Monoarthritis Flashcards
classification of arthritis
mono=?
oligo= ?
polyarthrits= multiple joints
spA= affects the axial skeleton
classification of arthritis
mono= e.g septic arthritis
oligo= (more than 1)
polyarthrits= multiple joints (symmetrical RA, asymetrical psoriatic arthritis)
spA= affects the axial skeleton (spondyl arthritis)
stiffness in the morning
osteo arthrits= worse in the morning
cortisol levels change
cortisol levels are very low at 4am and then start to rise. all the cytokines that cause the inflammation cause worsening of symptoms
joint symptoms are worse in the morning
stiffness in the morning
swelling of joints is worse
terminology
arthralgia= joint pain
arthritis= inflammation of joint
synovitis= inflammation of the synovium (membrane)
enthesitis= inflammation of entasi (attachment of ligament and tendon to the bone) (hallmark in psoriatic and spondylitis)
dactylitis= swelling of the whole finger (soft tissue)
bursitis= inflammation of the bursae (sac of fluid between the two types of tissue, skin and bone) greater trochenteric brusae
3 major classifications of arthritis
- inflammatory
- non-inflammatory
- connective tissue disease
timing: acute / chronic
distribution of joint involvement: mono / poly / spine
degenerative v inflammatory
similarities: pain, deformity, reduced movement, functional loss
differences: location, swelling, stiff/gelling, diurnal
sjogrens syndrome (Sica symptoms)
felty syndrome
nodules
vasculitis
lungs- pulmonary fibrosis (interstitial lung disease) ask about breathing difficulties/issues with lungs (and methotrexate can effect the lungs too)
eye disease
raynards
rheumatology systemic enquiry
raynards- colour change with cold weather (white= blue = pink triphasic)
rheumatoid arthritis
raynaurds, inflammatory eye disease
lupus- raynards,mouth ulcers, clump alopecia, obstetric catastrophe, venothromboembolic disease
psoriatic arhtirtis
psoriasis - scalp, extensor, umbilicus, nasal cleft. inflammatory eye disease, dactylics, plantar fasciitis, inflammatory spine, buttock, colitis, fhx
normal MCP joint
(knuckle) bone cartilage capsule (ligaments) synovial lining cartilage bone
in RA the synovium hyperproliferates= increased vasculature in the synovium= inflammation
this translates into erosions on the bone
PIP boggy and spongy swelling
RA investigations
rheumatoid factor Anti CCP Anti nuclear antibody Radiographs MRI *but you can get seronegative RA
CXR
ultrasound (increased fluid around joints- grey) (little red dots sign of hyper vascular synovitis) (sign of true inflammation)
synovial fluid analysis
RA= leukocytes (WCC)
RA hand
hyperextension of the PIP and flexion of the DIP
ulnar deviation
telescoping of fingers (joint has collapsed on itself)
disabling and erosive
rheumatoid nodules
fibrous nodules that can develop in association with sero-positive RA
(always examine wrist, hand and elbow) feels like pebbles under the skin
how to manage RA
drugs- analgesia, NSAIDs, glucocorticoids, cDMART, bDMARD
- hyoxychlorsin
- sulfasalzine
- methotrexate
MDT - specialist nurse, OT, physio, podiatry, orthotics, GP, rheumatology, orthopaedics
suppot- NRAS, lupus UK, NAAS, versus arthritis
self management
crystal arthritis
monosodium urate monohydrate: gout
calcium phyrophosphate: pseudogout
- hydroxyapatite
- oxalate
- synthetic glucocorticoids
causes of hyperuricaemia
fhx obesity increased cell break donw renal function HTN
dietary purines- red meat, strawberries
alcohol
fructose (fruit juice)
drugs (diuretics)
gout treatment
acute:
conservative: foot care, stop ppt drugs
medical: analgesia, NSAIDs, colchicine, fluid
* don’t start or stop hypouricaemics
long term:
conservative: modify risk factors like weight loss, stop alcohol, stop drugs, IHD, HTN
add hypouricaemics like allopurinol and febuxostat
surgical:
aspirate
