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Musculoskeletal Y2 > 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 (e.g. Chlamydia trachomatis) and gastrointestinal (e.g. Salmonella, Shigella, Campylobacter infections) infections

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2
Q

Extra-articular manifestations of reactive arthritis? (4)

A
  • Important extra-articular manifestations include:
     Enthesopathy
     Skin inflammation
     Eye inflammation
     Reactive arthritis may be first manifestation of HIV or hepatitis C infection
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3
Q

What 2 need to happen for reactive arthritis? (1 can control 1 can’t)

A

with genetic predisposition (e.g. HLA-B27) and environmental trigger (e.g. Salmonella infection)

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4
Q

Which HLA predisposes to ReA?

A

HLA-B27

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5
Q

Onset of symptoms post infection?

A

1-4 weeks

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6
Q

3 categories of musculoskeletal symptoms of ReA?

A

Arthritis
ENTHESITIS
SPONDYLITIS

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7
Q

Manifestations of arthritis in ReA? Typically affects…?

A
  • Asymmetrical
  • Oligoarthritis (<5 joints)
  • Lower limbs typically affected
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8
Q

Symptoms of enthesitis in ReA? (3)

A
  • Heel pain (Achilles tendonitis)
  • Swollen fingers (dactylitis)
  • Painful feet (metatarsalgia due to plantar fasciitis)
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9
Q

Symptoms of spondylitis in ReA? (2)

A
  • Sacroiliitis (inflammation of the sacro-iliac joints)

- Spondylitis (inflammation of the spine)

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10
Q

Extraarticular areas of manifestations of ReA and the manifestation? (3)

A 
OCULAR:
-	Sterile conjunctivitis
GENITO-URINARY:
-	Sterile urethritis
SKIN:
-	Circinate balanitis
-	Psoriasis-like rash on hands and feet (keratoderma blennorrhagicum)
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11
Q

Rheumatoid vs reactive arthritis:

More common in what sex?

A

Rheumatoid: Females

Reactive: Males

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12
Q

Rheumatoid vs reactive arthritis:

Age of onset?

A

Rheumatoid: all ages

Reactive: 20-40

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13
Q

Rheumatoid vs reactive arthritis:

Differences in arthritis

A

Rheumatoid: Symmetrical, polyarticular, small and large joints

Reactive: asymmetrical, oligorticular, large joints

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14
Q

Rheumatoid vs reactive arthritis:

Enthesopathy present??

A

Rheumatoid: No

Reactive: Yes

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15
Q

Rheumatoid vs reactive arthritis:

Spondylitis present?

A

Rheumatoid: Yes (except anti-axial joint in cervical spine)

Reactive:

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16
Q

Rheumatoid vs reactive arthritis:

Urethritis present?

A

Rheumatoid: No

Reactive: Yes

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17
Q

Rheumatoid vs reactive arthritis:

Skin involvement to what level?

A

Rheumatoid: Subcutaneous nodules

Reactive: K. blennorhagicum, circinate balanitis

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18
Q

Rheumatoid vs reactive arthritis:

Rheumatoid factor present

A

Rheumatoid: Yes

Reactive: No

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19
Q

Rheumatoid vs reactive arthritis:

HLA association?

A

Rheumatoid: HLA-DR4

Reactive: HLA-B27

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20
Q

How to establish diagnosis of ReA?

A
  1. Clinical diagnosis

2. Investigations to exclude other causes of arthritis e.g. septic arthritis

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21
Q

What investigations would you conduct to exclude other causes of arthritis?

A

Microbiology
Immunology
Synovial fluid examination

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22
Q

Septic vs reactive arthritis:

Synovial fluid culture

A

Septic: Positive

Reactive: Sterile

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23
Q

Septic vs reactive arthritis:

Antibiotic therapy

A

Septic: Yes

Reactive: No

24
Q

Septic vs reactive arthritis:

Joint lavage

A

Septic: Yes - for large joints

Reactive: No

25
Q

Articular treatment of ReA? (2)

A
  • NSAIDs

- Intra-articular corticosteroid therapy

26
Q

Extra-articular treatment of ReA? (2)

A
  • Typically, self-limiting, hence symptomatic therapy e.g. topical steroids & keratolytic agents in keratoderma
27
Q

Refractory disease treatment of ReA? (2)

A
  • Oral glucocorticoids

- Steroid-sparing agents e.g. sulphasalazine

28
Q

What is osteoarthritis?

A

Chronic slowly progressive disorder due to failure of articular cartilage that typically affecting joints of the hand (especially those involved in pinch grip), spine and weight-bearing joints (hips and knees)

29
Q

OA typically affects what joints? (3+5)

A 
-	Joints of the hand:
 Distal interphalangeal joints (DIP)
 Proximal interphalangeal joints (PIP)
 First carpometacarpal joint (CMC)
-	Spine
-	Weight-bearing joints of lower limbs
 Especially knees and hips
 First metatarsophalangeal joint (MTP)
30
Q

What are Heberdens nodes

A

Osteophytes at the DIP joint

31
Q

What are Bouchards nodes

A

Osteophytes at the PIP joint

32
Q

Osteophytes at the PIP joint are termed…

A

Bouchards nodes

33
Q

Osteophytes at the DIP joint are termed…

A

Heberdens nodes

34
Q

OA is associated with… (6)

A
  • Joint pain worse with activity, better with rest
  • Joint crepitus creaking, cracking, grinding sound on moving affected joint
  • Joint instability
  • Joint enlargement e.g. Heberden’s nodes
  • Joint stiffness after immobility (‘gelling’)
  • Limitation of motion
35
Q

4 radiographic features of OA? (4)

A
  • Joint space narrowing
  • Subchondral bony sclerosis
  • Osteophytes
  • Subchondral cysts
36
Q

Rheumatoid vs reactive arthritis:

Joint space narrowing present?

A

Rheumatoid: No

Reactive: Yes

37
Q

Rheumatoid vs reactive arthritis:

Subchondral sclerosis present?

A

Rheumatoid: No

Reactive: Yes

38
Q

Rheumatoid vs reactive arthritis:

Osteophytes present?

A

Rheumatoid: No

Reactive: Yes

39
Q

Rheumatoid vs reactive arthritis:

Osteopenia present?

A

Rheumatoid: Yes

Reactive: No

40
Q

Rheumatoid vs reactive arthritis:

Bony erosions present?

A

Rheumatoid: Yes, initially at markings of the joint where synovium is in direct contact with bone

Reactive: No

41
Q

What is a bone spur

A

Lack of cartilage space leading to bone pressing bone and sometimes a little ridge comes out

42
Q

Cause of OA?

A and B leading to C, D and E causing F, G and H

A

Abnormal stress and abnormal cartilage leading to loss of proteoglycans, chondrocyte apoptosis and collagen fibril damage causing cartilage fibrillation, osteophyte formation and subchondral sclerosis

43
Q

What is articular cartilage made of? (2)

A

T2 collagen and aggrecan (proteoglycan)

44
Q

What is synovium made of? (4)

A

1-3 cell deep lining
Macrophage like phagocytic cells
Fibroblast like cells
T1 collagen

45
Q

What is synovial fluid composed of? (4)

A

Hyaluronic acid

46
Q

what secretes hyaluronic acid?

A

Fibroblast like cells

47
Q

Weight-bearing properties of articular cartilage depend on X and Y

A

intact collagen scaffold and high aggrecan content

48
Q

Articular cartilage structure?
Type of collagen?
Cells in it?
Molecule in it?

A

Avascular, aneuronal
Collagen type 1
Chondrocytes
Proteoglycan monomers (aggrecan)

49
Q

What are proteoglycans?

A

glycoproteins containing one or more sulphated glycosaminoglycan (GAG) chains

50
Q

what molecular group do many proteoglycans contain?

51
Q

X is the major proteoglycan in articular cartilage

52
Q

Hyaluronic acid is the only X GAG and is major component of YY where it has an important role in ZZZZ

A

non-sulphated

synovial fluid

maintaining synovial fluid viscosity

53
Q

Hyaluronic acid disaccharides are:

A

glucuronic acid and N-acetyl glucosamine

54
Q

Cartilage changes in OA? (3)

A
  1. reduced proteoglycan
  2. reduced collagen
  3. chondrocyte changes e.g. apoptosis
55
Q

BONE CHANGES IN OA: (2, 2 and 2)

A
  1. Changes in denuded sub-articular bone
     Proliferation of superficial osteoblasts results in production of sclerotic bone e.g. subchondral sclerosis
    Focal stress on sclerotic bone can result in focal superficial necrosis
  2. New bone formation at the joint margins (termed osteophytes)
     Sometimes you can detect osteophytes clinically (‘at the bedside’) and these have names
     Osteophytes at the distal inter-phalangeal joints are called ‘Heberden’s nodes’
     Osteophytes at the proximal inter-phalangeal joints are called ‘Bouchard’s nodes’
56
Q

Management of OA? (7)

A
  • Education
  • Physical therapy – physiotherapy, hydrotherapy
  • Occupational therapy
  • Weight loss where appropriate
  • Exercise
  • Analgesia Paracetamol, NSAIDs, intra-articular corticosteroid injection
  • Joint replacement
57
Q

Medicinal treatments aids for OA?

A

There are none in the UK

Musculoskeletal Y2 (11 decks)

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