Inflammatory Joint Conditions Flashcards
How is musculoskeletal pain characterised
- Back pain
- Myalgia - myalgia
pain in a muscle or group of muscles. - Arthralgia - joint pain
what can cause musculoskeletal pain
- soft tissue
- bone
- joint
- referred/central e.g. hip arthritis being referred to the knee
what are the two type of arthritis
Inflammatory disorder
- e.g. Rheumatoid arthritis
Degenerative disorder
- e.g. osteoarthritis - probably a failure of repair
name the types of inflammatory disorders
Autoimmune disorder
- rheumatoid arthritis
- connective tissue disorder
- spondarthritis
crystal arthropathy
- gout
infection
What should you look for in a musculoskeletal history
- Chronological history + distribution
- episodic, additive etc
- mono, oligo, poly (one joint is gout or infection, or multiple joints in poly arthritis)
- symmetrical (rheumatoid)
Precipitating factors (infections, trauma, drugs)
Responsiveness to therapy
Constitutional factors / systemic illness
what can cause one joint to be affected
- Infection
- Crystal arthropathy
- degenerative disorder such as osteoarthritis
what is it called when one joint is affected
monarthralgia
What is it called when many joints are affected
polyarthralgia
What causes many joints to be infected
- Rheumatoid arthritis
- Connective tissue disorder
- Spondarthritis
How do you evaluate polyartricular pain
- polyarthralgia
- do you have synovitis or not
- if yes is the duration greater than 6 weeks
- if yess then systemic rheumatic disease
- if no then viral arthritis
- if you do not have synovitis
- are there any tender spots
- if there are tender spots then it is fibromyaliga
- if there are not any tender points then osteoarthritis, soft tissue, hypothyroidism
what are the signs of synovitis
- swollen
- tender
- warm
- redness
What is the prevalence of rheumatoid arthritis
Prevalence 387,000 adults in UK (0.81% population)
Incidence 12,000 new cases each year
who is more affected in age and sex for rheumatoid arthritis
Gender Female : male ratio - 3 : 1
Peak onset Between 20 - 50 years of age
What are the features of rheumatoid arthritis
Symmetrical arthropathy
Hands & feet > 80% cases, PIP and metacarpaphalgeanl joints but not DIP
Early morning stiffness
describe, early middle and late stage rheumatoid arthritis
Early stage
Swollen, tender and puffy – called
Middle stange
Damage caused by synovitis to the teathers
End stage
Sublaxatation
Nodules
What are the problems in and around the knee in rheumatoid arthritis
- Valgus deformity
- Bakers cysts
- fusion can’t go forward and back therefore they can bulge out posteriorly these are barkers cysts
What are the ocular complications in RA
Keratoconjunctivitis sicca - caused by dry eyes
Scleritis & episcleritis - can lead to potential blindness
Scleromalacia perforans
What are neuromuscular complications in RA
Muscle wasting = thenar eminence wasting
Carpal tunnel syndrome - may occur early in disease - can get median nerve pressure, patients with a carpal tunnel syndrome with irritation of the medial nerve can get tingling in the joints
Atlanto-axial subluxation
- loss of support structures such as the dens which sublaxes backwards and hits the spinal cord
what are the clinical signs of cervical mylopathy
- increased reflexes
- spasiticty
- extensor and plantar responses
what does rheumatoid arthritis look like in pathology terms
- synovitis
- destructive pannus
- hypertrophy and hyperplasia of the synovium
- infiltration of leucocytes
What are rheumatoid factors
- antibodies against antibodies
How many people with rheumatoid arthritis have rheumatoid factors
RA > 70 – 80% +ve
- frequency of false positive rheumatoid factor rises with age
what does imaging show of rheumatoid arthritis
- periarticular osteoporosis
- soft tissue swelling
- bone erosion
- 12 months – 15 – 30% erosive changes
- 24 month – 90% in those with non-responsive disease
how can you detect Rheumatoid arthtiirs is terms of imaging
ultrasound scan
- this will show the synovitis
how can you detect Rheumatoid arthritis is terms of imaging
ultrasound scan
- this will show the synovitis
what does the ultrasound scan show
Synovial thickening
Effusion
What is the diagnosis criteria for rheumatoid arthritis
Inflammation of three or more joints
Rheumatoid factor / anti-CCP
Raised ESR / CRP
name 3 connective tissue diseases
Systemic lupus erythematosus
Scleroderma / Systemic sclerosis
Dermatomyositis
What are connective tissue diseases
= all multi-system inflammatory diseases characterised by
characterised by autoantibodies and immunological
abnormalities
name what lupus can do
Lots of cytokines Skin rashes Photosensitivity Renal involvement requiring dialysis and or kidney replacement Poor cirualtion
describe
Scleroderma / Systemic sclerosis
Significant mortality – consequence or renal or CNS involvement
Fibrosis and scarring in the peripheral tissues associated with poor circulation
What is Dermatomyositis
rashes on the back of the hand and around the eye
When is the onset of ankylosing spondylitis
Onset of back discomfort before age 40
- usually in men
describe characteristics of ankylosing spondylitis
Duration longer than 3 months
Associated with morning stiffness
Improvement with exercise
bamboo spine
whole spine becomes encased
- eyeritis
what gene is ankylosing spondylitis associated with
HLA B27
how do you treat ankylosing spondylitis
Conventional analgesia /
NSAIDs
Physiotherapy to maintain
Flexibility (hydrotherapy)
responds well to anti TNF treatments
describe reactive arthritis
Seronegative asymmetric arthritis following:
- Urethritis or cervicitis
- Infectious diarrhea
Less strong association with HLA B27 than AS
May go on to develop ankylosing spondylitis
