intro to rheumatology Flashcards
what are the three subtypes of inflammatory joint problems?
autoimmune
crystal arthritis
infection
What are the 4 pillars of inflammation?
Red (rubor) Painful (dolor) Hot (calor) Swollen (tumour) [loss of function]
what are the characteristics of bone pain?
pain at rest and at night
what is the characteristic of pain in degenerative conditions?
pain with use
What is the characteristic of pain in inflammatory conditions?
pain eases with use
enthesitis and dactylitis are features of RA, T or F?
FALSE - they are features of psoriatic arthritis
What is the timeline for gout?
there is an initial acute phase where the gout is episodic and in between episodes, the gout goes away, with time if the gout is not treated, then the gout will become chronic and there will be persistence of symptoms
What is the timeline for RA?
RA onset is more slow and it is persistent. can come on by traumatic events if already genetically susceptible
what is the timeline for palindromic RA?
episodic, but doesn’t completely go away between episodes
what is the timeline for ReA?
gets better over time over a period of months
Name two types of deformities that can be seen with RA
ulnar drift
swan neck deformity
Is erosion seen with RA?
Yes erosion is a characteristic feature of RA
Why is there ulnar drift in RA?
damage to the MCP joint means the extensor tendon pulls the digits towards the ulnar side
In inflammatory joint problems how long does it take the pain to go away in the morning
> 60 mins
In degenerative joint problems how long does it take the pain to go away in the morning
<30 mins
What are the only 2 arthropathies to affect the DIP?
osteoarthritis
psoriatic arthritis
What type of arthritis affects the base of the thumb?
osteoarthritis
What happens in nodal OA?
there are bony swellings due to osteophytes
What are osteophytes
growths of Ca2+ around the joints
Do pts with connective tissue diseases have erosive arthritis?
NO! erosion is a feature of RA
what are the investigations that can be carried out in rheumatology?
inflammatory markers: ESR, CRP
autoantibodies
what do you need to bear in mind when doing an ESR?
ESR takes a long time to rise and fall ie day/weeks
there are some causes of false positives in ESR
ESR cannot differentiate between inflammation and infection
what causes the erythrocytes to stick together in ESR?
fibrinogen - an acute phase protein
What are some of the reasons that doing an ESR may give a false positive for inflammatory arthropathy?
older age female obesity race hypercholesterolaemia high Igs incl. myeloma
What inflammatory marker changes are seen in SLE?
rise in ESR with normal CRP
which organ produces CRP?
liver
How is CRP produced?
activated macrophages or adipocytes release inflammatory cytokines eg IL1. IL-6, TNF which cause the liver to produce CRP
What is CRP’s normal function in the body?
binds to damaged cells
activates complement
causes phagocytosis by macrophages
What is an autoantibody?
Igs that bind to self antigens
what autoantibodies may be detected in RA?
RF - rheumatoid factor
anti-CCP
what autoantibodies may be detected in SLE?
ANA
anti-dsDNA Abs
