Inflammatory joint disorders Flashcards

1
Q

word for single joint pain

A

monoarthralgia

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2
Q

word for mutliple joint pain

A

polyarthralgia

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3
Q

conditions associated with polyarthralgia

A

AUTOIMMUNE JOINT DISEASES

  1. RA
  2. C.T disorders
  3. Spondyloarthritis
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4
Q

conditions associated with monoarthralgia

A
  1. crystal arthropathy (gout,psudeogout)
  2. infection
  3. degenerative disorder (OA)
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5
Q

RA

  • prevalence
  • incidence
  • gender
  • peak onset
A
  • 1% pop
  • 12,000 new cases per year
  • females (3:1)
  • 20-50yrs
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6
Q

RA

  • joints commonly affected
  • clinical features
A
  • MCP +PIP of wrist (+ knees + ankles + feet)

- symmetrical polyarthralgia + early morning stiffness

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7
Q

RA hands

  1. early stage
  2. intermediate stage
  3. late stage
A
  1. erythema + swelling + warmth + tender MCP
  2. swan neck deformity + boutinnere deformity
  3. rheumatoid nodules + ulnar deviation + sublax phalanges
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8
Q

RA knees

A
  1. valgus deformity

2. bakers cyst (calf muscles)

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9
Q

RA occular complications

A

RA affects mucous membranes not just synovium

  1. keratoconjuncttivitis sicca (no tears - dry eyes)
  2. scleritis

scleritis - intracoccular content herniates - SCLEROMALACIA PERFORANS

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10
Q

RA neuromuscular complications in hand

A

CARPAL TUNNEL SYNDROME

  • median nerve entrapment
  • test = phalen’s /tinel’s
  • thenar eminence wastage
  • numbness of thumb/1st 2 fingers
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11
Q

RA neuromusclar complication spinal cord

A

ATLANTO-AXIAL SUBLUXATION

  • NECK PAIN = red flag
  • exc movement between C1 + C2 -damages SC
  • UMN signs in legs = babinksi,spasticity, hyperflexia

can lead to death

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12
Q

Reason for mortality in RA patients

A

IHD - reduces L.E 10years

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13
Q

Systemic complications in RA

  1. cardiac
  2. bone
A
  1. IHD, pericarditis, nodules

2. accelerated osteoporosis

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14
Q

Pathology RA

A
  1. hypertrophy of synovium - pannus - cartilage destruction + bone exposed
  2. infiltration of immune cells - mass pro-inflammatory cytokine release - cartilage + bone destruction
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15
Q

what rheumatoid factor (RF)

A

autoantibody to Fc portion of IgG

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16
Q

% RA patients with RF

A

70-80%

n.b - ppl with RF may not have RA also

17
Q

why is anti CCP a better diagnostic test for RA than RF

A
  • anti CCP gives less false positives than RF

- higher % have anti CCP - have RA

18
Q

Radiological changes in RA

  1. 3 features
  2. % patients with changes after 1yr
  3. % patients with changes after 2yr
A
  1. bony erosions + soft tissue swelling + peri-articular osteoporosis
  2. 15-30%
  3. 90%

*x-rays - RA progression too far before diagnosis (+treatment)

19
Q

what type of imaging can provide earlier diagnostic for RA

A

ULTRASOUND

  1. synovial thickening
  2. effusion
20
Q

3 clinical features qualify RA diagnosis

A
  1. polyarthritis
  2. raised ESR/CRP (inflammatory markers)
  3. RF + anti-CCP
21
Q

Currentr treatment for RA

A

COMBINATION THERAPY

  1. conventional DMARDs
  2. steroids (inflammation)
  3. analgesics
  4. adjucntive theraphy
22
Q

Adjunctive therapy for RA

  1. use of statins
  2. use of bisphosphonates
A
  1. slow IHD

2. slow osteoporosis

23
Q

Name 3 autoimmune connective tissue disorders

A
  1. systemic lupus erthyematous
  2. dermatomyositis
  3. scleroderma
24
Q

SYSTEMIC LUPUS

  1. clinical features
    - face
    - systemic
  2. antibody
  3. mortality
A

1.butterfly rash + alopecia + telangiectasia
renal failure + polyarthralgia + fatigue
2.antinuclear antibody
3.accelerated atherosclerosis

25
Q

SCLERDERMA

  1. define
  2. clinical features
  3. mortality
A
  1. hardening of the skin
  2. waxy, fibrotic hands + raynauds + renal disease + polyarthritis
  3. acc athersclerosis
26
Q

DERMATOMYSOSITIS

  1. define
  2. clinical features
  3. mortality
A
  1. inflammation of skin + muscle
  2. gottren papules (hands) + helitrope rash (eyelids + back) + muscles weakness/pain
  3. respiratory muscle weakness - respiratory failure
27
Q

SPONDYLOARTHRITIS

  1. define
  2. how differs from normal arthritis
  3. two types
A
  1. inflammatory rhematic disease - leads to arthritis
  2. effects entheses
  3. anklyosing spondylitis + reactive arthritis
28
Q

ANKYLOSING SPONDYLITIS

  1. define
  2. onset
  3. commonly affects which joints
  4. clincial features
  5. gender
A
  1. chronic inflammtory disease of axial skeleton
  2. 20s
  3. sacro-illac joints
  4. IRITIS + asymmetrical effusion (50%)
  5. men
29
Q

REACTIVE ARTHRITIS

  1. another name
  2. define
  3. triad of symptoms
  4. clinical features
A

1.Reiter’s syndrome
2. autoimmune condition that develops in response to an infection in another part of the body
3.inflammatory eye disease (conjunctivitis)
polyarthritis in large joints
urethritis (men) + cervictis (women)
4.CONJUNCTIVIS + KERATODERMA BLENORHAGIUM (hard nodules sole of foot)

30
Q

EYE PROBLEMS

  1. Conjunctivitis
  2. Iritis
  3. Scleritis
A
  1. Reactive Arthritis
  2. Ankolysing spondylitis
  3. RA