Inflammatory conditions Flashcards
What is a common factor in all inflammatory conditions
inflammation affecting synovial membranes of joints, tendon sheaths, bursa and entheses
What is the aetiology of inflammatory conditions
unsure but a genetic predisposition and the environment have an effect
What part of the joint is usually found to be chronically inflamed
Synovial membrane
What appears to destroy the cartilage from the edges
infiltration of vascular synovium around the periphery of the articular cartilage, forming a dull red panes
What happens to the ligaments and the joint as a whole in inflammatory conditions
Ligaments become softened and the joint becomes lax –> considerable effusion
What might bone erosion lead to
subarticular cysts and in severe cases anklosis
What are some of the most important questions to ask in a rheumatology history
Pattern of joint involvement spinal involvement pre-existing CTD evidence of recent infection History of IBD or symptoms of IBD Psoriasis or family history of psoriasis Ocular inflammation Family history of inflammatory arthritis or CTD Constitutional symptoms History of malignancy Neuro symptoms - bladder and bowel! Extremes of age (65)
Why do we do a FBC in inflammatory conditions
joint inflammation can produce an anaemia
Many are associated with leucopenia, neutropenia, lymphopenia or thrombocytopenia
Why do we investigate Erythrocyte sedimentation rate (ESR)
it is a non-specific indicator f inflammation
Elevated in the presence of anaemia
What is the important of C-reactive protein
it is a non-specific indicator of inflammation
very sensitive to change and will reflect improvement or deterioration more than ESR
Why is a routine biochemical screen carried out
to assess the degree of systemic involvement
Many drugs can affect major organ function and so a baseline needs to be obtained prior to starting treatment
When is a blood culture mandatory
if septic arthritis is suspected
When might CPK (creatinine phosphokinase) be raised
metabolic or inflammatory myopathy
exercise
If the patient has not done much exercise and the CPK is high, then metabolic or inflammatory myopathy should be considered!
What is untreated haemochromatosis associated with
systemic complications including diabetes and hepatic and cardiac dysfunction
What is measured as an indication of haemochromatosis
ferritin
What are the first-line investigations for a patient with suspected inflammatory arthritis
X ray
What investigations can be done to provide more information about a joint with suspected inflammatory arthritis
MRI and US
What is ultrasound particularly useful in assessing
inflammation in other synovial-lined structure e.g. bursa and tendon sheaths
What is MRI useful to establish
the extent of invites and the involvement of soft tissue structures e.g. tendons, enthuses, bursae, capsules and muscles
Describe the appearance of normal synovial fluid
Very pale yellow hue
transparent
normal viscosity
Describe the appearance of synovial fluid in inflammatory arthritis
deeper yellow colour and some clarity
When should synovial fluid be obtained in suspected septic arthritis
prior to giving antibiotics
The presence of monosodium rate and calcium pyrophosphate crystals in synovial fluid is diagnostic for what
gout and pseudo-gout respectively
What are the 3 classes of drugs used to treat inflammatory arthritis
DMARDs
Biological therapies
steroids
