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Year 3 > MedEd arthritides > Flashcards

MedEd arthritides Flashcards

1
Q

What is osteoarthritis?

A

asymetrical degenerative synovial joint disease

cartilage destruction exceeds repair causing pain and instabiility

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2
Q

What are the 2 types of arthritis and who is more likely to have each?

A

Primary- obese, older, female, occupation using hands eg hairdresser
Secondary- when someone already has an altered/damaged joint eg RA, septic arthritis, congenital, trauma

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3
Q

How will someone with osteoarthritis present?

A

Morning stiffness for around 15 mins
Joint pain worse with activity better with rest
More common in high use or weight bering joints- hips, knee, DIP, PIP, wrist
Late night pain
Loss of function

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4
Q

What will you see on examination in osteoarthritis?

A 
Crepitus
Effusion
Erythema
Squaring of base of thumb
Hebeden's and bouchard's nodes
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5
Q

What acronym is used to remember what you see on xray in osteoarthritis? What does it stand for

A 
LOSS:
loss of joint space
osteophytes
subarticular sclerosis
subchondral cysts- fluid filled hole following joint line
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6
Q

What is the first line investigation for osteoarthritis? What others might you do

A

X ray

Joint aspirate

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7
Q

Who is more likely to have primary osteoarthritis?

A

Older people
Obese people
Females post menopause
Those who use joints in their occupation eg hairdresser

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8
Q

What is secondary osteoarthritis?

A

When someone’s joint is already damaged for some reason and then they get it

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9
Q

How is osteoarthritis managed? Give first, second and third line

A

Oral paracetamol +- topical NSAID/capasaicin
Oral NSAID+PPI
Opiates- use with caution as after a few weeks the analgesic effects will wear off and they have side effects

Short term management= intraarticular steroids

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10
Q

What do you need to co prescribe with NSAIDs?

A

PPI

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11
Q

What is RA?

A

autoimmune chronic and progressive inflammation of synovial lining, tendon sheaths and bursa

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12
Q

How long do you have to have inflammation for a diagnosis of RA?

A

6 weeks or more

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13
Q

Who is more likely to get RA?

A 
HLA DR4
HLA DR1
Smokers
Females
Family hx
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14
Q

How is RA diagnosed?

A

Clinical

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15
Q

What are the 2 main features of RA?

A 
Symmetrical polysrthritis (>4 joints)
Extraarticular manifestations
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16
Q

How many joints need to be affected in RA?

A

4 or more

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17
Q

How will someone with RA classically present?

A

Pain and stiffness in hands and wrists
Worse when they wake up
Resolves over the morning
Fatigue but no other systemic symptoms

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18
Q

What is seen on examination in RA?

A

Swelling
Tenderness
Small joint affected- wrist, ankle, MCP, PIP, MTP
DIP is spared

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19
Q

What joint is spared in RA?

A

DIP

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20
Q

What are chronic signs of RA

A

Ulnar deviation at MCP
Radial deviation at wirst
Z deformity of the thumb
Swan neck deformity- distal joint is flexed
Boutonnieres deformity- proximal joint is flexed

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21
Q

What joints are flexed in boutonieres vs swan neck deformity? How do you remember this?

A

boutonieres- proximal
swan neck- distal

B is before s in the alphabet

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22
Q

What are extra art features of RA

A 
Rheumatoid nodules
Felty's syndrome- RA, splenomegaly, neutropenia
episcleritis/scleritis
lymphadenopathy
pericadarditis
carpel tunnel syndrome 
pulmonary fibrosis/pleuritis
bursitis
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23
Q

What ix are done for RA? What is seen?

A

RF ab- high
Anti CCP antibody- high
ESR- high

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24
Q

When should you refer someone for RA? When is urgent referral done

A

Anyone with persistent synovitis

Urgent referral if- small joints of hands/feet, multiple joints, <3 months

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25
Q

How is RA managed?

A

Short course steroids
NSAIDs/ COX 2 inhib
DMARDs
Surgery

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26
Q

Describe how dmards are prescribed stepwise in RA

A

Hydroxychloroquine if mild
Then one out of methotrexate, leflunomide or sulfasalazine
Then give 2 of the above in combination
Then give methotrexate and a biologic (anti TNF)
Then give methotrexate and rituximab

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27
Q

What is the main way to differentiate osteoarthritis and RA?

A 
Osteo= asymmetrical
RA= symmetrical
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28
Q

What joints are flexed v extended in swan neck deformity

A

DIP- flexed

PIP- extended

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29
Q

What is ankylosing spondylitis?

A

Chronic progressive inflammation of axial skeleton (can effect peripheral joints), also affects tendon/ligament attachments are extra art sights

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30
Q

Who is more like to get AS?

A

HLA b27
Male
ERAP 1 and IL-23R
Family hx

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31
Q

How will someone with AS present?

A

Pain and stiffness of lower back and hips
Worse in morning
Better with movement
Chronic onset
Pmhx of tendon/ligament pathology eg plantar fascitis

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32
Q

What are extra art features of AS?

A 
Anterior uveitis
Apical lung fibrosis
Aortic regurg 
Psoriasis 
IBD
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33
Q

What are later changes of AS?

A

Khyphosis
Loss of lumbar lordosis
Neck extension

Causes question mark posture

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34
Q

What clinical tests are done in AS and what do you see?

A

Schober’s test
Tragus to wall
Stress test

35
Q

What is seen on xray/MRI in AS

A

Sacroilitis

Bamboo spine

36
Q

What is reactive arthritis?

A

Sterile, seronegative joint inflammation in response to extra art infection

37
Q

Who is more likely to get reactive arthritis?

A

HLA b27
Male
20-30 yrs old
hx of previous infection

38
Q

What syndrome is associated with reactive arthritis and what is it?

A

Reiters syndrome- cant see, cant pee and cant climb a tree

39
Q

How will someone with reactive arthritis classically present?

A 
painful swollen one joint 
no speicific pain trigger
no fever
able to weight bear
previous infection
40
Q

What are extra art features of reactive arthritis?

A

Reiter’s triad: arthritis+urethritis+ conjunctivitis
Keratoderma blenorrhagicum- vesicles which are plaque like or pustular on the soles and palms
Circinate balantis- painless ulcers/plaques on the shaft or glans
Oral ulcers

41
Q

If you have sickle cell what infective organism for osteomyelitis are you particularly susceptible to?

A

Salmonella

42
Q

What joints are affected in osteoarthritis?

A

Weight bearing joints eg hip, knee, DIP, PIP, wrist

43
Q

What joints are affected in RA?

A

wrist, ankle, MCP, PIP, MTP

DIP is spared

44
Q

What is used for short term management in an acute flare up of OA?

A

Intraarticular steroids

45
Q

Why are opiates not recommended for OA?

A

Because there therapeutic effects wear off after a few weeks
Patients are at risk of addiction
There are bad associated side effects like pruritus and constipation

46
Q

What is the triad for Felty’s syndrome?

A

Rheumatoid arthritis
Splenomegaly
Neutropenia

47
Q

What medication is given in mild RA?

A

Hydroxychloroquine

48
Q

What DMARDs can be prescribed in RA?

A

Methotrexate
Leflunomide
Sulfasalazine

49
Q

What biologic agent is commonly used to treat RA alongside methotrexate? When is it given

A

anti TNF

It is given after 2 DMARDs have been tried in combination and haven’t been effective

50
Q

What monoclonal antibody is commonly used to treat RA alongside methotrexate? When is it given

A

Rituximab

It is given once 2 DMARDs in combination and then methotrexate+anti TNF have been tried but have been ineffective

51
Q

When is schober’s test done? How is it carried out and what is a positive result

A

It is a clinical test done to diagnose ankylosing spondylitis
You mark 10cm above L5 and 5 cm below
Get the patient to bend forward
If the point-point distance increases >5cm this is positive for ankylosing spondylitis

52
Q

When is tragus to wall test done? How is it carried out and what is a positive result

A

Get the patient to stand with their back and head against the wall
Measure the distance from the tragus to the wall
If its over 15cm this is positive and suggests they have ankylosing spondylitis

53
Q

In what condition is keratoderma blenorrhagicum seen? What does it look like and where on the body is it common

A

Seen in reactive arthritis on the soles and palms usually

Vesicles which are plaque like or pustular

54
Q

What is reiter’s traid? In what condition is it seen?

A

Triad of arthritis, urethitis and conjunctivitis

Seen in reactive arthritis

55
Q

What is circinate balanitis? In what condition is it seen and where on the body?

A

Painless ulcers and plaques on the shaft or glans of the penis
Seen in reactive arthritis

56
Q

What are the 3 acute monoarthritides?

A

Septic arthritis
Gout
Pseudogout

57
Q

How will septic arthritis classically present?

A

very painful, erythematous, swollen joint
restricted ROM
fever

58
Q

How will gout classically present? Which joint is usually affected

A

1st MTP most commonly affected
Sudden onset severe pain of a joint
Erythematous, swelling, tenderness

59
Q

How will pseudogout classically present? What joints does it usually effect?

A

Acute painful joint

Usually effects large joints eg the knee and also affects multiple joints because its chronic

60
Q

What organisms usually cause septic arthritis in under 30s vs over 30s?

A

under 30= neisseria gonorrhoea

over 30= staph aureus

61
Q

What is gout precipitated by?

A

Trauma and infection

62
Q

What crystals are present in gout?

A

Monosodium urate

63
Q

What imbalance underlies gout?

A

Hyperuricaemia

64
Q

What is pseudogout precipitated by?

A

Trauma and illness

65
Q

What crystals are present in pseudogout?

A

Calcium pyrophosphate

66
Q

What are some causes of pseudogout?

A 
Idiopathic 
Hyperparathyroidism 
Hypophosphataemia 
Hypomagnesia 
Metabolic causes
67
Q

What are RF for infection in septic arthritis and RF for joint damage?

A

Infection: IV drug use, diabetes, immunosupression

Joint damage: RA, prosthetic joint, gout

68
Q

What are RF for gout?

A 
Alcohol
High purine diet
Obesity
Male
Diuretics
69
Q

What are RF for pseudogout?

A

Elderly

Female

70
Q

What will aspirate, MC&S and bloods in septic arthritis show?

A 
Aspirate= turbid, yellow, low viscosity fluid, raised WCC (>90% neutrophils) 
MC&S= organism
Bloods= elevated WCC and CRP
71
Q

What will aspirate, bloods and XR in gout show?

A 
Aspirate= turbid, yellow, low viscosity fluid, raised WCC (neutrophils), needle shaped negatively birifringent crystals 
Bloods= elevated WCC, CRP, uric acid (4-6 weeks later) 
XR= rat bite erosions
72
Q

What needles are seen in gout on aspirate?

A

Negatively birifringent needle shaped crystals

73
Q

What is seen on x ray in gout?

A

Rat bite erosions

74
Q

What will aspirate, bloods and XR in pseudogout show?

A

Aspirate= turbid, yellow, low viscosity fluid, raised WCC (neutophils), rhomboid shaped positively birifringent crystals
Bloods= elevated WCC and CRP
X ray= chondrocalcinosis

75
Q

What crystals are seen in pseudogout?

A

Rhomboid shaped positively birifringent crystals

76
Q

How do you remember what crystals are in gout vs pseudogout?

A 
Pseudo= positive for being fake= positively birifringent rhomboid shaped crystals 
Gout= negative and not fake= negatively birifringent needle shaped crystals
77
Q

What might cause infection of the bone in osteomyelitis?

A

Haematogenous spread- immunosupression, diabetes etc
Contiguous spread- cellulitis, localised infection
Direct inoculation- penetrating injury, ulcers, surgery

78
Q

What is osteomyelitis?

A

Infection of the bone leading to inflammation, necrosis and new bone formation

79
Q

What are the types of osteomyelitis?

A

Acute
Subacute
Chronic

80
Q

How long does chronic osteomyelitis have to go one for?

A

Over 6 weeks

81
Q

How will someone with osteomyelitis classically present?

A

Non specific pain in the area
Fever
malaise
preceding skin lesion, infection

82
Q

What will you see on examination in osteomyelitis?

A

Localised eythema, swelling and warmth
Reduced ROM of joint
Discharge from the wound or ulcer

83
Q

What ix are done for osteomyelitis and what will you see?

A

Bloods- raised WCC and CRP
XR/MRI- no changed in the first 2 weeks, darkening of the affected area and periosteal thickness
Bone culture- shows the causative organism

84
Q

How is osteomyelitis managed?

A

Supportive treatment like analgesia and immobilisation
High dose IV abx- empirical at first then after culture returns adjust and 2-4 week course
Surgical debridement- this is needed if biofilm indicates it or if there is dead bone

Year 3 (104 decks)

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