Other Types of Arthritis Flashcards
Other than rheumatoid, list 4 other types of arthritis.
Septic arthritis
Crystal arthropathy
Reactive arthritis
Degenerative arthritis
Describe the clinical features of septic arthritis. (6)
Signs of infection:
- Pain
- Fever
- Swollen joint
- Loss of function
Only one joint affected
Associated with preceding infection
List 3 common causative organisms in septic arthritis.
List 4 less common causative organisms.
COMMON ORGANISMS:
Staph aureus
Neisseria gonorrhoea
Haemophilus influenza
LESS COMMON: TB Lyme disease (Borrelia burgdoferi) Brucellosis Syphilis
List 2 risk factors for septic arthritis.
Steroid use
Rheumatoid arthritis
List 4 routes of infection which can cause septic arthritis.
Haematogenous (from systemic infection)
From adjacent osteomyelitis
From skin/soft tissue
Disruption of the joint capsule (e.g. injection, trauma)
Describe the pathophysiology of septic arthritis. (2)
- Infection within the joint causes inflammation
- 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
Which investigations would you do for septic arthritis? (4)
Joint aspirate microbiology:
- Gram staining
- Aspirate culture
Blood tests:
- FBC (increased WCC)
- Blood cultures
What are the 2 types of crystal arthropathy?
Gout
Pseudo-gout
Define gout.
Defective purine metabolism, causing an excess of uric acid and its salts to accumulate in the bloodstream and joints
Describe the clinical features of gout. Consider:
a) Acute gout (2)
b) Chronic gout (2)
ACUTE:
Acute inflammation of joint
Monoarthritis
CHRONIC:
Tophi in skin/cartilage (especially ears)
Joint destruction
Describe the usual distribution of gout. (2)
Monoarthritis
Often MTP joint of big toe
List 5 factors which might precipitate an acute gout attack.
Trauma Surgery Starvation Infection Diuretic use
What is gout caused by? (11)
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
What investigations would you do for gout? (4)
Bloods:
- Serum urate levels
- U&Es
Joint aspirate:
-Polarised light microscopy
X-ray
In gout, what would you see on polarised light microscopy? (1)
What would you see on x-ray? (2)
MICROSCOPY:
Negatively birefringent needle-shaped crystals
X-RAY:
Soft tissue swelling
Punched out juxta-articular swellings
How would treat an acute attack of gout? (3)
NSAIDs (high dose), e.g.
- Colchicine
- Corticosteroids
Rest
Elevate affected joint
How would you treat chronic gout, to prevent recurrent acute attacks?
Lifestyle changes, e.g.
- Weight loss
- Better diet
Prophylactic drugs, e.g.
- Allopurinol
- Probenecid
List 3 side effects of allopurinol.
List 2 important features to remember when prescribing it.
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
What kind of drug is probenecid?
What is it used for? Describe its mechanism of action.
Uricosuric agent
INDICATIONS: gout
MECHANISM OF ACTION: increases secretion of uric acid into urine
Define pseudo-gout. What is another name for it?
Joint pain and swelling, resembling gout, caused by crystals of calcium pyrophosphate in the synovial membrane and fluid
Calcium pyrophsphate deposition (CPPD)
What can cause pseudo-gout? (3)
Primary causes:
- Hyperparathyroidism
- Hypophosphataemia
Secondary causes:
-Haemochromatosis
Describe the pathophysiology of pseudo-gout. (2)
- Synovium becomes inflamed
- Calcium pyrophosphate is deposited in the joint, which may cause:
a. Chondrocalcinosis
b. Calcification of extra-articular tissues
What investigations would you do in pseudo-gout? (5)
Bloods:
- U&Es
- Phosphate levels
- PTH levels
Joint aspirate:
-Polarised light microscopy
X-ray
In pseudo-gout, what would you see on polarised light microscopy? (1)
What would you see on x-ray? (2)
MICROSCOPY:
Positively birefringent rhomboid shaped crystals
X-RAY:
Chondrocalcinosis of:
-Meniscal fibrocartilage
-Articular hyaline cartilage
How would you treat pseudo-gout? (3)
Aspiration
NSAIDs
Colchicine
Define reactive arthritis.
Sterile synovitis which occurs following an infection
List 6 common causes of reactive arthritis.
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
Describe the clinical features of reactive arthritis. (2)
List 3 associated features.
Acute, asymmetrical lower limb arthritis
Occurs days-weeks after infection
ASSOCIATED FEATURES:
Enthesitis (tendon inflammation)
Sacroiliitis
Keratoderma blenorrhagica
What is keratoderma blenorrhagica?
What type of arthropathy is it seen in?
Skin lesions commonly found on palms/soles, resembling psoriasis, appearing as a waxy yellow-brown vesicopustular lesion
Seen in: reactive arthritis
List 3 complications of reactive arthritis.
Aortic regurgitation
Aortitis
Amyloidosis
List 1 type of reactive arthritis.
What condition is this associated with?
Enteropathic arthritis
Associated with: IBD
How would you manage reactive arthritis? (3)
Analgesia (e.g. NSAIDs)
Intra-articular steroids
Treatment of underlying condition (if needed)
What is Reiter’s syndrome? What type of arthritis is it associated with?
Reiter’s syndrome = arthritis + urethritis + conjunctivitis
Seen in: reactive arthritis
Define osteoarthritis.
Degenerative joint disease
Describe the clinical features of osteoarthritis. (3)
Pain
Stiffness
Commonly affects weight-bearing joints
Describe the pathophysiology of osteoarthritis. (3)
- Loss of articular cartilage leads to exposure of underlying bone
a. Formation of subchondral cysts
b. Formation of osteophytes - Synovium becomes hyperplastic, with mild inflammation
- Synovium will also contain bony detritus
List 11 causes of osteoarthritis. Consider:
a) Primary OA (2)
b) Secondary OA (9)
PRIMARY:
Age
Wear and tear
SECONDARY: Fractures Previous sepsis RA Osteonecrosis Congenital diaphragmatic hernia Gout Haemochromatosis Ochronosis Peripheral neuropathy
What investigations would you do for OA? (1)
X-ray
In OA, which features would you see on x-ray? (4)
LOSS:
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
How would you manage OA? (7)
Exercise Weight loss Physiotherapy Analgesia (paracetamol and NSAIDs) Topical capsaicin Intra-articular steroid injection Surgical joint replacement
