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LCRS Musculoskeletal > Osteoarthritis and reactive arthritis > Flashcards

Osteoarthritis and reactive arthritis Flashcards

1
Q

What is reactive arthritis?

A

Sterile inflammation in joints following infection, especially urogenital and gastrointestinal infections

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2
Q

What urogenital infection is associated with reactive arthritis?

A

Chlamydia trachomatis

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3
Q

What gastrointestinal infections are associated with reactive arthritis?

A

Salmonella
Shigella
Campylobacter

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4
Q

What important extra-articular manifestations of reactive arthritis are there?

A

Enthesopathy
Skin inflammation
Eye inflammation

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5
Q

What is a crucial fact about the inflammation in reactive arthritis?

A

It is sterile, not due to ongoing infection- it happens after the infection has gone

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6
Q

What could reactive arthritis be the first manifestation of?

A

HIV or Hep C infection

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7
Q

Who does reactive arthritis occur most commonly in?

A

Young adults with a genetic predisposition (HLA-B27) and an environmental trigger (salmonella infection)

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8
Q

When do symptoms of reactive arthritis tend to appear?

A

1-4 weeks afrwe infection

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9
Q

What are the musculoskeletal symptoms of reactive arthritis?

A

It is asymmetrical and occurs in relatively few joints
The entheses can get affected:
- Achilles tendonitis
- Dactylitis
-Metatarsalgia (painful feet because of inflammation of plantar fascia

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10
Q

What is very common in seronegative spondyloarthropathies?

A

Sacro-iliitis

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11
Q

What extra-articular features are there in reactive arthritis?

A

Ocular- sterile conjunctivitis
Genito-urinary- sterile urethritis
Skin:
Keratoderma blennorhagicum- psoriasis-like rash appears transiently on hands and feet
Circinate balantis- epithelial inflammation of glans

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12
Q

Reactive arthritis is sometimes called Reiter’s syndrome which refers to what triad of symptoms?

A

Joint inflammation
Urethritis
Conjunctivitis

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13
Q

What are the differences between rheumatoid and reactive arthritis?

A 
Rh:
More common in females
Affects all ages 
Symmetrical, polyarticular and all joints
No enthesopathy, spondylitis (except where there is synovium) or urethritis
Subcutaneous nodules
Rh factor
Associated with HLA-DR4
Re: More common in males
20-40 yrs
Asymmetrical, oligoarticular and large joints
Enthesopathy
Spondylitis
Urethritis 
K blennorhagicum and circinate balantis
No Rh factor
HLA-B27
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14
Q

How is reactive arthritis diagnosis established?

A

Clinical diagnosis

Investigations to exclude other causes of arthritis like septic arthritis

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15
Q

What is septic arthritis commonly caused by?

A

Bacterial infections- bacteria release very potent metalloproteinase enzymes that rapidly degrade articular cartilage

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16
Q

Why is septic arthritis a surgical emergency?

A

Bacteria release very potent metalloproteinase enzymes that rapidly degrade articular cartilage- it requires antibiotics and sometimes lavage of the joints to get rid of the enzymes

17
Q

Why is there no role for antibiotics in reactive arthritis?

A

Site of inflammation is sterile

18
Q

How is reactive arthritis treated?

A 
Articular:
NSAIDs to control therapy
Intra-articular corticosteroid therapy (oral or IM into the joint)
Extra-articular:
Typically self limiting
Therapy is symptomatic
Refractory disease:
Oral glucocorticoids
Steroid-sparing agents
19
Q

What is the definition of osteoarthritis?

A

Chronic slowly progressive disorder due to failure of articular cartilage that typically affects joints of the hands (especially those involved in the pinch grip), spine and weight-bearing joints (hips and knees)
- joints that are most commonly used

20
Q

Which joints of the hand are commonly affected?

A

Distal interphalangeal joints
Proximal interphalangeal joints
First carpometacarpal joint

21
Q

What are osteophytes?

A

Bony swellings around joints that occur commonly in osteoarthritis

22
Q

What are osteophytes at the DIP and PIP referred to as?

A

DIP- Heberden’s nodes

PIP- Bouchard’s nodes

23
Q

What is osteoarthritis associated with?

A

Joint pain- worse with activity and better with rest
Joint crepitus- creaking/cracking sound on moving affected joint
Joint instability
Joint enlargement
Joint stiffness after immobility
Limitation of motion

24
Q

What are the radiographic features of osteoarthritis?

A

Joint space narrowing
Subchondral bony sclerosis
Osteophytes
Subchondral cysts

25
Q

What is subchondral bony sclerosis?

A

Bone underneath failed cartilage tries to react with more bone formation so you get whitening underneath cartilage

26
Q

What is the problem in osteoarthritis?

A

Defective and irreversible articular cartilage and damage to underlying bone

27
Q

What could the abnormal articular cartilage in osteoarthritis be due to?

A

Abnormal joint components and excessive loading on joints

28
Q

What is the most important component of articular cartilage?

A

Proteoglycan called aggrecan

29
Q

What is aggrecan made up of?

A

Chondroitin sulphate and keratan sulphate chains

30
Q

What is aggrecan important for?

A

Keeping water within the articular cartilage

31
Q

What do the GAG chains do?

A

Attract water and are important in integrity of articular cartilage

32
Q

What is a proteoglycan?

A

Glycoproteins that contain one or more sulphated glycosaminoglycan chains

33
Q

What are GAGs?

A

Repeating polymers of disaccharides

34
Q

Give some examples of GAGs?

A 
Chondroitin sulphate
Keratan sulphate
Heparan sulphate
Dermatan sulphate
Heparin
35
Q

Why is hyaluronic acid special?

A

It is the only non-sulfated GAG and is a major component of synovial fluid where it has an important role in maintaining synovial fluid viscosity

36
Q

What are the disaccharides of hyaluronic acid?

A

Glucoronic acid

N-acetyl glucosamine

37
Q

What cartilage changes are there in osteoarthritis?

A

Reduced proteoglycan

Reduced collagen

38
Q

How do you manage osteoarthritis?

A

Education
Physical therapy- physiotherapy, hydrotherapy
Occupational therapy
Weight loss where appropriate
Exercise
Analgesia- paracetamol, NSAIDs and intra articular corticosteroid injection
Joint replacement

LCRS Musculoskeletal (7 decks)

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