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Holibobs Revision of all Semester 1 (yr 2) diseases > MSK diseases > Flashcards

MSK diseases Flashcards

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1
Q

What is rheumatoid arthritis?

A

Chronic
autoimmune
systemic illness
characterised by synovial joint inflammation leading to symmetrical peripheral arthritis and extra-articular symptoms.

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2
Q

In arthritis, we see chronic inflammation of synovial lining of what

A

joints, tendon sheafs, and bursa

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3
Q

Synovial inflammation of tendons increase risk of what

A

tendon rupture

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4
Q

What is the pattern of rheumatoid arthritis, crucially?

A

It’s symmetrical

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5
Q

Which joints would arthritis tend to affect, broadly speaking?

A

smaller ones

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6
Q

Risk factors for rheumatoid arthritis?

A

smoking and obesity

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7
Q

When does rheumatoid arthritis most commonly develop?

A

middle age

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8
Q

Which gender is rheumatoid arthritis most common in?

A

2-3 times more common in women than men

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9
Q

Disease course of rheumatoid arthritis?

A

relaxing and remitting, or severe and progressive

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10
Q

Positive antibodies/immunoglobulins predict worse disease. What is the autoantibody present in 70% of all rheumatoid arthritis cases?

A

rheumatoid factor

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11
Q

What does rheumatoid factor antibody/immunoglobulin actually do?

A

Causes immune system activation against the patient’s own IgG, therefore systemic inflammation.

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12
Q

What are the two antibodies in rheumatoid arthritis?

A

rheumatoid factor and anti-CCP antibodies

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13
Q

Out of rheumatoid factor and anti-CCP antibodies, which is more sensitive and often pre-dates onset of symptoms?

A

anti-CCP

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14
Q

Speed of onset of rheumatoid arthritis?

A

Varies:
Can be rapid: overnight
or
Gradual: over months

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15
Q

What are the three joint symptoms of rheumatoid arthritis?

A

stiffness
pain
swelling

nb not heat or red

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16
Q

On palpation of the joints, in rheumatoid arthritis, what would you find?

A

tenderness and synovial thickening, hiving them a ‘boggy’ feeling

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17
Q

Which joint in the finger is rarely affected rheumatoid arthritis?

A

distal interphalangeal joint

18
Q

distal interphalangeal joint affected by arthritis is most likely due to?

A

more likely to represent Heberden’s nodes due to osteoarthritis

19
Q

rheumatoid arthritis symptoms are worse when, and improve when?

A

worse with rest, and improve with activity.
Worse in the morning therefore

20
Q

How to distinguish between symptoms of inflammatory arthritis (e.g. rheumatoid arthritis) or mechanical arthritis like osteoarthritis?

A

Inflammatory is best with activity, worse with rest.
The opposite is true for mechanical problems- worse with activity. This is a crucial point to make clear.

osteoarthritis is wear and tear

21
Q

Hand signs in advanced disease of rheumatoid arthritis?

A

thumb = z
swan like fingers
maybe ulnar deviation

22
Q

What are rheumatoid nodules?

A

Firm, painless lumps under the skin, especially on the elbows and fingers

23
Q

You see a patient with persistent synovitis. Where do you refer them?

A

Urgent rheumatology referral (to be seen within 3 weeks).

24
Q

You’ve seen a patient with persistent synovitis, and you’ve referred them for urgent rheumatology. What do you consider?

A

Consider an NSAID and arrange baseline bloods.

25
Q

What investigations would you tick when ordering a baseline blood test, for someone just presenting with rheumatoid arthritis?

A

rheumatoid factor
anti CPP antibodies
Inflammatory markers like CRP and ESR

maybe x-rays for bone changes
or ultrasound to detect synovitis

26
Q

Why would you check for ESR in bloods for rheumatoid arthritis?

A

it’s erythrocyte sedimentation rate. ESR. It means how fast red blood cells in unclotted blood settle down. In inflammation, red blood cells clump closer together and settle faster.

27
Q

What is the diagnosis for rheumatoid arthritis based on? Actually think about this.

A

Clinical findings- hence why examination is so important, as well as systemic signs
and
blood results such as seeing antibodies anti CCP and rheumatoid factor

28
Q

What two things are used to monitor success of treatment of rheumatoid arthritis?

A

DAS28 (Disease activity score on 28 joints)- assigning points for: swollen joints, tender joints, and the ESR/CRP result

and
CRP

29
Q

How to manage rheumatoid arthritis initially?

A

short term steroids (oral or intramuscular)… at initial presentation.

30
Q

Treatment of rheumatoid arthritis?

A

cDMARDs such as methotrexate, leflunomide, or sulfasalazine - mono or as a combo
also
biologic therapies.

31
Q

You can use biologic therapies for rheumatoid arthritis. What do they cause, increase risk of, and what suffix do they tend to end in?

A

immunosuppression
infection and cancer
‘mab’

32
Q

How often is methotrexate given?

A

Once a week, WITH folic acid once a week (Methotrexate interferes with folate metabolism)

33
Q

Why does button-hole deformity occur in the hands for rheumatoid arthritis?

A

when extensor tendon splits

34
Q

What deviation occurs in the fingers for rheumatoid arthritis?

A

Ulnar deviation

35
Q

How are blood vessels affected with rheumatoid arthritis?

A

vasculitis, which can encourage atheromatous plaques. (cardiovascular disease)

36
Q

Commonality in cause of symptoms in skin and visceral organs in rheumatoid arthritis?

A

rheumatoid nodules

37
Q

Advanced symptoms of rheumatoid arthritis (rarely seen due to treatment)?

A

pericarditis
pulmonary fibrosis
pericarditis
pleural effusion
anaemia
carpal tunnel
raynauds

38
Q

Structure of articular cartilage:

A

first layer = chondroblasts which produce collagen. We also see lubricin (produced by chondrocytes) which acts as a layer for boundary lubrication.
Next layer(s) = full of chondrocytes for aggrecan (attracts water)

Throughout it, the collagen orientation changes. (near bone = vertical)

39
Q

Purpose of synovial fluid

A

provides nutrients and takes away waste product, to cartilage

40
Q

Main constituents of synovial fluid?

A

hyaluronic acid, and lubricin

41
Q
A

Holibobs Revision of all Semester 1 (yr 2) diseases (5 decks)

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