Introduction to Rheumatology :) Flashcards
define rheumatology
medical specialty dealing with diseases of the musculoskeletal system
define joint
where 2 bones meet
define tendon
tissue that attaches muscle to bone
what are tendons made of?
cords of strong fibrous collagen tissue
what are the role of ligaments
connects 2 bones
what are ligament tissues made of?
flexible fibrous connective tissue
define acute
develop suddenly and last a short time
define sub-acute
state between acute and chronic
define chronic
long-lasting condition, that develops over time
how many joints are involved in monoarthiritis
1 joint involved
how many joints are involved in oligoarthritis
2-4
how many joints are involved in polyarthritis
5+
define systemic features
entire body effects
what is arthritis
disease of the joints
what is sterile inflammation?
inflammation occurring in the absence of micro-organisms
what is defined as prolonged inactivity/morning stiffness
stiffness that lasts >30 mins
define non-sterile inflammation
inflammation occurring due to micro-organisms
define lavage
surgical wash out
define rheumatoid arthritis
chronic autoimmune disease characterized by pain, stiffness and synovitis
what is synovitis
inflammation of synovial membrane
define osteophytes
bony lumps that grow on bones in spine or around joint
define osteopenia
when mineral content of bone is reduced, but less so than osteoporosis
how can you detect osteopenia on a X-ray
bone appears darker and less bright
define birefringence
refraction of light in a transparent material
define tophi
aggregated deposits of MSU in tissue
state the 2 divisions of arthritis
- degenerative joint disease (osteoarthritis)
- inflammatory joint disease
state the difference in onset between inflammatory joint disease and osteoarthritis
inflammatory = rapid onset
osteoarthritis = slow onset
state the difference in joint pattern between inflammatory joint disease and osteoarthritis
inflammatory joint disease = symmetrical joint pattern
osteoarthritis = asymmetrical joint pattern
state the difference in the age range of patients impacted between inflammatory joint disease and osteoarthritis
inflammatory = younger age groups
osteoarthritis = older age groups
is osteoarthritis autoimmune?
no
in which arthritis division is osteopenia common?
inflammatory joint disease
in which arthritis division is osteophytes common?
osteoarthritis
what is the cause of septic arthritis
bacteria
what is the clinical presentation of septic arthritis
inflammation = rubor, tumor, calor and fever
what type of arthritis is septic arthritis
monoarthritis
when is septic arthritis not monoarthritis?
when gonoccoccal bacteria is involved => polyarthritis
state the technique used to diagnose septic arthritis
joint aspiration
what happens in joint aspiration
obtain a fluid sample from septic joint => analyse
state the 2 treatments of septic arthritis
lavage and IV antibiotics
state the bacterial causes of septic arthritis (3)
streptococci, staphylococcus aureus and gonococcus
does rheumatoid arthritis have a symmetrical or asymmetrical joint pattern?
symmetrical
how many joints are impacted in rheumatoid arthritis
5+ (polyarthritis)
what joints does rheumatoid arthritis impact
small and larger joints
what is the cause of rheumatoid arthritis
auto-immune
what is the clinical presentation of an individual with rheumatoid arthritis?
early morning stiffness in and around joints => long term joint damage
what is used to diagnose rheumatoid arthritis?
autoantibody against IgG (rheumatoid antibody) => found in blood test
state 3 areas commonly impacted by rheumatoid arthritis
- hands
- wrists
- feet
state 2 types of crystal arthritis
- gout
- pseudogout
state the cause of crystal gout
deposition of monosodium urate (MSU) crystals
what is a risk factor of gout
high uric acid levels
state the 3 causes of gout
- genetic tendency
- increased intake of purine rich foods
- kidney failure
where is gout common?
big toe
what is the name of the joint in the big toe which is impacted by gout
metatarsophalangeal joint
state the onset of gout
abrupt
what is a characteristic of gout on X-Rays?
‘juxta-articular erosions’ aka rat bite erosions
state 2 diagnostic tests for gout
- joint aspiration and synovial fluid analysis
- bloods => C-reactive proteins and serum urate
positive result of joint aspiration and synovial fluid analysis test for gout - 2
needle shaped crystals and negative bifringence
how is the joint aspiration and synovial fluid analysis done?
Needle inserted => fluid aspirated => sent to lab for microbiology OR polarising light microscopy to detect crystals
what are the positive blood tests for gout? - 2
increased C-reactive proteins
increased serum urate
problem of using blood tests to diagnose gout
non-specific and only shows inflammation
what is the acute treatment of gout?
reduces inflammation (steroids and anti-inflammatory drugs)
what is the chronic treatment for gout?
reduces long term uric acid levels (lifestyle diet changes and xanthine oxidase inhibitors)
state the cause of pseudogout
deposition of calcium pyrophosphate dihydrate (CPPD) crystals
state the 2 risk factors of pseudogout
- elderly
- background of OA
State the diagnostic test for pseudogout
synovial fluid analysis and joint aspiration
state the positive result of joint aspiration and synovial fluid analysis for pseudogout
- brick shaped crystals
- +ve birefringence
is osteoarthritis inflammatory?
no
what is the speed of onset of osteoarthritis
gradual
when is osteoarthritis prevalent
as age increases and if there is previous joint trauma
state the 4 common joints impacted by osteoarthritis
- spine
- hand joints
- knees
- hips
state 3 signs of osteoarthritis
- joint pain when moving
- joint crepitus
- joint enlargement
what is joint crepitus
cracking sound when moving joint
what are the names of the enlarged joints
Heberden’s nodes
state the 3 X-Ray features of osteoarthritis
- joint space narrowing
- sub-chondral bony sclerosis
- osteophytes
what is sub-chondral bony sclerosis
whiteness on X-Rays
what is sub-chondral bony sclerosis
whiteness on X-Rays
what clinical features are analysed in rheumatology?
- speed of onset
- pattern of joint movement
- size
- symmetrical or asymmetrical