Osteoarthritis and Reactive Arthritis Flashcards
Define reactive arthritis.
Sterile inflammation in joints following infection, especially urogenital and gastrointestinal infections
State a urogenital infection that can cause reactive arthritis.
Chlamydia trachomatis
Give some examples of gastrointestinal infections that are associated with reactive arthritis.
Shigella
Salmonella
Campylobacter
What subset of the population does reactive arthritis tend to occur in?
It occurs mainly in young adults with a genetic predisposition and an environmental trigger
How long after the infection does the reactive arthritis tend toappear?
1-4 weeks
Describe the features of the arthritis in reactive arthritis.
It is an asymmetrical arthritis that occurs in relatively few joints
Reactive arthritis can cause enthesopathy. Which entheses are likely to get affected and what symptoms will that cause?
Achilles tendonitis
Dactylitis
Metatarsalgia (painful feet because of inflammation of the palmar fascia)
What is a very common feature of seronegative spondyloarthropathies?
Sacro-iliitis
State some extra-articular features of reactive arthritis?
Sterile conjunctivitis
Sterile urethritis
Circinate balanitis
Keratoderma blennorhagicum
What is the triad of symptoms that can be used to describe reactive arthritis?
Reiter’s syndrome – joint inflammation + urethritis + conjunctivitis
Where can you get spondylitis in rheumatoid arthritis?
At the atlanto-axial joint – there is synovium here
Describe the main differences between rheumatoid arthritis and reactive arthritis.
Rheumatoid Arthritis vs Reactive Arthritis Sex Ratio: F>M - M>F Arthritis: Symmetrical, Polyarticular, Small&Large Joints - Asymmetrical, Oligoarticular, Large joints Enthesopathy: NO - YES Spondylitis: NO (Except atlanto-axial joint in cervical spine) - YES Urethritis: NO - YES Skin involvement: Subcutaneous nodules - K.blennorhagicum, Circinate balanitis Rheumatoid factor: YES - NO HLA association: HLA-DR4 - HLA-B27
What is the main danger in septic arthritis?
The bacteria produce metalloproteinases that can rapidly degrade the articular cartilage
What are the main differences between septic arthritis and reactive arthritis?
Septic arthritis has a positive synovial fluid culture
It is treated with antibiotics and may even require joint lavage
Describe the treatment of reactive arthritis.
It usually resolves by itself
NSAIDs to control pain and symptomatic treatment of extra-articular manifestations
Define osteoarthritis.
Chronic slowly progressive disorder due to failure of articular cartilage that typically affects the hands (especially those involved in the pinch grip), spine and weight-bearing joints (hips and knees)
Which joints are most commonly affected in osteoarthritis?
DIP PIP First metacarpophalangeal joint Spine Knees Hips First metatarsophalangeal joint
What are the names given to the osteophytes found on the hand in osteoarthritis?
Bouchard’s Nodes – PIP
Heberden’s Nodes – DIP
What are symptoms of osteoarthritis?
Joint pain (worse with activity) Joint crepitus Joint instability Joint enlargement Joint stiffness after immobility Limitation of motion
What are some radiographic features of osteoarthritis?
Joint space narrowing
Osteophytes
Subchondral bony sclerosis
Subchondral cysts
Describe the differences between the radiographic features of rheumatoid arthritis and osteoarthritis.
Rheumatoid arthritis also has joint space narrowing but it doesn’t have subchondral sclerosis or osteophytes
There is osteopenia and there are bone erosions in rheumatoid arthritis but not in osteoarthritis
What can osteoarthritis be caused by?
Abnormal cartilage
Abnormal stress
What is the most important component of articular cartilage?
Aggrecan
How is osteoarthritis managed?
Physiotherapy – strengthening the muscle around the joint improves joint stability
Analgesia – paracetamol, NSAIDs, intra-articular corticosteroid injections
Joint replacement
Weight loss where appropriate
