MSK arthritis

Question 1

What is rheumatoid arthritis?

Answer 1

Systemic inflammatory disorder of autoimmune origin primarily characterised by progressive, symmetric joint destruction.

Question 2

What type of joint is primarily affected in rheumatoid arthritis?

Answer 2

Synovial

Question 3

Which joints are affected in rheumatoid arthritis?

Answer 3

Usually 5 or more, symetrically

• commonly affected joints (small joints)
  
  • metacarpophalangeal
  • proximal interphalangeal
  • metatarso-phalangeal
• as disease progresses (large joints)
  
  • shoulders
  • elbows
  • knees
  • ankles

Question 4

Symptoms of a rheumatoid arthritis flare

Answer 4

Joints are:

• swollen
• warm
• red
• painful

Question 5

When is stiffness worst in rheumatoid arthritis?

Answer 5

• Morning - lasting more than 30 minutes
• After inactivity

Question 6

Specific deformities seen in rheumatoid arthritis

Answer 6

• ulnar deviation of fingers
• boutonniere deformity - PIP flexion, DIP extension
• swan neck deformity - PIP hyperextension, DIP flexion
• popliteal cysts

Question 7

Rheumatoid arthritis - extra-articular symptoms

Answer 7

• fever
• malaise
• low appetite
• weakness
• rheumatoid nodules
• increased risk of atherosclerosis
• increased hepcidin → iron deficiency anaemia
• interstitial lung fibrosis
• pleural effusions

Question 8

What is the Felty syndrome triad?

Answer 8

• rheumatoid arthritis
• splenomegaly
• granulocytopenia

Question 9

Blood tests for rheumatoid arthritis

Answer 9

• rheumatoid factor
• anti-cyclic citruillinated peptide (anti-CCP) antibody
• ↑ ESR + CRP

Question 10

Imaging for rheumatoid arthritis

Answer 10

• ↓ bone density
• bony erosions
• soft tissue swelling
• narrowing of joint space

Question 11

Treatment for rheumatoid arthritis

Answer 11

• disease modifying anti-rheumatic medications (DMARDs)
  
  • methotrexate
• biological response modifiers (biologics)
  
  • rituximab - suppress B-cells
  • infliximab - blocks chemokines
• acute flares
  
  • NSAIDs
  • glucocorticoids (short term)

Question 12

Osteoarthritis pathology

Answer 12

Progressive loss of articular cartillage → friction → inflammation → pain

Question 13

Risk factors for osteoarthritis

Answer 13

• age
• inflammation
• joint injury
• mechanical stress and obesity

Question 14

When does stiffness occur in osteoarthritis?

Answer 14

• Morning (lasts less than 30 minutes)
• End of the day

Question 15

Articular symptoms experienced in osteoarthritis

Answer 15

• stiffness
• pain
  
  • sharp ache
  • burning
  • worse with activity
• usually no swelling

Question 16

Bloods for osteoarthritis

Answer 16

Not diagnostic but may be relevant when OA is related to another condition such as haemachromatosis.

Question 17

Radiological signs for osteoarthritis

Answer 17

X-ray - LOSS

• Loss of joint space
• Ostephytes
• Subchondral cysts
• Sclerosis

Question 18

What are the osteophytes in the interphalangeal joints called?

Answer 18

• Distal interphalangeal - Heberden nodes
• Proximal interphalangeal - Bouchard nodes

Question 19

Treatment of osteoarthritis

Answer 19

• Non-pharmacological (important for large weight bearing joints)
  
  • losing weight
  • mild exercise
  • physical therapy
• Pharmacological
  
  • reduce pain and inflammation
• Hyaluronic acid injections
• Surgery
  
  • joint replacement