Joint Disorders - JRA, SEPTIC, GOUTY, Flashcards
JRA
Juvenile rheumatoid arthritis
How many different types can JRA occur as?
Several
How does JRA differ from RA (thew adult form)?
onset usually more acute systemic effects more marked but rheumatoid nodules absent large joints usually affected RF not usually present other abnormal antibodies present e.g. antinuclear antibodies (ANAs)
ANAs
antinuclear antibodies
How does the systemic form (Still disease) of JRA develop?
with fever rash lymphadenopathy hepatomegaly as well ass joint involvement
What does a second form of JRA cause?
polyarticular inflammation similar to adult form
What does a third form of JRA involve?
four or fewer joints
but cause uveitis…
inflammation of iris, ciliary body, choroid (uveal tract) in eye
In how many joints does Infectious (Septic) Arthritis develop?
usually develop in a single joint
How does the joint appear in Infectious (Septic) Arthritis?
red, swollen, painful
decreased range movement
synovium swollen, purulent exudate forms
Dx Infectious (Septic) Arthritis
aspiration synovial fluid followed by culture and sensitivity tests - confirms
Cause Infectious (Septic) Arthritis
blood-borne bacteria e.g. gonococcus or staphylococcus source infection many cases
although anaerobic - becoming increasingly common
Example of Infectious (Septic) Arthritis
Lyme disease
In some cases of Infectious (Septic) Arthritis, what is there a Hx of?
trauma surgery
spread from nearby infection e.g. osteomyelitis
What is Lyme disease caused by?
spirochete and transmitted by ticks
What is Lyme disease characterised by?
migratory arthritis
rash developing several weeks to months after tick bite
knee and large joints most often involved
What is now available for Lyme disease?
vaccine
What Tx is necessary Infectious (Septic) Arthritis?
immediate, aggressive antimicrobial tx
prevent excessive cartilage destruction and fibrosis to the joint
Fibrosis
aka fibrotic scarring
pathological wound healing
connective tissue replaces normal parenchymal tissue to the extent that it goes unchecked, leading to considerable tissue remodelling and the formation of permanent scar tissue
Parenchymal
relating to or affecting the functional tissue of an organ
In what group is Gout most common?
males older than 40yrs
What does Gout result from?
from deposits of uric acid and urate crystals in the joint that then cause an acute inflammatory response
What is Uric acid a waste product of?
purine metabolism
normally excrete through the kidneys
What leads to Primary Gout?
Hyperuricemia may develop if renal excreion is not adequate or a metabolic abnormality often agentic factor such as deficit of the enzyme uricase leading to elevated levels of uric acid (Primary Gout) is present.
What usually precipitates a Gout attack?
sudden increase in serum uric acid levels usually precipitates
What part of the body does Gout usually affect?
affects a single joint e.g. such as in the big toe
What causes acute inflammation in Gout?
What if the effect of this?
develops from uric acid deposits
articular cartilage is damaged
inflammation causes redness, swelling of joint, severe pain
Gout attack occurs…
intermittently
Dx Gout
examination of synovial fluid and blood tests
Tophus
large, hard nodule
consist of urate crystals precipitated in soft tissue or bone
What do Tophus result in?
inflammatory response
Typically,
How long after Gout attack do Tophi occur?
few years after the first attack of gout
Where may Tophi develop?
joint bursae
extensor surfaces forearm
pinnae of the ear
Tx Gout:
reducing serum uric acid levels - dietary, drugs changes, depending on the underlying cause
increasing fluid intake and increasing the pH
urine - promote excretion of excess uric acid
colchicine - during an acute episode
allopurinol - preventative and maintenance
normalisation serum uric acid levels
inflammtion and pain associated with acute attacks by NSAIDs should be relieved as soon as possible
Serum Levels:
…
Why is the normalisation of Serum Uric acid levels important?
- important - uric acid kidney stones - threat - anyone w chronic hyperuricemia
