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BRS Y2 > Intro to Rheumatology > Flashcards

Intro to Rheumatology Flashcards

1
Q

What is a joint?

A

Where 2 bones meet

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2
Q

What are tendons?

A

Chords of strong fibrous collagen tissue attaching muscle to bone

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3
Q

What are ligaments?

A

Flexible fibrous connective tissue which connect two bones

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4
Q

How many cells deep is the synovium?

A

1-3 cells

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5
Q

What cells does the synovium contain?

A

macrophage like phagocytic cells and fibroblast cells that produce hyaluronic acid

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6
Q

What is synovial fluid rich in?

A

Hyaluronic acid

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7
Q

What is articular cartilage formed of?

A

Type II collagen and proteoglycan (aggrecan)

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8
Q

What are the 3 big components of synovial joint?

A

Synovium, synovial fluid and articular cartilage

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9
Q

Define arthritis

A

Disease of the joints

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10
Q

What are the 2 main types of arthritis?

A

Osteoarthritis and inflammatory

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11
Q

What is osteoarthritis?

A

A degenerative type of arthritis

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12
Q

Define inflammation

A

A physiological response to deal with injury or infection

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13
Q

What are the clinical signs of inflammation?

A 
Rubor (red)
Dolor (pain)
Calor (hot)
Tumor (swelling)
Loss of function
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14
Q

What physiological, cellular and molecular changes occur with inflammation?

A

Increased blood flow
Migration of white blood cells (leucocytes) into the tissues
Activation/differentiation of leucocytes
Cytokine production

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15
Q

What are the 2 causes of joint inflammation?

A

Crystal arthritis and immune mediated

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16
Q

What are the types of crystal arthritis?

A

Gout and pseudogout

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17
Q

What is gout?

A

A syndrome caused by deposition of urate (uric acid) crystals that causes inflammation

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18
Q

What are crystals in gout made of?

A

Urate (uric acid)

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19
Q

What is the main risk factor for gout?

A

Hyperuricaemia (high uric acid levels)

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20
Q

What are some causes of hyperuricaemia?

A 
Genetic tendency
Increased intake of purine rich foods
Reduced excretion (kidney failure)
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21
Q

What are tophi?

A

Aggregated deposits of mono sodium urate in tissue, they are white looking

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22
Q

What joint does gouty arthritis most commonly affect?

A

Metatarsophalangeal joint of the big toe (‘1st MTP joint’)

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23
Q

How does gout come on and how is it characterised?

A

Abrupt onset
Extremely painful
Joint red, warm, swollen and tender
Resolves spontaneously over 3-10 days

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24
Q

What is pseudogout?

A

A syndrome caused by deposition of calcium pyrophosphate dihydrate (CPPD) crystal deposition crystals that leads to inflammation

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25
Q

What are crystals in pseudogout made of?

A

Calcium pyrophosphate dihydrate (CPPD)

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26
Q

What are risk factors for pseudogout?

A

Background osteoarthritis, elderly patients, intercurrent infection

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27
Q

How is acute pseudogout managed?

A

colcihine, NSAIDs, Steroids

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28
Q

How is chronic pseudogout managed?

A

Allopurinol

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29
Q

What sample can be examined in gout and pseudogout?

A

Synovial fluid

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30
Q

What shape are crystals in gout?

A

Needle

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31
Q

What shape are crystals in pseudogout?

A

Brick

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32
Q

What is the result for polarising light microscopy in gout?

A

Negative

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33
Q

What is the result for polarising light microscopy in pseudogout?

A

Negative

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34
Q

Is rheumatoid arthritis chronic or acute?

A

Chronic

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35
Q

How is rheumatoid arthritis characterised?

A

Pain, stiffness and symmetrical synovitis (inflammation of the synovial membrane) of synovial (diarthrodial) joints

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36
Q

What is abnormal is rheumatoid arthritis?

A

The synovial membrane, it becomes proliferated due to neovascularisation, lymphangiogenesis and inflammatory cells

37
Q

What happens to the cytokine balance in rheumatoid arthritis?

A

There is an excess of pro-inflammatory vs. anti-inflammatory cytokines

38
Q

What is the function of a healthy synovial membrane?

A

Maintenance of synovial fluid

39
Q

What is the consistency of synovial fluid?

A

Viscous

40
Q

What is seen in rheumatoid arthritis at the joint?

A

Synovitis
Bone erosion
Pannus (proliferated mass of synovial membrane)
Cartilage degradation (joitn space narrowing)

41
Q

What is the main pro inflammatory cytokine that is present in excess in rheumatoid arthritis?

A

TNF alpha

42
Q

What cytokine is often inhibited when treating rheumatoid arthritis and how?

A

TNF alpha, achieved through parenteral administration (most commonly sub-cutaneous injection) of antibodies or fusion proteins

43
Q

What is polyarthritis?

A

Swelling of the small joints of the hand and wrists, it is symmetrical, more prominent in the early morning

44
Q

What extra articular disease can occur in rheumatoid arthritis?

A

Rheumatoid nodules
Vasculitis
Episcleritis

45
Q

What factor may be detected in blood in rheumatoid arthritis?

A

Rheumatoid factor= autoantibody against IgG

46
Q

What is the pattern of joint involvement in rheumatoid arthritis?

A 
Symmetrical
Polyarthritis (affects multiple joints)
Affects small and large joints
47
Q

What joints are commonly involved in rheumatoid arthritis?

A 
Metacarpophalangeal joints (MCP)
Proximal interphalangeal joints (PIP)
Wrists 
Knees
Ankles
Metatarsophalangeal joints (MTP)
48
Q

What are the common extra articular features in RA?

A

Fever, weight loss, subcutaneous nodules

49
Q

What are the uncommon extra articular features in RA?

A

Vasculitis
Ocular inflammation e.g. episcleritis
Neuropathies
Amyloidosis
Lung disease – nodules, fibrosis, pleuritis
Felty’s syndrome – triad of splenomegaly, leukopenia and rheumatoid arthritis

50
Q

What are subcutaneous nodules associated with in RA?

A

Severe disease
Extra-articular manifestations
Rheumatoid factor

51
Q

What is a typical position for a subcutaneous nodule in RA?

A

Ulnar border of forearm (near elbow)

52
Q

What are the 2 antibodies found in RA?

A

Rheumatoid factor

Antibodies to citrullinated protein antigens (ACPA)

53
Q

What do rheumatoid factor antibodies target?

A

Fc portion of IgG

54
Q

What type of antibody is rheumatoid factor?

A

IgM

55
Q

What enzymes mediate ACPA in RA?

A

Peptidyl arginine deiminases (PADs)

Arginine becomes citrulline

56
Q

What is the treatment goal in RA?

A

Prevent joint damage

57
Q

How does ideal treatment of RA start and progress?

A

Early symptom recognition and referral
Prompt initiation of treatment
Aggressive treatment to allow early suppression

58
Q

What is the main class of drugs used in RA? What ones are used first line?

A

DMARDs, 1st line is methotrexate in combination with hydroxychloroquine or sulfasalazine

59
Q

What is the second line treatment for RA?

A

Biological therapies

60
Q

What are biological therapies (in ref to RA)?

A

Proteins (usually antibodies) that specifically target a protein such as an inflammatory cytokine

61
Q

What are the 4 ways biological therapies can be used in RA?

A

Inhibition of tumour necrosis factor-alpha (‘anti-TNF’)
B cell depletion
Modulation of T cell co-stimulation
Inhibition of interleukin-6 signalling

62
Q

Are autoantibdies found in akylosing spondylitis?

A

No

63
Q

What does ankylosis refer to in akylosing spondylitis?

A

Spinal fusion

64
Q

What is the common demographic for akylosing spondylitis?

A

20-30yr old males

65
Q

How does akylosing spondylitis present clinically?

A 
Lower back pain + stiffness
(early morning, improves with exercise)
Reduced spinal movements
Peripheral arthritis
Plantar Fasciitis
Achilles Tendonitis
Fatigue
Hyper extended neck
Loss of lumbar lordosis
Flexed hips and knees
66
Q

What is found in bloods in ankylosing spondylitis?

A

Normocytic anaemia
Raised CRP, ESR
HLA-B27

67
Q

What is found on MRI in ankylosing spondylitis?

A 
Squaring Vertebral bodies Romanus lesion
Erosion
Sclerosis
Narrowing SIJ
Bamboo Spine (vertebrae start to fuse together)
Bone marrow oedema
68
Q

How is ankylosing spondylitis managed?

A

Physiotherapy
Exercise regimes
NSAIDs
Peripheral joint disease – DMARDs

69
Q

What is psoriatic arthritis?

A

Joint inflammation in those with psoriasis

70
Q

How does psoriatic arthritis differ from RA?

A

It is seronegative, there are no autoantibodies

71
Q

How does psoriatic arthritis present clinically?

A

Classically asymmetrical arthritis affecting IPJs, there can also be symmetrical small joint involvement, spinal and sacroiliac joint inflammation, oligoarthritis of large joints, arthritis mutilans

72
Q

How is psoriatic arthritis managed?

A

DMARDs – methotrexate

73
Q

What must be avoided in psoriatic arthritis and why?

A

Oral steroids due to risk of pustular psoriasis due to skin lesions

74
Q

What is reactive arthritis?

A

Sterile inflammation in joints following infection especially urogenital and gastrointestinal infections

75
Q

What are important extra articular manifestations of reactive arthritis?

A

Enthesitis (tendon inflammation)
Skin inflammation
Eye inflammation

76
Q

What may reactive arthritis be a first manifestation of?

A

HIV or hepatitis C infection

77
Q

What demographic does reactive arthritis commonly affect?

A

Commonly young adults with genetic predisposition (e.g. HLA-B27) and environmental trigger (e.g. Salmonella infection)

78
Q

How is reactive arthritis managed?

A

Usually is self limiting but can be managed with NSAIDS or DMARDs if required

79
Q

What is reactive arthritis distinct from?

A

Septic arthritis (infection in joints)

80
Q

What is SLE?

A

A multi-system autoimmune disease with multi-site inflammation (can affect almost any organ)

81
Q

What are autoantibodies in SLE directed against?

A

Components of the cell nucleus (nucleic acids and proteins)

82
Q

What are the 2 clinical tests for autoantibodies in SLE?

A
  1. Antinuclear antibodies (ANA):
    High sensitivity for SLE but not specific.
    A negative test rules out SLE, but a positive test does not mean SLE.
  2. Anti-double stranded DNA antibodies (anti-dsDNA Abs):
    High specificity for SLE in the context of the appropriate clinical signs.
83
Q

Which gender does SLE affect more commonly? By how much?

A

More females (9:1)

84
Q

What demographic does SLE affect more commonly?

A

15 - 40 yrs

Increased prevalence in African and Asian ancestry populations

85
Q

What is a common rash in those with SLE?

A

Butterfly/malar rash

86
Q

What condition does symmetrical arthritis of the hand and wrists and morning stiffness indicate?

A

Rheumatoid arthritis

87
Q

What tests are ordered if rheumatoid arthritis is suspected?

A 
Rheumatoid factor
X ray
Lupus antibody (to exclude)
CRP
ESR
Bloods (to check for normocytic anaemia)
88
Q

If psoriatic arthritis is suspected, what other signs can you look for?

A

Other skin manifestations of psoriasis
Symmetry
Check ICPs
Is there saco-iliac joint inflammation?

BRS Y2 (85 decks)

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