Joint Disorders - JRA, SEPTIC, GOUTY,

Question 1

JRA

Answer 1

Juvenile rheumatoid arthritis

Question 2

How many different types can JRA occur as?

Answer 2

Several

Question 3

How does JRA differ from RA (thew adult form)?

Answer 3

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)

Question 4

ANAs

Answer 4

antinuclear antibodies

Question 5

How does the systemic form (Still disease) of JRA develop?

Answer 5

with fever
rash
lymphadenopathy 
hepatomegaly
as well ass joint involvement

Question 6

What does a second form of JRA cause?

Answer 6

polyarticular inflammation similar to adult form

Question 7

What does a third form of JRA involve?

Answer 7

four or fewer joints
but cause uveitis…
inflammation of iris, ciliary body, choroid (uveal tract) in eye

Question 8

In how many joints does Infectious (Septic) Arthritis develop?

Answer 8

usually develop in a single joint

Question 9

How does the joint appear in Infectious (Septic) Arthritis?

Answer 9

red, swollen, painful
decreased range movement
synovium swollen, purulent exudate forms

Question 10

Dx Infectious (Septic) Arthritis

Answer 10

aspiration synovial fluid followed by culture and sensitivity tests - confirms

Question 11

Cause Infectious (Septic) Arthritis

Answer 11

blood-borne bacteria e.g. gonococcus or staphylococcus source infection many cases
although anaerobic - becoming increasingly common

Question 12

Example of Infectious (Septic) Arthritis

Answer 12

Lyme disease

Question 13

In some cases of Infectious (Septic) Arthritis, what is there a Hx of?

Answer 13

trauma surgery

spread from nearby infection e.g. osteomyelitis

Question 14

What is Lyme disease caused by?

Answer 14

spirochete and transmitted by ticks

Question 15

What is Lyme disease characterised by?

Answer 15

migratory arthritis
rash developing several weeks to months after tick bite
knee and large joints most often involved

Question 16

What is now available for Lyme disease?

Answer 16

vaccine

Question 17

What Tx is necessary Infectious (Septic) Arthritis?

Answer 17

immediate, aggressive antimicrobial tx

prevent excessive cartilage destruction and fibrosis to the joint

Question 18

Fibrosis

Answer 18

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

Question 19

Parenchymal

Answer 19

relating to or affecting the functional tissue of an organ

Question 20

In what group is Gout most common?

Answer 20

males older than 40yrs

Question 21

What does Gout result from?

Answer 21

from deposits of uric acid and urate crystals in the joint that then cause an acute inflammatory response

Question 22

What is Uric acid a waste product of?

Answer 22

purine metabolism

normally excrete through the kidneys

Question 23

What leads to Primary Gout?

Answer 23

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.

Question 24

What usually precipitates a Gout attack?

Answer 24

sudden increase in serum uric acid levels usually precipitates

Question 25

What part of the body does Gout usually affect?

Answer 25

affects a single joint e.g. such as in the big toe

Question 26

What causes acute inflammation in Gout? | What if the effect of this?

Answer 26

develops from uric acid deposits articular cartilage is damaged inflammation causes redness, swelling of joint, severe pain

Question 27

Gout attack occurs...

Answer 27

intermittently

Question 28

Dx Gout

Answer 28

examination of synovial fluid and blood tests

Question 29

Tophus

Answer 29

large, hard nodule | consist of urate crystals precipitated in soft tissue or bone

Question 30

What do Tophus result in?

Answer 30

inflammatory response

Question 31

Typically, | How long after Gout attack do Tophi occur?

Answer 31

few years after the first attack of gout

Question 32

Where may Tophi develop?

Answer 32

joint bursae extensor surfaces forearm pinnae of the ear

Question 33

Tx Gout:

Answer 33

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

Question 34

Serum Levels:

Answer 34

...

Question 35

Why is the normalisation of Serum Uric acid levels important?

Answer 35

- important - uric acid kidney stones - threat - anyone w chronic hyperuricemia