Inflammatory Arthropathies

Question 1

What is meant by spondyloarthropathy?

Answer 1

Inflammatory arthritis affecting both spine and joints

Question 2

What is enthesitis?

Answer 2

Inflammation at the site where tendon joins to bone

Question 3

What is dactylitis?

Answer 3

Inflammation of an entire digit

Question 4

What is ankylosing spondylitis?

Answer 4

Inflammatory spinal arthritis, usually affecting sacroiliac joint too

Question 5

Is ankylosing spondylitis more common in males or females?

Answer 5

Males

Late adolescence

Question 6

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

Answer 6

4 As:
Anterior uveitis
Peripheral arthiritis
Aortic regurgitation
Apical fibrosis

Question 7

What examinations can be used to diagnose ank. spond?

Answer 7

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

Question 8

List treatment for ankylosing spondylitis

Answer 8

Exercise, physiotherapy
NSAID
Anti-TNF (infliximab)
Surgery

Question 9

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

Answer 9

Nail pitting
Onycholysis
Oligoarthiritis (typically DIPJs)
Spondylitis
Dactylitis

Question 10

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

Answer 10

False

Question 11

What is the source of reactive arthritis?

Answer 11

Infection, leading to inflammatory synovitis

Question 12

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

Answer 12

False

Typically up to 4wks after infection

Question 13

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

Answer 13

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

Question 14

List features suggestive of joint inflammation

Answer 14

Joint pain
Swelling
Morning stiffness
Improvement with exercise
Synovitis

Question 15

What is the most prevalent seropositive arthropathy?

Answer 15

Rheumatoid arthritis

Question 16

List the main seronegative arthropathies

Answer 16

Ankylosing spondilitis
Psoriatic arthritis
IBD arthritis
Reactive arthritis

Question 17

Which HLA is often associated with seronegative arthropathies?

Answer 17

HLA-B27

Question 18

Where does ankylosing spondilitis usually affect?

Answer 18

Spine

Sacroiliac joints

Question 19

Who is more affected by AS - males or females?

Answer 19

Males 3:1 females

Question 20

What is the age of onset of AS?

Answer 20

20-40yrs

Question 21

List clinical features of AS

Answer 21

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

Question 22

Which test is used to assess lumbar spine flexion?

Answer 22

Schobers test

Question 23

What does AS show on XR?

Answer 23

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

Question 24

Psoriatic arthritis is usually symmetrical. True/False?

Answer 24

False

Question 25

Which GU infections can typically cause reactive arthritis?

Answer 25

Chlamydia | Neisseria

Question 26

Which GI infections can typically cause reactive arthritis?

Answer 26

Salmonella | Campylobacter

Question 27

What causes gout?

Answer 27

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

Question 28

What is uric acid a product of?

Answer 28

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

Question 29

What are gout tophi?

Answer 29

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

Question 30

How do gout crystals appear on polarised microscopy?

Answer 30

Negatively birefringent needle-shaped crystals

Question 31

Outline treatment of acute gout

Answer 31

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

Question 32

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

Answer 32

Allopurinol (or feboxustat) | 2-4 weeks after acute attack

Question 33

What causes pseudogout?

Answer 33

Deposition of calcium pyrophosphate crystals

Question 34

What does chondocalcinosis mean?

Answer 34

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

Question 35

Define inflammatory arthritis

Answer 35

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

Question 36

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

Answer 36

Pencil in cup deformity

Question 37

Outline the treatment for psoriatic arthiritis

Answer 37

``` NSAIDs DMARDs Anti-TNF Surgery Physiotherapy ```

Question 38

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

Answer 38

Joint fluid analysis

Question 39

Reactive arthritis is self-limiting. True/ False?

Answer 39

True | Resolves in 6 months

Question 40

Outline the treatment for reactive arthritis

Answer 40

CCS IM Antibiotics Physiotherapy NSAIDs

Question 41

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

Answer 41

Inflammatory Bowel Disease

Question 42

Outline the treatment for IBD arthritis

Answer 42

``` Treat IBD Analgesia Steroids DMARDs Anti-TNF ```

Question 43

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

Answer 43

>7mg/dl | No - lots of population have increased uric acid levels but not gout

Question 44

List some causes of overproduction of uric acid

Answer 44

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

Question 45

List some causes of underexcretion of uric acid

Answer 45

Renal insufficiency Dehydration Diuretics Alcohol abuse

Question 46

List three differential diagnoses for gout

Answer 46

Septic arthritis Trauma Seronegative arthritis

Question 47

List some clinical features of gout

Answer 47

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

Question 48

What is the main investigation used to diagnose gout?

Answer 48

Joint aspirate

Question 49

How do pseudogout crystals appear on polarised microscopy?

Answer 49

Positive birefringent rhomboid (envelope) shaped crystals

Question 50

Outline treatment for pseudogout

Answer 50

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

Question 51

Hydroxyapitate deposition disease is characterised by what clinical sign?

Answer 51

Milwaukee shoulder

Question 52

What is the microscopic appearance of hydroxyapitate deposition disease?

Answer 52

Alzarin stain-red clumps