Intro To Rheum P1 Flashcards
What is rheumatology?
Medical specialty dealing with diseases of the musculoskeletal system
What is a joint?
Where two bones meet
What are tendons?
Cords of strong fibrous Collagen tissue attaches muscle to bone
What are ligaments?
Flexible fibrous connective tissue which connects two bones
When looking at joints what four things should you look for?
Pain, swelling, stiffness, restricted range of movement
At what time of the day is stiffness of the joints more likely?
Morning
What is the term for when only one joint is involved?
Monoarthritis
What is the term for when 2-4 joints are involved?
Oligoarthritis
What is the term for when over five joints are involved?
Polyarthritis
What are some systemic features you should look for when dealing with patients with rheumatological problems
Fever, weight loss, malaise
What is malaise?
General feeling of discomfort
What is arthritis?
Disease of the joints
What are the two major divisions of arthritis?
Degenerative joint disease (osteoarthritis)
Inflammatory joint disease
Why is arthritis categorised into two major divisions?
As the treatment of these two are completely different
What are the five cardinal features of inflammation
Red, pain, hot, swelling, loss of function
What is inflammation?
Physiological response to deal with injury or infection
What are the physiological cellular and molecular changes associated with inflammation?
Increase blood flow,
migration of leucocytes into tissue
, activation of leucocytes,
cytokines production
Which cytokines are produced an inflammation?
TNF alpha, IL-1, IL-6, IL17
What are the three main causes of joint inflammation?
Infection, crystal arthritis, immune mediated (autoimmune)
What are the two main infections that can cause joint inflammation?
Septic arthritis and tuberculosis
What can cause Crystal arthritis?
Gout and pseudogout
What can cause immune mediated joint inflammation?
Mainly rheumatoid arthritis
What Is an example cause of sterile joint inflammation?
Crystal arthritis and immune mediated
What can cause septic arthritis?
Bacterial infection of a joint typically staphylococcus aureus
How might a patient with septic arthritis present in a clinic?
Acute red spots painful swollen joint
Monoarthritis
Fever
How can you diagnose septic arthritis?
Do a joint aspiration and send a sample for urgent gram staining
How do you treat septic arthritis?
Surgical lavash which is essentially washing out the joint
What form of septic arthritis affects multiple joints?
Gonococcal septic arthritis
 what are the two main types of crystal arthritis
Gout and pseudogout
What causes gout?
Deposition of monosodium urate (Uric acid) around joints
What is a risk factor for gout?
Hyperuricaemia (high uric acid levels)
What causes pseudogout?
Caused by deposition of calcium pyrophosphate dehydrate (cppd) crystals in joints
What does cppd stand for
Calcium pyrophosphate dihydrate
What is tophi? 
Aggregated deposits of monosodium urate crystals in tissue and develop on hands feet elbows and ears
In which condition is tophi seen in
 gout
Which joint is particularly affected by gout?
Metatarsophalangeal joint (big toe)
What is the term for when uric acid crystals deposit in the big toe joint?
Podagra
What blood markers would you look at for gout?
Raised c reactive protein (marker of inflammation)
Raised uric aicd
What would an x-ray of a patient with chronic gout look like?
Would have juxta-articular erosions (look like rat bites)
How would you diagnose gout?
Joint aspiration & synovial fluid analysis
What is rheumatoid arthritis?
Chronic autoimmune disease characterised by pain stiffness and symmetrical synovitis of Synovial joint
Which joint is particularly affected by rheumatoid arthritis?
Proximal inter-phalangeal joint
What joint is affected here?
Proximal inter-phalangeal joint
What areas other than the synovial joints are affected by rheumatoid arthritis?
Tenosynovium
Bursa
What condition is this picture showing and in which disease do you see this in?
Extensor tenosynovitis seen in RA
What condition is the image showing and which disease causes this?
Olecranon (elbow) bursitis from RA
Describe the pattern in RA?
Symmetrical,
Poly arthritis,
Affects mainly small joints but affects big joints too
What causes osteoarthritis?
Wearing away of articular cartilage
What are some of the symptoms of osteo arthritis?
Joint point (worser with activity)
Joint crepitus (creaking)
Joint enlargement
Limited range of motion
What are some signs of osteoarthritis
Heberdens nodes and Bouchard nodes
What is the term for this sign and which joint is affected in this image?
Heberdens nodes & distal interphalangeal joints
What is the term for this sign and which joint is affected?
Bouchard nodes & proximal interphalangeal joints
What are some radiograph in features seen in osteoarthritis?
Joint space narrowing
Subchondral bony sclerosis (increased whiteness)
Osetophytes
What is the speed of onset of rheumatoid arthritis?
Rapid
