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MSK > Osteoarthritis + RA, reactive + seronegative arthritis > Flashcards

Osteoarthritis + RA, reactive + seronegative arthritis Flashcards

1
Q

Prevalence for hip + knee

A

11% hip

24% knee

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2
Q

Pathology of OA

A

Loss of cartilage, remodelling of adjacent bone + associated inflammation

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3
Q

RF for OA

A 
Genetic 
Ageing
Females
Obesity 
Joint injury 
Reduced muscle strength
Joint laxity + misalignment
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4
Q

Symptoms of OA

A

Joint pain exacerbated by exercise
Hip OA = felt in groin + anterior/ lateral thigh
Joint stiffness in morning + after rest
Reduced function

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5
Q

Signs of OA

A 
Reduced range of movement 
Pain on movement 
Joint swelling
Crepitus 
Bony swellings due to osteophytes
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6
Q

Management of OA

A 
Exercise 
Physio
Weight loss 
Topical NSAIDs + paracetamol 
Intra-articular corticosteroid injections 
Refer for surgery if not responding
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7
Q

RF for RA

A 
Female 
Smoking 
HLA-DR1 linked 
Winter onset 
High birth weight 
Obesity 
DM
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8
Q

Pathology of RA

A

Chronic, autoimmune systemic inflammatory disease

Symmetrical, deforming, peripheral polyarthritis

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9
Q

Symptoms of RA

A

Fatigue, flu, fever, sweats, weight loss
Insidious symmetrical polyarthritis, commonly in small joints of hands and feets
Heat, redness, swelling, pain, stiffness (especially in morning or after rest)
Progressive deformity + disability

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10
Q

Signs of RA

A

Muscle wasting + tendon rupture

Ulnar deviation, swan neck + Boutonniere’s deformity, Z deformity of thumb + piano key deformity of wrist

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11
Q

Other manifestations of RA

A

Eyes: secondary Sjogrens syndrome, scleritis, episcleritis
Leg ulcers + rashes
Rheumatoid nodules on eyes, subcut, heart, lung
Vasculitis, valvulitis, fibrosis

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12
Q

Investigations for RA

A

Rheumatoid factor positive in 70%
Inflammation = high platelets, high ESR, high CRP
Positive anti-CCP + negative ANA
FBC: normochrmoic, normocytic anaemia

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13
Q

X Ray findings for RA

A

Soft tissue swelling, juxta-articular osteopenia + decreased joint space
Bony erosions, sublucation + carpal destruction

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14
Q

Management of RA

A

Early use of DMARDs eg methotrexate, sulfasaline, hydroxychloroquine
Biological agents (TNF alpha inhibitors = infliximab)
Steroids to reduce symptoms + inflammation = methylprednisolone
NSAIDs for symptomatic relief

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15
Q

Complications of RA

A

Immunosuppression - neutropenic sepsis

Vasculitis, lymphadenopathy, dry eye syndrome, neuropathy, Felty’s syndrome (enlarged spleen + low white cell count)

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16
Q

Complications of DMARDs

A 
Methotrexate = pneumonitis, oral ulcers, hepatotoxicity 
Sulfasaline = rash, low sperm count, oral ulcers 
Hydroxychloroquine = irreversible retinopathy
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17
Q

Complications of biological agents used to treat RA

A

Infections, reactivation of TB, worsening HF, hypersensitivity, blood disorders

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18
Q

Differentials for back pain

A 
Sciatica 
Sacro-iliac joint dysfunction 
Cauda equina 
Fractured vertebrae 
Bone mets 
Ankylosing spondylitis (young males)
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19
Q

What is a yellow flag?

A

Psychosocial factors indicative of long term chronicity + disability

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20
Q

What is seronegative arthritis?

A

Group of inflammatory rheumatic disease with involvement of axial + peripheral joints + enthesitis

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21
Q

What is enthesitis?

A

Inflammation at site of insertion of tendons + ligaments to bone

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22
Q

What diseases are in the group of seronegative spondyloarthropathies?

A 
Ankylosing spondylitis
Reiters syndrome 
Enteropathic arthritis 
Psoriatic arthritis 
Behcet's disease
Juvenile idiopathic arthritis
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23
Q

What is the gene involved in seronegative spondyloarthropathies?

A

hla-b27

24
Q

How do seronegative spondyloarthropathies present?

A 
20-40 y/o 
Inflammatory back pain, stiffness in AM 
Sacroiliitis 
Peripheral arthritis 
Enthesitis 
Dactylitis 
Psoriasis 
Anterior uveitis
25
Q

Investigations for seronegative spondyloarthropathies

A 
ESR + CRP 
Serum urate
Rheumatoid factor, ANA
X ray of sacroiliac joints 
MRI lumbar spine
26
Q

Management of seronegative spondyloarthropathies?

A

Physical therapy
NSAIDs
DMARDS (sulfasalazine + methotrexate)
Surgery - joint replacements

27
Q

Complications of seronegative spondyloarthropathies?

A

Aortitis
Mitral valve insufficiency
Restrictive lung disease
Amyloidosis

28
Q

What is reactive arthritis?

A

Form of seronegative spondyloarthritis associated with inflammatory back pain, additive or migratory oligoarthritis + extra-articular symptoms that follow a gastro/ uro infection by 1-6 weeks.

29
Q

What is Reiter’s syndrome?

A

Clinical subtype of reactive arthritis

Characterised by presence of large joint oligoarthritis, urogenital tract infection + uveitis

30
Q

What are the 2 subgroups of Reiters syndrome?

A 
Post-enteric = following campylobacter, salmonella or shigella 
Post-venereal = following chlamydia or HIV
31
Q

How does reactive arthritis present?

A 
2-4 weeks after infection 
Acute onset with fatigue + fever 
Asymmetrical, lower extremity oligoarthritis 
Lower back pain 
Heel pain
32
Q

What is the Reiter’s triad?

A

Urethritis, conjunctivitis, arthritis

33
Q

Investigations + results for reactive arthritis

A 
Microbial tests negative 
ESR + CRP high 
FBC - normocytic normochromic anemia 
HLA-B27 positive 
RF + ANA negative 
PCR for chlamydia
34
Q

Management of reactive arthritis

A 
Rest joints, then physio 
NSAIDs
Corticosteroids - intra-articular or systemically 
DMARDs 
Abx to treat infection
35
Q

Common sites of osteoarthritis

A 
Hand (DIP, PIP, 1st CMC)
Hip
Knee
1st MTP 
L4-L5, L5-S1 
C spine
36
Q

How much calcium do we need a day?

A

1200mg

37
Q

When to do bone mineral testing?

A

Everyone over 65
Anyone under 50 w/ fragility fractures, hypogonadism, chronic inflammatory conditions, hyperparathyroidism
50-65 with fragility fractures, prolonged steroid use, parental hip fractures, vertebral fractures, osteopenia, high alcohol intake, low body weight

38
Q

Management of moderate fracture risk (+ what is it?)

A

10 yr fracture risk = 10-20%
T4-L4 X ray
Consider medications

39
Q

What is RA, OA + SPA a disease of?

A 
RA = disease of synovium 
OA = disease of cartilage + bone 
SPA = disease of enthesitis
40
Q

What does osteopenia look like on x ray?

A

black

41
Q

RA X ray findings

A

Erosions, loss of joint space, subluxed joints (partially dislocated)

42
Q

What bloods are done in ?RA + what blood is used to monitor?

A

Rheum investigations: anti CCP, RF, CRP, ESR

Monitoring: CRP

43
Q

OA X ray findings

A

LOSS (loss of joint space, osteophytes, subchondral sclerosis + subchondral bone cysts)

44
Q

Where are Bouchards + Heberdens nodes found?

A 
Bouchards = PIP
Heberdens = DIP
45
Q

What are the forms of SPA?

A

AS, juvenile SPA, reactive arhtritis, psoriatic, ant uveitis associated

46
Q

What drugs work for AS, and which don’t?

A

DMARDS don’t work

Anti-TNF works

47
Q

What hand joints are affected by RA + OA?

A

OA - DIP PIP

RA - MCP, PIP

48
Q

What drugs can be used long term for gout?

A

Allopurinol + febuxostat

49
Q

What are the causes of secondary raynauds?

A 
Occlusive arterial disease
Connective tissue disease
Vascular injury
Neurovascular compression 
Drugs (BB, bleomycin, cocaine, caffeine)
Hyperviscosity
50
Q

Presentation of NOF fracture

A

Shortened, abducted + externally rotated

Pain exacerbated with rotation of hip

51
Q

What is the Beighton score?

A 
Evidence of joint hypermobility 
Palms on the ground 
Elbow extension 
Knee extension 
Thumbs extended to forearm 
5th finger extended
52
Q

What are the types of biologics?

A

T cells (type of white blood cell)
Tumor necrosis factor (chemical in body that causes inflammation)
Il-1 or Il-6 (inflammatory chemicals)
B cells (type of white blood cell

53
Q

Describe the presentation of Behcets

A

Syndrome of mouth + genital ulcers, skin problems + other symptoms

54
Q

What screening needs to be done before starting a biologic?

A

Hep B/C, HIV, CXR, TB

55
Q

What is myositis vs dermomyositis?

A 
Myositis = inflammation of muscles, autoimmune 
Dermatomyositis = myositis + rash
56
Q

How do you diagnose myositis?

A

Electromyography test, muscle biopsy, MRI nbv

MSK (10 decks)

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