Other arthritis's Flashcards
What is psoriatic arthritis?
inflammatory arhtritis that occurs mainly in people with arthritis, 10-15% dont have arthritis
Is psoriatic arthritis rheumatoid factor positive or negative?
negative
What are the different signs of psoriatic arthritis?
pitting and onchyloysis of nails
ankylosing spondylitis
dactylitis (sausage digit)
uveitis
What is the common presentation of PA?
asymmetric oligoarthritis with dactylitis
What is arthritis mutilans?
very aggressive form of psoriatic arthritis
What is the investigations for PA?
Bloods - RF (-ve), raised inflammatory markers
Xrays - marginal erosions, osteolysis, enthesitis
What is the non pharmacological treatment for PA?
physiotherapy
orthotics
What is the pharmacological treatment for PA?
NSAIDs Steroid injections DMARDS Anti TNF if very severe Anti IL-17
What is reactive arthritis?
inflammatory arthritis following a systemic illness
What systemic illnesses can cause reactive arthritis?
Salmonella
Chlamidya
Shigella
Yersinea
What is reactive arthritis characterised by?
inflammatory synovitis fomr which viable microorganisms cannot be cultured
What is the peak population for reactive arthritis?
young adults 20-40
What is the investigations for reactive arthritis?
Bloods - RF, increased inflammatory markers HLA-B27 positive Blood, urine and stool cultures X ray of affected joint joint fluid analysis
What is Reiters Syndrome?
Type of reactive arthritis characterised by uveitis/conjunctivitis, urethritis and arthritis
What are the common signs of reactive arthritis?
enthesitis
fever, malaise, fatigue
asymmetrical monoarthrtis or oligoarthritis
muscutaneous lesions - oral ulcers
visceral manifestations - mild renal disease, carditis
occular lesions - conjunctivitis and iritis
What is the treatment for reactive arthritis?
90% resolve spontaneously - some become chronic NSAIDs antibiotics for underlying infection DMARDs if chronic Physio/Occupational Therapy
How long after the initial disease/infection do symptoms start to show for RA?
1-4 weeks
What is enteropathic arthritis associated with?
associated with IBD
What is the presentation of EA?
arthritis in several joints - commonly sacroilitis weight loss fever uveitis skin involvement GI watery stools enthesitis oral ulcers
What are the investigations for EA?
upper and lower GI endoscopy showing IBD signs joint aspirate increased inflammatory markers Xray/MRI showing sacroilitis USS showing synovitis/tenosynovitis
What is the treatment for EA?
analgesia - paracetamol, cocodamol DONT GIVE NSAIDS Treat IBD Steroids DMARDs Anti-TNF
What is septic arthritis?
high bacterial load causes sepsis
What is the pathophysiology of spetic arthritis?
proteolytic enzymes degrade hyaline cartilage and destroy the joint, may cause osteonecrosis of the hip
What is the presentation of septic arthritis?
unable to weight bear hip/groin pain HIP FLEXED AND EXTERNALLY ROTATED severe hip pain on passive movement usually pyrexial
What causes septic arthritis in neonates?
strep and gram -ve
What causes septic arthritis in infants to adults?
staph aureus
What causes septic arthritis in IV drug users?
pseudomonas
atypical organisms
How is septic arthritis investigated?
blood tests - FBC, CRP blood cultures kochers criteria ultrasound +- aspiration Xrays
How is septic arthritis treated?
URGENT
open surgical washout
antibiotics
How can septic arthritis happen? (where can the organisms get in from?)
direct innoculation from trauma/surgery
carried through blood
can travel from adjacent bone e.g. osteomyelitis
spreads from the metaphysis
What is reactive synovitis?
inflammation of the synovium secondary to illness
What is the presentation of reactive synovitis?
HIP FLEXED AND EXTERNALLY ROTATED
groin/hip pain and limp
pyrexial
What distinguishes between reactive synovitis and septic arthritis?
Kochers criteria
- fever
- refusing to bear weight
- serum WBC >12,000
- CRP >20
How is reactive synovitis investigated?
Ultrasound
Kochers criteria
How is reactive synovitis treated?
self limiting
analgesia and NSAIDs
