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LOCO 2 > Inflammatory Joint Conditions > Flashcards

Inflammatory Joint Conditions Flashcards

1
Q

How is MSK pain characterized? (3)

A

Myalgia (muscles)
Arthralgia (joints)
Back pain

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2
Q

What are the sources of MSK pain? (4)

A

Bone
Soft tissue
Joint
Referred/central

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3
Q

What can joint problems be divided into?

A

Inflammatory disorders or degenerative disorders

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4
Q

What are inflammatory disorders divided into? (3)

A

Autoimmune diorders
Crystal arthropathy
Infection

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5
Q

What autoimmune joint disorders are there? (3)

A

RA
Connective tissue disorder
Spondarthritis

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6
Q

What should the history consist of? (4)

A

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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7
Q

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

A

RA
Connective tissue disorder
Spondarthritis

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8
Q

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

A

Crystal arthropathy
Infection
Degenerative disorder

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9
Q

What is fibromyalgia?

A

Widespread mechanical hypersensitivity

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10
Q

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

A

Systemic rheumatic disease

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11
Q

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

A

Viral arthritis

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12
Q

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

A

Osteoarthritis, soft tissue disorder, or hypothyroidism etc

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13
Q

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

A

Fibromyalgia

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14
Q

What is the prevalence of RA in the UK?

A

387,000 adults in UK (0.81% population)

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15
Q

What is the female:male ratio for RA?

A

3:1

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16
Q

What is the peak age of onset for RA?

A

Between 20 - 50 years of age

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17
Q

What are the features of RA? (3)

A

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

18
Q

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

A

Valgus deformity

Baker’s cyst

19
Q

What are the ocular complications in RA? (3)

A

Keratoconjunctivitis sicca
Scleritis & episcleritis
Scleromalacia perforans

20
Q

What are the neuromuscular complications of RA? (2)

A

Muscle wasting
Carpal tunnel syndrome
Atlanto-axial subluxation

21
Q

What are the cardiac complications of RA? (4)

A

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

22
Q

What are the bone complications of RA?

A

Accelerated osteoporosis

23
Q

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

A

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

24
Q

What is rheumatoid factor?

How many % of RA patients are positive for this?

A

Auto-antibody against Fc fragment of IgG

> 70-80%

25
Q

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

A 
Old age (>70 years old)
Sjogren’s
SLE
Sarcoidosis
Infections
26
Q

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

A

10-25%

27
Q

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

A

Periarticular osteoporosis
Soft tissue swelling
Bone erosion

28
Q

By 12 months, how many % have erosive changes?

A

15-30%

29
Q

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

A

90%

30
Q

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

A

Synovial thickening
Effusion
Power Doppler signal

31
Q

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

A 
Morning stiffness
Arthritis of three or more joint areas
Symmetric arthritis
Rheumatoid factor
Rheumatoid nodules
Characteristic radiological changes
32
Q

How is RA diagnosed pragmatically? (3)

A

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

33
Q

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

A

Bisphosphonates for accelerated osteoporosis

Statins for accelerated IHD

34
Q

What combination therapy is there for RA?

A

Methotrexate plus sulfasalazine plus cholorquine

35
Q

What are connective tissue diseases?

A

Multi-system inflammatory diseases characterised by

autoantibodies and immunological abnormalities.

36
Q

Give three examples of connective tissue diseases.

A

Systemic lupus erythematosus
Scleroderma / Systemic sclerosis
Dermatomyositis

37
Q

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

A 
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)
38
Q

What does ankylosing spondylitis have a strong association with?

A

HLA B27

39
Q

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

A

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

40
Q

How is ankylosing spondylitis treated? (2)

A

Conventional analgesia / NSAIDs

Physiotherapy to maintain flexibility (hydrotherapy)

41
Q

What is the clinical history like for reactive arthritis?

A

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

42
Q

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

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

LOCO 2 (28 decks)

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