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11. Orthopaedics > Other Types of Arthritis > Flashcards

Other Types of Arthritis Flashcards

1
Q

Other than rheumatoid, list 4 other types of arthritis.

A

Septic arthritis
Crystal arthropathy
Reactive arthritis
Degenerative arthritis

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2
Q

Describe the clinical features of septic arthritis. (6)

A

Signs of infection:

  • Pain
  • Fever
  • Swollen joint
  • Loss of function

Only one joint affected
Associated with preceding infection

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3
Q

List 3 common causative organisms in septic arthritis.

List 4 less common causative organisms.

A

COMMON ORGANISMS:
Staph aureus
Neisseria gonorrhoea
Haemophilus influenza

LESS COMMON:
TB
Lyme disease (Borrelia burgdoferi)
Brucellosis
Syphilis
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4
Q

List 2 risk factors for septic arthritis.

A

Steroid use

Rheumatoid arthritis

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5
Q

List 4 routes of infection which can cause septic arthritis.

A

Haematogenous (from systemic infection)
From adjacent osteomyelitis
From skin/soft tissue
Disruption of the joint capsule (e.g. injection, trauma)

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6
Q

Describe the pathophysiology of septic arthritis. (2)

A
  1. Infection within the joint causes inflammation
  2. Synovium becomes inflamed with the formation of a fibrin exudate (containing many neutrophils)
    a. This causes fibrin deposits on joint surface
    b. This leads to loss of articular cartilage
    c. This causes secondary osteoarthritis
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7
Q

Which investigations would you do for septic arthritis? (4)

A

Joint aspirate microbiology:

  • Gram staining
  • Aspirate culture

Blood tests:

  • FBC (increased WCC)
  • Blood cultures
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8
Q

What are the 2 types of crystal arthropathy?

A

Gout

Pseudo-gout

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9
Q

Define gout.

A

Defective purine metabolism, causing an excess of uric acid and its salts to accumulate in the bloodstream and joints

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10
Q

Describe the clinical features of gout. Consider:

a) Acute gout (2)
b) Chronic gout (2)

A

ACUTE:
Acute inflammation of joint
Monoarthritis

CHRONIC:
Tophi in skin/cartilage (especially ears)
Joint destruction

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11
Q

Describe the usual distribution of gout. (2)

A

Monoarthritis

Often MTP joint of big toe

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12
Q

List 5 factors which might precipitate an acute gout attack.

A 
Trauma
Surgery
Starvation
Infection
Diuretic use
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13
Q

What is gout caused by? (11)

A

Excess levels of uric acid, e.g.

  • Age
  • Obesity
  • Alcohol abuse
  • High protein diet
  • Diabetes mellitus

Primary causes, e.g.

  • Genetic predisposition
  • Lesch-Nyhan syndrome

Secondary causes, e.g.

  • Myeloproliferative disorders
  • Leukaemia
  • Thiazide diuretics
  • Chronic renal disease
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14
Q

What investigations would you do for gout? (4)

A

Bloods:

  • Serum urate levels
  • U&Es

Joint aspirate:
-Polarised light microscopy

X-ray

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15
Q

In gout, what would you see on polarised light microscopy? (1)

What would you see on x-ray? (2)

A

MICROSCOPY:
Negatively birefringent needle-shaped crystals

X-RAY:
Soft tissue swelling
Punched out juxta-articular swellings

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16
Q

How would treat an acute attack of gout? (3)

A

NSAIDs (high dose), e.g.

  • Colchicine
  • Corticosteroids

Rest
Elevate affected joint

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17
Q

How would you treat chronic gout, to prevent recurrent acute attacks?

A

Lifestyle changes, e.g.

  • Weight loss
  • Better diet

Prophylactic drugs, e.g.

  • Allopurinol
  • Probenecid
18
Q

List 3 side effects of allopurinol.

List 2 important features to remember when prescribing it.

A

Rash
Fever
Decreased WCC

IMPORTANT INFO:

  • Do NOT give in acute attack (wait at least 3 weeks)
  • Cover with NSAIDs/colchicine for first 6 weeks to prevent acute attack
19
Q

What kind of drug is probenecid?

What is it used for? Describe its mechanism of action.

A

Uricosuric agent

INDICATIONS: gout

MECHANISM OF ACTION: increases secretion of uric acid into urine

20
Q

Define pseudo-gout. What is another name for it?

A

Joint pain and swelling, resembling gout, caused by crystals of calcium pyrophosphate in the synovial membrane and fluid

Calcium pyrophsphate deposition (CPPD)

21
Q

What can cause pseudo-gout? (3)

A

Primary causes:

  • Hyperparathyroidism
  • Hypophosphataemia

Secondary causes:
-Haemochromatosis

22
Q

Describe the pathophysiology of pseudo-gout. (2)

A
  1. Synovium becomes inflamed
  2. Calcium pyrophosphate is deposited in the joint, which may cause:
    a. Chondrocalcinosis
    b. Calcification of extra-articular tissues
23
Q

What investigations would you do in pseudo-gout? (5)

A

Bloods:

  • U&Es
  • Phosphate levels
  • PTH levels

Joint aspirate:
-Polarised light microscopy

X-ray

24
Q

In pseudo-gout, what would you see on polarised light microscopy? (1)

What would you see on x-ray? (2)

A

MICROSCOPY:
Positively birefringent rhomboid shaped crystals

X-RAY:
Chondrocalcinosis of:
-Meniscal fibrocartilage
-Articular hyaline cartilage

25
Q

How would you treat pseudo-gout? (3)

A

Aspiration
NSAIDs
Colchicine

26
Q

Define reactive arthritis.

A

Sterile synovitis which occurs following an infection

27
Q

List 6 common causes of reactive arthritis.

A

Cross-reactivity after bacterial infection, e.g.

  • Salmonella infection
  • Shigella
  • Yersinia
  • Chlamydia trachomatis

Specific types of infection, e.g.

  • Urethritis
  • Diarrhoea

Genetic predisposition, e.g.
-HLA B27

28
Q

Describe the clinical features of reactive arthritis. (2)

List 3 associated features.

A

Acute, asymmetrical lower limb arthritis
Occurs days-weeks after infection

ASSOCIATED FEATURES:
Enthesitis (tendon inflammation)
Sacroiliitis
Keratoderma blenorrhagica

29
Q

What is keratoderma blenorrhagica?

What type of arthropathy is it seen in?

A

Skin lesions commonly found on palms/soles, resembling psoriasis, appearing as a waxy yellow-brown vesicopustular lesion

Seen in: reactive arthritis

30
Q

List 3 complications of reactive arthritis.

A

Aortic regurgitation
Aortitis
Amyloidosis

31
Q

List 1 type of reactive arthritis.

What condition is this associated with?

A

Enteropathic arthritis

Associated with: IBD

32
Q

How would you manage reactive arthritis? (3)

A

Analgesia (e.g. NSAIDs)
Intra-articular steroids
Treatment of underlying condition (if needed)

33
Q

What is Reiter’s syndrome? What type of arthritis is it associated with?

A

Reiter’s syndrome = arthritis + urethritis + conjunctivitis

Seen in: reactive arthritis

34
Q

Define osteoarthritis.

A

Degenerative joint disease

35
Q

Describe the clinical features of osteoarthritis. (3)

A

Pain
Stiffness
Commonly affects weight-bearing joints

36
Q

Describe the pathophysiology of osteoarthritis. (3)

A
  1. Loss of articular cartilage leads to exposure of underlying bone
    a. Formation of subchondral cysts
    b. Formation of osteophytes
  2. Synovium becomes hyperplastic, with mild inflammation
  3. Synovium will also contain bony detritus
37
Q

List 11 causes of osteoarthritis. Consider:

a) Primary OA (2)
b) Secondary OA (9)

A

PRIMARY:
Age
Wear and tear

SECONDARY:
Fractures
Previous sepsis
RA
Osteonecrosis
Congenital diaphragmatic hernia
Gout
Haemochromatosis
Ochronosis
Peripheral neuropathy
38
Q

What investigations would you do for OA? (1)

A

X-ray

39
Q

In OA, which features would you see on x-ray? (4)

A

LOSS:

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

40
Q

How would you manage OA? (7)

A 
Exercise
Weight loss
Physiotherapy
Analgesia (paracetamol and NSAIDs)
Topical capsaicin
Intra-articular steroid injection
Surgical joint replacement

11. Orthopaedics (13 decks)

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