Osteoarthritis & Reactive arthritis Flashcards
Define reactive arthritis
sterile inflammation in joints following infection especially urogenital (e.g. Chlamydia trachomatis) and gastrointestinal (e.g. Salmonella, Shigella, Campylobacter infections) infections
Reactive arthritis is not due to ongoing infection. (septic arthritis
What are the important extra-articular manifestations?
Enthesopathy
Skin inflammation
Eye inflammation
What can RA be a first manifestation of?
HIV or Hepatitis C infection
What are the musculoskeletal symptoms of RA?
Arthritis - Asymmetrical - Oligoarthritis (<5 joints) - Lower limbs typically affected
Enthesitis
- Heel pain (Achilles tendonitis)
- Swollen fingers (dactylitis)
- Painful feet (metatarsalgia due to plantar fasciitis)
Spondylitis
- Sacroiliitis (inflammation of the sacro-iliac joints)
- Spondylitis (inflammation of the spine)
Describe the extra-articular features of RA?
Occular - Sterile conjunctivitis
Genito-urinary - Sterile urethritis
Skin - Circinate balanitis, Psoriasis- like rash on hands a feet
Rheumatoid arthritis vs Reactive arthritis?
See slides
How is reactive A diagnosed?
- Clinical diagnosis
- Investigations to exclude other causes of arthritis e.g. septic arthritis
- Examples of important investigations
See slides
Septic arthritis vs Reactive arthritis?
See slides
How is reactive A treated?
in majority of patients complete resolution occurs within 2-6 months
No role for antibiotics
Just give anti-inflammatorys
See slides
Define osteoarthritis?
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)
There is defective and irreversible articular cartilage and damage to underlying bone
What joints are affected by osteoarthritis?
Joints of the hand
Distal interphalangeal joints (DIP)
Proximal interphalangeal joints (PIP)
First carpometacarpal joint (CMC)
Spine
Weight bearing joints of the lower limbs - Knees hips, First metatarsophalangeal joint
What can osteoarthritis be associated with?
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
What are the clinical features of osteoarthritis?
Boney out growths at the DIP/PIP - called osteophytes
Heberden’s nodes - DIP
Bouchard’s nodes - PIP
What are the radiographic features of osteoarthritis?
Joint space narrowing
Subchondral bony sclerosis - white
Osteophytes
Subchondral cysts
What are the radiographic changes in Rheumatoid Arthritis vs. Osteoarthritis
Eroisions are seen in RA not osteoarthritis
See slides
Why does osteoarthritis develop?
Excessive loading on joints
Abnormal joint components
What is the viscosity of synovial fluid based on?
Viscosity of synovial fluid is depenedent on hyaluronic acid.
What is articular cartilage composed of?
Type II collagen
Proteoglycan (aggrecan)
Articualar cartilage
…
ECM Proteoglycans
…
How does the cartilage change in osteoarthritis?
- Reduced Proteoglycan
- Reduced collagen
- Chondocyte changes (apoptosis)
What are the bone changes in osteoarthritis?
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
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’
What is the management of osteoarthritis?
Education
Physical therapy – physiotherapy, hydrotherapy
Occupational therapy
Weight loss where appropriate
Exercise
Analgesia
- Paracetamol
- Non-steroidal anti-inflammatory agents
- Intra-articular corticosteroid injection
Joint replacement
