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YR2: Musculoskeletal > Osteoarthritis and Reactive Arthritis > Flashcards

Osteoarthritis and Reactive Arthritis Flashcards

1
Q

Define reactive arthritis.

A

Sterile inflammation in joints following infection, especially urogenital + GI infections

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2
Q

State 1 urogenital and 1 GI infection that can cause reactive arthritis.

A

Urogenital: Chlamydia trachomatis
GI: Salmonella

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3
Q

What subset of the population does reactive arthritis tend to occur in?

A

Mainly in young adults with a genetic predisposition + an environmental trigger

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4
Q

How long after the infection does the reactive arthritis tend to appear?

A

1-4 weeks

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5
Q

Describe the features of the arthritis in reactive arthritis.

A

Asymmetrical arthritis that occurs in relatively few joints (Oglioarthritis)

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6
Q

Reactive arthritis can cause enthesopathy. Which entheses are likely to get affected and what symptoms will that cause?

A

Achilles tendonitis (Heel pain)
Dactylitis (swollen fingers)
Metatarsalgia (painful feet because of inflammation of the palmar fascia)

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7
Q

What is a very common feature of sero-negative spondyloarthropathies?

A

Sacro-iliitis

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8
Q

State 3 extra-articular features of reactive arthritis?

A

Occular: Sterile conjunctivitis
Genito-urinary: Sterile urethritis
Skin: Circinate balanitis + Keratoderma blennorhagicum

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9
Q

What is the triad of symptoms that can be used to describe reactive arthritis?

A

Reiter’s syndrome: arthritis + urethritis + conjunctivitis following infection

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10
Q

Where can you get spondylitis in rheumatoid arthritis?

A

At the atlanto-axial joint– there is synovium here

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11
Q

Describe the main differences between rheumatoid arthritis and reactive arthritis.

A 
Rheumatoid Arthritis
F>M
All ages (esp. 30-50)
Symmetrical, Polyarticular, Small + Large Joints
No Enthesopathy 
No Spondylitis (Except atlanto-axial joint in cervical spine)
No Urethritis
Subcutaneous nodules
Rheumatoid factor
HLA-DR4
Reactive Arthritis:
M>F
20-40 year olds
Asymmetrical, Oligoarticular, Large joints
Enthesopathy
Spondylitis
Urethritis
K.blennorhagicum + Circinate balanitis
No Rheumatoid factor
HLA-B27
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12
Q

What is the main danger in septic arthritis?

A

Bacteria produce metalloproteinases that can rapidly degrade the articular cartilage

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13
Q

What are the main differences between septic arthritis and reactive arthritis?

A

Septic arthritis has a positive synovial fluid culture

Treated with antibiotics + may require joint lavage

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14
Q

Describe the treatment of reactive arthritis.

A

Usually resolves by itself
NSAIDs to control pain + symptomatic treatment of extra-articular manifestations
Use oral glucocorticoids in refractory disease

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15
Q

Define osteoarthritis.

A

Chronic slowly progressive disorder due to failure of articular cartilage that typically affects the hands (esp. those involved in the pinch grip), spine + weight-bearing joints (hips + knees)

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16
Q

Which 7 joints are most commonly affected in osteoarthritis?

A 
DIP 
PIP  
1st metacarpophalangeal joint  
Spine 
Knees  
Hips  
1st metatarsophalangeal joint
17
Q

What are the names given to the osteophytes found on the hand in osteoarthritis?

A

Bouchard’s Nodes: PIP

Heberden’s Nodes: DIP

18
Q

List 6 associations of osteoarthritis

A 
Joint pain (worse with activity, better with rest)  
Joint crepitus (creaking/ cracking/ grinding)
Joint instability  
Joint enlargement  
Joint stiffness after immobility  
Limitation of motion
19
Q

List 4 radiographic features of osteoarthritis

A

Joint space narrowing
Osteophytes
Subchondral bony sclerosis
Subchondral cysts

20
Q

Describe the differences between the radiographic features of rheumatoid arthritis and osteoarthritis.

A

Both have joint space narrowing
Rheumatoid doesn’t have subchondral sclerosis or osteophytes
Rheumatoid has osteopenia + bone erosions

21
Q

What can the osteoarthritis be caused by?

A 
Abnormal stress (Excessive loading on joints)
Abnormal cartilage
22
Q

What is the most important component of articular cartilage?

A

Aggrecan

23
Q

What makes cartilage robust under compression?

A

Type 2 Collagen + Aggrecan retain water

24
Q

What is special about hyaluronic acid?

A

It’s the only non-sulphated GAG

Maintains synovial viscosity

25
Q

How is osteoarthritis managed?

A

Physiotherapy: strengthening muscle around joint improves joint stability
Analgesia: paracetamol, NSAIDs, intra-articular corticosteroid injections
Joint replacement
Weight loss where appropriate
Education
Occupational therapy

26
Q

What is the distribution of effected joints in septic arthritis? What is the exception to this?

A

Usually effects just 1 joint

Exception: Gonococcal arthritis effects multiple joints

27
Q

What characterises the swellings in osteoarthritis?

A

They are boney + hard on palpation

28
Q

Which joint is effected by rheumatoid arthritis, but spared by osteoarthritis?

A

MCP

29
Q

What is indicated by lack of space in joints in osteoarthritis?

A

Loss of articular cartilage

Leads to bone in contact with bone

30
Q

Describe 5 characteristics of an osteoarthritic joint

A 
Breakdown of cartilage
Changes to underlying bone
Muscular atrophy
Boney spur formation
Cartilage fragments in synovial fluid
31
Q

What can cause abnormal stress or cartilage leading to development of osteoarthritis?

A

Genetic predisposition

32
Q

Give 2 causes of abnormal stress on cartilage

A

Trauma + Misalignment

Obesity

33
Q

What are 3 cartilage changes seen in osteoarthritis?

A

Reduced proteoglycan
Reduced collagen
Chrondrocyte changes e.g. apoptosis

34
Q

What are 3 boney changes seen in osteoarthritis?

A

Proliferation of superficial osteoblasts – Sclerotic bone
Focal stress on sclerotic bone – superficial necrosis
Osteophytes (new bone formation at joint margins)

YR2: Musculoskeletal (10 decks)

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