Pathophys. of Joint Inflammation

Question 1

What percentage of the population have Rheumatoid arthritis?

Answer 1

1%

Question 2

What joints are mostly swollen in RA?

Answer 2

MCP, MTPs, PIPs and wrists

Question 3

Early morning stiffness that eases throughout day is a characteristic sign of OA or RA?

Answer 3

RA

Question 4

symmetrical polyarthritis is characteristic of OA or RA?

Answer 4

RA - OA tends to not be symmetrical and can be monoarthritic

Question 5

In RA: you usually have a genetic predisposition for it then get some sort of trigger which causes (1)? to activate (2)? and (3) which, in turn mobilises (4)? such as TNF, IL-1, which drive (5)?.
B-cells are also activated to produce (6)? together with inflammation causes (7)?.

Answer 5

1 - T-cells
2 - Macrophages
3 - Fibroblasts
4 - cytokines
5 - inflammation
6 - antibodies
7 - tissue damage

Question 6

Early intervention with RA makes a difference to reducing effects. True or false?

Answer 6

True - the damage to articular cartilage is permanent so want to try and intervene early to prevent this

Question 7

List some of the cells that TNF-alpha acts on in RA and the outcome of this.

Answer 7

T-lymphocytes and macrophages –> pro inflammatory cytokines, increased adhesion molecules –> increased inflammation and cell infiltration
Endothelium –> VEGF –> increased angiogenesis
Hepatocytes –> increased CRP
Epidermis –> keratinocyte hyperproliferation –> skin plaques
synoviocytes –> increased metalloproteinase syntehsis –> articular cartilage degradation

Question 8

List some of the 7 consequences of chronic systemic inflammation

Answer 8

• early ischaemic heart disease
• sarcopenia (loss of muscle strength)
• hypercholestrolaemia
• pain sensitisation
• osteoporosis
• insulin resistance
• dementia

Question 9

What process occurs that makes people with RA at a higher risk of CVD?

Answer 9

Accelerated atherosclerosis

Question 10

What two things detected in an autoimmune profile could indicate RA and which is more specific?

Answer 10

Rheumatoid factor and anti-CCP. Anti-CCP is more specific.

Question 11

What joints are more commonly affected in OA?

Answer 11

DIP, PIP, CMC, MTPI, axial skeleton and large wt-bearing joints

Question 12

List some risk factors for Osteoarthritis

Answer 12

• age (older people affected more)
• female
• genetic fam. hx
• obese
• oestrogen deficiency
• low BMD
• occupation (e.g. manual labour)
• past fractures

Question 13

How prevalent is OA in people over 75?

Answer 13

80%

Question 14

What are the 4 management objectives for OA?

Answer 14

1. patient education and information access
2. Pain relief
3. Optimisation of function
4. Modification of disease process

Question 15

What is an example of a type of crystal arthritis?

Answer 15

Gout

Question 16

Is gout more common in men or women?

Answer 16

Men

Question 17

Name some common comorbidities in gout

Answer 17

• Renal impairment
• CHD
• Metabolic syndromes (e.g. hypertension, diabetes, obesity, dyslipidaemia)

Question 18

List some non-modifiable risk factors for gout

Answer 18

• age (prevalence ^ with age)
• male gender
• race (afroamerican more at risk than caucasians)
• genetic factors
• impaired renal function

Question 19

list some modifiable risk factors of gout

Answer 19

• hyperuricaemia
• high purine diet (seafood, red meat)
• alcohol consumpton (particularly beer)
• obesity
• certain medications (e.g. diuretics, aspirin, some cytotoxic drugs etc.)

Question 20

The precipitation of what crystals in joints causes inflammation which causes gout?

Answer 20

urate (uric acid).

Hyperuricaemia is the cause of gout.

Question 21

What drug is used to treat gout and what is its mechanism of action?

Answer 21

Allopurinol - blocks xantine oxidase whcih reduces amount of uric acid in body

Question 22

Triggers of gout

Answer 22

• direct trauma
• intercurrent illness (or surgery) that triggers the acute phase response
• dehydration/acidosis (including alcoholic binge)
• medications
• rapid weight loss

Question 23

Is gout usually slow or quick-onset

Answer 23

quick - people may wake up in middle of light in pain suddenly

Question 24

What is the name of the condition where you get recurrent attacks of gout over time and the swelling is hard crystals?

Answer 24

Chronic tophaceous gout

Question 25

Inflammation of the Metatarsophalangeal joint in the big toe caused by gout is known as what?

Answer 25

Podagra

Question 26

What two bacteria most commonly cause septic arthritis?

Answer 26

Staphylococcus or Streptococcal

Question 27

what systemic symptoms might you see in septic arthritis?

Answer 27

• fever
• sweats
• rigors
• confusion

Question 28

What from the history might make you think it’s septic arthritis?

Answer 28

Sudden recent increase in joint swelling. Joint - heat, erythematous, loss of function and effusion

Question 29

How is septic arthritis diagnosed?

Answer 29

Joint aspiration then culturing the aspirate