MSK diseases Flashcards
nahJKADGASUDHILQWdhskjdhajoojksjI
What is rheumatoid arthritis?
Chronic
autoimmune
systemic illness
characterised by synovial joint inflammation leading to symmetrical peripheral arthritis and extra-articular symptoms.
In arthritis, we see chronic inflammation of synovial lining of what
joints, tendon sheafs, and bursa
Synovial inflammation of tendons increase risk of what
tendon rupture
What is the pattern of rheumatoid arthritis, crucially?
It’s symmetrical
Which joints would arthritis tend to affect, broadly speaking?
smaller ones
Risk factors for rheumatoid arthritis?
smoking and obesity
When does rheumatoid arthritis most commonly develop?
middle age
Which gender is rheumatoid arthritis most common in?
2-3 times more common in women than men
Disease course of rheumatoid arthritis?
relaxing and remitting, or severe and progressive
Positive antibodies/immunoglobulins predict worse disease. What is the autoantibody present in 70% of all rheumatoid arthritis cases?
rheumatoid factor
What does rheumatoid factor antibody/immunoglobulin actually do?
Causes immune system activation against the patient’s own IgG, therefore systemic inflammation.
What are the two antibodies in rheumatoid arthritis?
rheumatoid factor and anti-CCP antibodies
Out of rheumatoid factor and anti-CCP antibodies, which is more sensitive and often pre-dates onset of symptoms?
anti-CCP
Speed of onset of rheumatoid arthritis?
Varies:
Can be rapid: overnight
or
Gradual: over months
What are the three joint symptoms of rheumatoid arthritis?
stiffness
pain
swelling
nb not heat or red
On palpation of the joints, in rheumatoid arthritis, what would you find?
tenderness and synovial thickening, hiving them a ‘boggy’ feeling
Which joint in the finger is rarely affected rheumatoid arthritis?
distal interphalangeal joint
distal interphalangeal joint affected by arthritis is most likely due to?
more likely to represent Heberden’s nodes due to osteoarthritis
rheumatoid arthritis symptoms are worse when, and improve when?
worse with rest, and improve with activity.
Worse in the morning therefore
How to distinguish between symptoms of inflammatory arthritis (e.g. rheumatoid arthritis) or mechanical arthritis like osteoarthritis?
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
Hand signs in advanced disease of rheumatoid arthritis?
thumb = z
swan like fingers
maybe ulnar deviation
What are rheumatoid nodules?
Firm, painless lumps under the skin, especially on the elbows and fingers
You see a patient with persistent synovitis. Where do you refer them?
Urgent rheumatology referral (to be seen within 3 weeks).
You’ve seen a patient with persistent synovitis, and you’ve referred them for urgent rheumatology. What do you consider?
Consider an NSAID and arrange baseline bloods.
What investigations would you tick when ordering a baseline blood test, for someone just presenting with rheumatoid arthritis?
rheumatoid factor
anti CPP antibodies
Inflammatory markers like CRP and ESR
maybe x-rays for bone changes
or ultrasound to detect synovitis
Why would you check for ESR in bloods for rheumatoid arthritis?
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.
What is the diagnosis for rheumatoid arthritis based on? Actually think about this.
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
What two things are used to monitor success of treatment of rheumatoid arthritis?
DAS28 (Disease activity score on 28 joints)- assigning points for: swollen joints, tender joints, and the ESR/CRP result
and
CRP
How to manage rheumatoid arthritis initially?
short term steroids (oral or intramuscular)… at initial presentation.
Treatment of rheumatoid arthritis?
cDMARDs such as methotrexate, leflunomide, or sulfasalazine - mono or as a combo
also
biologic therapies.
You can use biologic therapies for rheumatoid arthritis. What do they cause, increase risk of, and what suffix do they tend to end in?
immunosuppression
infection and cancer
‘mab’
How often is methotrexate given?
Once a week, WITH folic acid once a week (Methotrexate interferes with folate metabolism)
Why does button-hole deformity occur in the hands for rheumatoid arthritis?
when extensor tendon splits
What deviation occurs in the fingers for rheumatoid arthritis?
Ulnar deviation
How are blood vessels affected with rheumatoid arthritis?
vasculitis, which can encourage atheromatous plaques. (cardiovascular disease)
Commonality in cause of symptoms in skin and visceral organs in rheumatoid arthritis?
rheumatoid nodules
Advanced symptoms of rheumatoid arthritis (rarely seen due to treatment)?
pericarditis
pulmonary fibrosis
pericarditis
pleural effusion
anaemia
carpal tunnel
raynauds
Structure of articular cartilage:
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)
Purpose of synovial fluid
provides nutrients and takes away waste product, to cartilage
Main constituents of synovial fluid?
hyaluronic acid, and lubricin
