Inflammatory joint disorders

Question 1

word for single joint pain

Answer 1

monoarthralgia

Question 2

word for mutliple joint pain

Answer 2

polyarthralgia

Question 3

conditions associated with polyarthralgia

Answer 3

AUTOIMMUNE JOINT DISEASES

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

Question 4

conditions associated with monoarthralgia

Answer 4

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

Question 5

RA

• prevalence
• incidence
• gender
• peak onset

Answer 5

• 1% pop
• 12,000 new cases per year
• females (3:1)
• 20-50yrs

Question 6

RA

• joints commonly affected
• clinical features

Answer 6

• MCP +PIP of wrist (+ knees + ankles + feet)

- symmetrical polyarthralgia + early morning stiffness

Question 7

RA hands

1. early stage
2. intermediate stage
3. late stage

Answer 7

1. erythema + swelling + warmth + tender MCP
2. swan neck deformity + boutinnere deformity
3. rheumatoid nodules + ulnar deviation + sublax phalanges

Question 8

RA knees

Answer 8

1. valgus deformity

2. bakers cyst (calf muscles)

Question 9

RA occular complications

Answer 9

RA affects mucous membranes not just synovium

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

scleritis - intracoccular content herniates - SCLEROMALACIA PERFORANS

Question 10

RA neuromuscular complications in hand

Answer 10

CARPAL TUNNEL SYNDROME

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

Question 11

RA neuromusclar complication spinal cord

Answer 11

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

Question 12

Reason for mortality in RA patients

Answer 12

IHD - reduces L.E 10years

Question 13

Systemic complications in RA

1. cardiac
2. bone

Answer 13

1. IHD, pericarditis, nodules

2. accelerated osteoporosis

Question 14

Pathology RA

Answer 14

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

Question 15

what rheumatoid factor (RF)

Answer 15

autoantibody to Fc portion of IgG

Question 16

% RA patients with RF

Answer 16

70-80%

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

Question 17

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

Answer 17

• anti CCP gives less false positives than RF

- higher % have anti CCP - have RA

Question 18

Radiological changes in RA

1. 3 features
2. % patients with changes after 1yr
3. % patients with changes after 2yr

Answer 18

1. bony erosions + soft tissue swelling + peri-articular osteoporosis
2. 15-30%
3. 90%

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

Question 19

what type of imaging can provide earlier diagnostic for RA

Answer 19

ULTRASOUND

1. synovial thickening
2. effusion

Question 20

3 clinical features qualify RA diagnosis

Answer 20

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

Question 21

Currentr treatment for RA

Answer 21

COMBINATION THERAPY

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

Question 22

Adjunctive therapy for RA

1. use of statins
2. use of bisphosphonates

Answer 22

1. slow IHD

2. slow osteoporosis

Question 23

Name 3 autoimmune connective tissue disorders

Answer 23

1. systemic lupus erthyematous
2. dermatomyositis
3. scleroderma

Question 24

SYSTEMIC LUPUS

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

Answer 24

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

Question 25

SCLERDERMA 1. define 2. clinical features 3. mortality

Answer 25

1. hardening of the skin 2. waxy, fibrotic hands + raynauds + renal disease + polyarthritis 3. acc athersclerosis

Question 26

DERMATOMYSOSITIS 1. define 2. clinical features 3. mortality

Answer 26

1. inflammation of skin + muscle 2. gottren papules (hands) + helitrope rash (eyelids + back) + muscles weakness/pain 3. respiratory muscle weakness - respiratory failure

Question 27

SPONDYLOARTHRITIS 1. define 2. how differs from normal arthritis 3. two types

Answer 27

1. inflammatory rhematic disease - leads to arthritis 2. effects entheses 3. anklyosing spondylitis + reactive arthritis

Question 28

ANKYLOSING SPONDYLITIS 1. define 2. onset 3. commonly affects which joints 4. clincial features 5. gender

Answer 28

1. chronic inflammtory disease of axial skeleton 2. 20s 3. sacro-illac joints 4. IRITIS + asymmetrical effusion (50%) 5. men

Question 29

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

Answer 29

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)

Question 30

EYE PROBLEMS 1. Conjunctivitis 2. Iritis 3. Scleritis

Answer 30

1. Reactive Arthritis 2. Ankolysing spondylitis 3. RA