Inflammatory Joint Conditions Flashcards by Emilia McColm

How is MSK pain characterized? (3)

Myalgia (muscles)
Arthralgia (joints)
Back pain

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What are the sources of MSK pain? (4)

Bone
Soft tissue
Joint
Referred/central

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What can joint problems be divided into?

Inflammatory disorders or degenerative disorders

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What are inflammatory disorders divided into? (3)

Autoimmune diorders
Crystal arthropathy
Infection

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What autoimmune joint disorders are there? (3)

RA
Connective tissue disorder
Spondarthritis

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What should the history consist of? (4)

Chronological history + distribution
- episodic, additive etc
- mono, oligo, poly
- symmetrical
Precipitating factors (infections, trauma, drugs)
Responsiveness to therapy
Constitutional factors / systemic illness

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If the condition affects many joints (i.e polyarthralgia), what could it be? (3)

RA
Connective tissue disorder
Spondarthritis

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If the condition affects one joint (i.e monarthralgia), what could it be? (3)

Crystal arthropathy
Infection
Degenerative disorder

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What is fibromyalgia?

Widespread mechanical hypersensitivity

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If there is polyarthralgia with synovitis and a duration of >6 weeks, it is likely to be…

Systemic rheumatic disease

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If there is polyarthralgia with synovitis and a duration of <6 weeks, it is likely to be…

Viral arthritis

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If there is polyarthralgia without synovitis or tender points, it is likely to be…

Osteoarthritis, soft tissue disorder, or hypothyroidism etc

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If there is polyarthralgia without synovitis and with tender points, it is likely to be…

Fibromyalgia

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What is the prevalence of RA in the UK?

387,000 adults in UK (0.81% population)

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What is the female:male ratio for RA?

3:1

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What is the peak age of onset for RA?

Between 20 - 50 years of age

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What are the features of RA? (3)

Symmetrical arthropathy
Hands & feet > 80% cases
Early morning stiffness

What problems in and around the knee are there in RA? (2)

Valgus deformity

Baker’s cyst

What are the ocular complications in RA? (3)

Keratoconjunctivitis sicca
Scleritis & episcleritis
Scleromalacia perforans

What are the neuromuscular complications of RA? (2)

Muscle wasting
Carpal tunnel syndrome
Atlanto-axial subluxation

What are the cardiac complications of RA? (4)

Accelerated ischaemic heart disease (life expectancy reduced by 10 years)
Pericarditis
Nodules
Endocarditis

What are the bone complications of RA?

Accelerated osteoporosis

What is seen on the histology of RA? (4)

Hyperplasia of existing cells
Thickened synovial membrane
Infiltration of T cells and macrophages (synovitis)
Destructive pannus

What is rheumatoid factor?

How many % of RA patients are positive for this?

Auto-antibody against Fc fragment of IgG

> 70-80%

What might lead to false positives of RF? (5)

``` Old age (>70 years old) Sjogren’s SLE Sarcoidosis Infections ```

How many false positives are there in people >70 years old?

10-25%

What is seen on x-ray in RA? (3)

Periarticular osteoporosis Soft tissue swelling Bone erosion

By 12 months, how many % have erosive changes?

15-30%

By 24 months, how many % in those with non-responsive disease have erosive changes?

90%

What can be seen on ultrasound for early detection of synovitis? (3)

Synovial thickening Effusion Power Doppler signal

What are the classification criteria for RA – 1987 ACR? (6)

``` Morning stiffness Arthritis of three or more joint areas Symmetric arthritis Rheumatoid factor Rheumatoid nodules Characteristic radiological changes ```

How is RA diagnosed pragmatically? (3)

Inflammation of three or more joints Rheumatoid factor / anti-CCP Raised ESR / CRP

What evolving adjunctive therapies are there for RA? (2)

Bisphosphonates for accelerated osteoporosis | Statins for accelerated IHD

What combination therapy is there for RA?

Methotrexate plus sulfasalazine plus cholorquine

What are connective tissue diseases?

Multi-system inflammatory diseases characterised by | autoantibodies and immunological abnormalities.

Give three examples of connective tissue diseases.

Systemic lupus erythematosus Scleroderma / Systemic sclerosis Dermatomyositis

What are the most common symptoms of SLE? (10)

``` Low grade fever Photosensitivity Mouth and nose ulcers Muscles aches Arthritis Fatigue Loss of appetite Butterfly rash Inflammation (pleura and pericardium) Poor circulation (fingers and toes) ```

What does ankylosing spondylitis have a strong association with?

HLA B27

What are the signs and symptoms of ankylosing spondylitis? (4)

Insidious onset of back discomfort before age 40 Duration longer than 3 months Associated with morning stiffness Improvement with exercise

How is ankylosing spondylitis treated? (2)

Conventional analgesia / NSAIDs | Physiotherapy to maintain flexibility (hydrotherapy)

What is the clinical history like for reactive arthritis?

Seronegative asymmetric arthritis following urethritis or cervicitis, and infectious diarrhea May go on to develop ankylosing spondylitis Less strong association with HLA B27 than AS

What are the clinical features of reactive arthritis? (6)

``` Urethritis balanitis Knee effusion Heel pain Keratoderma blennorrhagica on sole Sausage toe Synovitis of MTP joint ```