can be used to diagnose ank. spond?

A

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

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8
Q

List treatment for ankylosing spondylitis

A

Exercise, physiotherapy
NSAID
Anti-TNF (infliximab)
Surgery

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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
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10
Q

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

A

False

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11
Q

What is the source of reactive arthritis?

A

Infection, leading to inflammatory synovitis

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12
Q

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

A

False

Typically up to 4wks after infection

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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’)

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14
Q

List features suggestive of joint inflammation

A 
Joint pain
Swelling
Morning stiffness
Improvement with exercise
Synovitis
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15
Q

What is the most prevalent seropositive arthropathy?

A

Rheumatoid arthritis

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16
Q

List the main seronegative arthropathies

A

Ankylosing spondilitis
Psoriatic arthritis
IBD arthritis
Reactive arthritis

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17
Q

Which HLA is often associated with seronegative arthropathies?

A

HLA-B27

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18
Q

Where does ankylosing spondilitis usually affect?

A

Spine

Sacroiliac joints

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19
Q

Who is more affected by AS - males or females?

A

Males 3:1 females

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20
Q

What is the age of onset of AS?

A

20-40yrs

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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?

A

False

25
Q

Which GU infections can typically cause reactive arthritis?

A

Chlamydia

Neisseria

26
Q

Which GI infections can typically cause reactive arthritis?

A

Salmonella

Campylobacter

27
Q

What causes gout?

A

High levels of uric acid, causing deposition of urate crystals within a joint

28
Q

What is uric acid a product of?

A

The breakdown of purines in DNA metabolism (adenine, guanine)

29
Q

What are gout tophi?

A

Painless white accumulations of uric acid that can erupt through the skin

30
Q

How do gout crystals appear on polarised microscopy?

A

Negatively birefringent needle-shaped crystals

31
Q

Outline treatment of acute gout

A

NSAID/colchicine (for those intolerant of NSAID)
Steroid
Analgesia (opiates, paracetamol)
Lifestyle changes (reduce purine rich foods, reduce alcohol, weight loss, fluids)

32
Q

What is the drug of choice for sufferers of recurrent gout? When should this be administered?

A

Allopurinol (or feboxustat)

2-4 weeks after acute attack

33
Q

What causes pseudogout?

A

Deposition of calcium pyrophosphate crystals

34
Q

What does chondocalcinosis mean?

A

Deposition of calcium pyrophosphate crystals in cartilage in the absence of acute inflammation

35
Q

Define inflammatory arthritis

A

Significant early morning stiffness, usually asymmetric, which improves throughout the day

36
Q

What is the characteristic sign on XR suggestive of psoriatic arthritis?

A

Pencil in cup deformity

37
Q

Outline the treatment for psoriatic arthiritis

A 
NSAIDs
DMARDs
Anti-TNF
Surgery
Physiotherapy
38
Q

Which investigation should be carried out in reactive arthritis to rule out infection?

A

Joint fluid analysis

39
Q

Reactive arthritis is self-limiting. True/ False?

A

True

Resolves in 6 months

40
Q

Outline the treatment for reactive arthritis

A

CCS IM
Antibiotics
Physiotherapy
NSAIDs

41
Q

Enteropathic arthritis is associated with flare-ups of which long-term clinical condition?

A

Inflammatory Bowel Disease

42
Q

Outline the treatment for IBD arthritis

A 
Treat IBD 
Analgesia
Steroids
DMARDs
Anti-TNF
43
Q

What is clinically defined as hyperuricaemia? Is this indicative of gout?

A

> 7mg/dl

No - lots of population have increased uric acid levels but not gout

44
Q

List some causes of overproduction of uric acid

A

Bleeding

Increased purine rich foods (red meat, shellfish, offal, sardines, legumes)

45
Q

List some causes of underexcretion of uric acid

A

Renal insufficiency
Dehydration
Diuretics
Alcohol abuse

46
Q

List three differential diagnoses for gout

A

Septic arthritis
Trauma
Seronegative arthritis

47
Q

List some clinical features of gout

A

Rapid onset
Red, hot, severe pain at joint (commonly big toe)
Gout tophi

48
Q

What is the main investigation used to diagnose gout?

A

Joint aspirate

49
Q

How do pseudogout crystals appear on polarised microscopy?

A

Positive birefringent rhomboid (envelope) shaped crystals

50
Q

Outline treatment for pseudogout

A

NSAIDs/colchicine (for those intolerant of NSAID)
Steroids
Rehydration

51
Q

Hydroxyapitate deposition disease is characterised by what clinical sign?

A

Milwaukee shoulder

52
Q

What is the microscopic appearance of hydroxyapitate deposition disease?

A

Alzarin stain-red clumps

Y2 MSK (30 decks)

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