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Lecture Notes- Orthopaedics and Fractures > Inflammatory conditions > Flashcards

Inflammatory conditions Flashcards

1
Q

What is a common factor in all inflammatory conditions

A

inflammation affecting synovial membranes of joints, tendon sheaths, bursa and entheses

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2
Q

What is the aetiology of inflammatory conditions

A

unsure but a genetic predisposition and the environment have an effect

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3
Q

What part of the joint is usually found to be chronically inflamed

A

Synovial membrane

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4
Q

What appears to destroy the cartilage from the edges

A

infiltration of vascular synovium around the periphery of the articular cartilage, forming a dull red panes

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5
Q

What happens to the ligaments and the joint as a whole in inflammatory conditions

A

Ligaments become softened and the joint becomes lax –> considerable effusion

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6
Q

What might bone erosion lead to

A

subarticular cysts and in severe cases anklosis

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7
Q

What are some of the most important questions to ask in a rheumatology history

A 
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)
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8
Q

Why do we do a FBC in inflammatory conditions

A

joint inflammation can produce an anaemia

Many are associated with leucopenia, neutropenia, lymphopenia or thrombocytopenia

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9
Q

Why do we investigate Erythrocyte sedimentation rate (ESR)

A

it is a non-specific indicator f inflammation

Elevated in the presence of anaemia

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10
Q

What is the important of C-reactive protein

A

it is a non-specific indicator of inflammation

very sensitive to change and will reflect improvement or deterioration more than ESR

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11
Q

Why is a routine biochemical screen carried out

A

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

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12
Q

When is a blood culture mandatory

A

if septic arthritis is suspected

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13
Q

When might CPK (creatinine phosphokinase) be raised

A

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!

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14
Q

What is untreated haemochromatosis associated with

A

systemic complications including diabetes and hepatic and cardiac dysfunction

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15
Q

What is measured as an indication of haemochromatosis

A

ferritin

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16
Q

What are the first-line investigations for a patient with suspected inflammatory arthritis

A

X ray

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17
Q

What investigations can be done to provide more information about a joint with suspected inflammatory arthritis

A

MRI and US

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18
Q

What is ultrasound particularly useful in assessing

A

inflammation in other synovial-lined structure e.g. bursa and tendon sheaths

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19
Q

What is MRI useful to establish

A

the extent of invites and the involvement of soft tissue structures e.g. tendons, enthuses, bursae, capsules and muscles

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20
Q

Describe the appearance of normal synovial fluid

A

Very pale yellow hue
transparent
normal viscosity

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21
Q

Describe the appearance of synovial fluid in inflammatory arthritis

A

deeper yellow colour and some clarity

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22
Q

When should synovial fluid be obtained in suspected septic arthritis

A

prior to giving antibiotics

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23
Q

The presence of monosodium rate and calcium pyrophosphate crystals in synovial fluid is diagnostic for what

A

gout and pseudo-gout respectively

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24
Q

What are the 3 classes of drugs used to treat inflammatory arthritis

A

DMARDs
Biological therapies
steroids

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25
Q

What is the purpose of NSAIDs in inflammatory arthritis

A

they help to reduce pain, swelling and stiffness but do not influence the underlying inflammatory process in terms of reaching joint damage

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26
Q

Name some DMARDs

A

Methotrexate
sulfasalazine
Hydroxychloroquine

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27
Q

How do DMARDs work

A

reduce synovitis
improve symptoms
improve function
reduce the likelihood of permanent joint damage

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28
Q

What are some side effects of DMARDs

A

regular monitoring of bloods - FBC, U&E, LFT

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29
Q

What is an example of a biological

A

Anti-TNF (anti- tumour necrosis factor)

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30
Q

Name some biologics

A

Infliximab

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31
Q

How quickly do biologics work

A

4 weeks

32
Q

How are biologics administered

A

injection

33
Q

What are the main side effects of Biologics

A

increased risk of serious and non-serious infection in particular tuberculosis

34
Q

Who does rheumatoid arthritis most commonly affect

A

middle age and in women more than men

35
Q

What is the earliest radiological change in rheumatoid arthritis

A

diffuse porosis around the joint due to the effects of cytokines with increased vascularity

36
Q

What is ankylosing

A

spontaneous fusion

37
Q

What are the surgical options for rheumatoid arthritis

A

Synovectomy - remove diseased synovium
Repair of rupture tendons and capsular procedure - may restore active movements
Joint fusion - subluxation of vertebra can cause a threat to cord damage
Arthroplasty - gives better function than fusion

38
Q

What does Juvenile chronic arthritis include

A

Stills disease and a number of less well-defined conditions

39
Q

What are the clinical features of Juvenile chronic arthritis

A 
Fever 
lymph gland involvement 
anaemia 
joint pain and stiffness 
Uveitis occasionally
40
Q

how can a diagnosis of Juvenile chronic arthritis be made

A

ESR is usually raised

history of preceding streptococcal infection favours the diagnosis of rheumatic fever

41
Q

What is the treatment for Juvenile chronic arthritis

A

Physio
rarely surgery
same local and general measures as an adult

42
Q

What is the prognosis for Juvenile chronic arthritis

A

Good - 60-75% of patents recover fully

43
Q

What is diagnostic of sero-negative arthritis

A

Dactylitis, the uniform sausage-like swelling of a digit

44
Q

What age of patients get polymyalgia rheumatica

A

usually those over 60

45
Q

What is characteristic of polymyalgia rheumatica

A

Aching pain and stiffness i the muscles of the neck, shoulder girls and occasionally into back and pelvic girdle

46
Q

What is polymyalgia often associated with

A

arteritis of the cranial vessels and sudden blindness due to occlusion of the retinal artery

47
Q

What is the treatment for polymyalgia rheumatic

A

high dose of steroids (50-60mg prednisolone/ day)

The disease then subsides over a period of months or years

48
Q

What is the histocompatibility antigen in ankylosing spondylitis

A

HLA-B27

49
Q

What are associated conditions of ankylosing spondylitis

A

Anterior uveitis and Reiter’s syndrome

50
Q

What are the symptoms of the beginning of ankylosing spondylitis

A

Pain and stiffness in the lumbar region - this then extends to involve the whole spine and the manubriosternal joints

51
Q

What is the characteristic feature of AS

A

ossification of the imagines of the sine and the intervertebral discs - the spine is converted into a solid rod with an increasing kyphosis

52
Q

What other joints are often affected in AS

A

sacro-iliac joints
Plantar fasciitis
Achilles tendinitis and tenderness over bony prominences

53
Q

What drug is useful in relieving painful joint symptoms and backache

A

Phenylbutazone

This is only considered if other NSAIDs have failed

54
Q

What is acute synovitis

A

Mono arthritis or the acute painful joint

55
Q

How do patients present with acute synovitis

A

swollen painful joint with an obvious effusion and often with synovial thickening

56
Q

What joint is most commonly affected in acute synovitis

A

knee

57
Q

What is Reiter’s syndrome

A

the synovitis or arthritis associated with non specific urethritis and conjunctivitis

58
Q

What are the clinical features of Reiter’s syndrome

A

Acute or gradual onset
ophthalmic symptoms and urethritis may occur separately
ESR raised
HLA-B27 often in patient

59
Q

What is the treatment of Reiter’s syndrome

A

Urethritis is often related to a chlmaydia infection - Antibiotics may be needed
Chronic joint symptoms are treated by rest in the acute phase with physio and NSAIDs

60
Q

What is reactive arthritis

A

inflammatory arthritis that has been triggered by an infection rather than infection within a joint

61
Q

When does reactive arthritis usually develop

A

2 weeks post infection

62
Q

What is the most common presentation of reactive arthritis

A

monoarthritis

63
Q

What types of infection are most notable for Reactive arthritis

A

strep
gastroenteritis
genitourinary infection
viral URTI

64
Q

What is gout

A

a metabolic disease characterised by the deposition of rates in the tissues, hyperuricaemia and increased excretion of uric acid i the urine

65
Q

Who does gout affect

A

mostly men and some post-menopausal women

66
Q

What are the features of gout

A

chronic disease with acute attacks

severly painful, swollen often red and impossible to move joints

67
Q

What are some factors that can precipitate a gout attack

A 
Trauma 
Surgery 
alcohol
certain antibiotics 
purine rich foods (liver)
68
Q

Describe what would be seen on Xray i a patient with gout

A

typical well demarcated rounded erosions close to the joint margins usually in the hands

69
Q

What is the most useful investigation for gout

A

serum uric acid - usually very high

70
Q

What are the drugs for treating an acute attack of gout

A

Colchicine (unpleasant to take)

NSAIDs

71
Q

How does allopurinol work

A

it lowers the serum uric acid in the anticipation of preventing further attacks of gout

72
Q

What is pseudo gout

A

similar to gout but is less acute

73
Q

Describe the differenes of the crystals found in gout and in pseudo gout

A

Gout - uric acid crystals

Pseudogout - calcium pyrophosphate

74
Q

What is a common feature of pseudo gout

A

Calcification of the menisci of the knees

75
Q

What is the treatment of pseudo gout

A

None really known but NSAIDs are helpful

Lecture Notes- Orthopaedics and Fractures (23 decks)

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