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Locomotor 2 > Inflammatory Joint Conditions > Flashcards

Inflammatory Joint Conditions Flashcards

1
Q

How is musculoskeletal pain characterised

A
  • Back pain
  • Myalgia - myalgia
    pain in a muscle or group of muscles.
  • Arthralgia - joint pain
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2
Q

what can cause musculoskeletal pain

A
  • soft tissue
  • bone
  • joint
  • referred/central e.g. hip arthritis being referred to the knee
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3
Q

what are the two type of arthritis

A

Inflammatory disorder
- e.g. Rheumatoid arthritis

Degenerative disorder
- e.g. osteoarthritis - probably a failure of repair

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4
Q

name the types of inflammatory disorders

A

Autoimmune disorder

  • rheumatoid arthritis
  • connective tissue disorder
  • spondarthritis

crystal arthropathy
- gout

infection

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5
Q

What should you look for in a musculoskeletal history

A
  1. 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

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6
Q

what can cause one joint to be affected

A
  • Infection
  • Crystal arthropathy
  • degenerative disorder such as osteoarthritis
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7
Q

what is it called when one joint is affected

A

monarthralgia

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8
Q

What is it called when many joints are affected

A

polyarthralgia

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9
Q

What causes many joints to be infected

A
  • Rheumatoid arthritis
  • Connective tissue disorder
  • Spondarthritis
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10
Q

How do you evaluate polyartricular pain

A
  • 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
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11
Q

what are the signs of synovitis

A
  • swollen
  • tender
  • warm
  • redness
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12
Q

What is the prevalence of rheumatoid arthritis

A

Prevalence 387,000 adults in UK (0.81% population)

Incidence 12,000 new cases each year

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13
Q

who is more affected in age and sex for rheumatoid arthritis

A

Gender Female : male ratio - 3 : 1

Peak onset Between 20 - 50 years of age

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14
Q

What are the features of rheumatoid arthritis

A

Symmetrical arthropathy

Hands & feet > 80% cases, PIP and metacarpaphalgeanl joints but not DIP

Early morning stiffness

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15
Q

describe, early middle and late stage rheumatoid arthritis

A

Early stage
Swollen, tender and puffy – called

Middle stange
Damage caused by synovitis to the teathers

End stage
Sublaxatation
Nodules

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16
Q

What are the problems in and around the knee in rheumatoid arthritis

A
  • Valgus deformity
  • Bakers cysts
  • fusion can’t go forward and back therefore they can bulge out posteriorly these are barkers cysts
17
Q

What are the ocular complications in RA

A

Keratoconjunctivitis sicca - caused by dry eyes

Scleritis & episcleritis - can lead to potential blindness

Scleromalacia perforans

18
Q

What are neuromuscular complications in RA

A

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

19
Q

what are the clinical signs of cervical mylopathy

A
  • increased reflexes
  • spasiticty
  • extensor and plantar responses
20
Q

what does rheumatoid arthritis look like in pathology terms

A
  • synovitis
  • destructive pannus
  • hypertrophy and hyperplasia of the synovium
  • infiltration of leucocytes
21
Q

What are rheumatoid factors

A
  • antibodies against antibodies
22
Q

How many people with rheumatoid arthritis have rheumatoid factors

A

RA > 70 – 80% +ve

- frequency of false positive rheumatoid factor rises with age

23
Q

what does imaging show of rheumatoid arthritis

A
  • periarticular osteoporosis
  • soft tissue swelling
  • bone erosion
  • 12 months – 15 – 30% erosive changes
  • 24 month – 90% in those with non-responsive disease
24
Q

how can you detect Rheumatoid arthtiirs is terms of imaging

A

ultrasound scan

- this will show the synovitis

25
Q

how can you detect Rheumatoid arthritis is terms of imaging

A

ultrasound scan

- this will show the synovitis

26
Q

what does the ultrasound scan show

A

Synovial thickening

Effusion

27
Q

What is the diagnosis criteria for rheumatoid arthritis

A

Inflammation of three or more joints

Rheumatoid factor / anti-CCP

Raised ESR / CRP

28
Q

name 3 connective tissue diseases

A

Systemic lupus erythematosus

Scleroderma / Systemic sclerosis

Dermatomyositis

29
Q

What are connective tissue diseases

A

= all multi-system inflammatory diseases characterised by
characterised by autoantibodies and immunological
abnormalities

30
Q

name what lupus can do

A 
Lots of cytokines 
Skin rashes
Photosensitivity 
Renal involvement requiring dialysis and or kidney replacement 
Poor cirualtion
31
Q

describe

Scleroderma / Systemic sclerosis

A

Significant mortality – consequence or renal or CNS involvement
Fibrosis and scarring in the peripheral tissues associated with poor circulation

32
Q

What is Dermatomyositis

A

rashes on the back of the hand and around the eye

33
Q

When is the onset of ankylosing spondylitis

A

Onset of back discomfort before age 40

  • usually in men
34
Q

describe characteristics of ankylosing spondylitis

A

Duration longer than 3 months

Associated with morning stiffness

Improvement with exercise

bamboo spine

whole spine becomes encased

  • eyeritis
35
Q

what gene is ankylosing spondylitis associated with

A

HLA B27

36
Q

how do you treat ankylosing spondylitis

A

Conventional analgesia /
NSAIDs

Physiotherapy to maintain
Flexibility (hydrotherapy)

responds well to anti TNF treatments

37
Q

describe reactive arthritis

A

Seronegative asymmetric arthritis following:

  • Urethritis or cervicitis
  • Infectious diarrhea

Less strong association with HLA B27 than AS

May go on to develop ankylosing spondylitis

Locomotor 2 (30 decks)

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