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R: Inflammatory Arthritis Flashcards

1
Q

what are the 3 subtypes of inflammatory arthritis?

A

antibody associated, seronegative spondylopathies, crystal arthritis

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2
Q

what are antibody associated arthritides (ie. seropositive)

A

this means that rheumatoid factor is present inducing the body to undergo an autoimmune inflammatory process which produces antibodies

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3
Q

which disease falls under antibody associated spondyloarthropathy?

A

rheumatoid arthritis

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4
Q

what is RA?

A

autoimmune inflammatory symmetric poly-arthroplasty which also affects tendons

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5
Q

epi of RA?

A

W, 2nd-5th generation, 1% of population affected

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6
Q

aetiology of RA?

A

genetic, certain infections, trauma

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7
Q

antibody that is associated to RA?

A

anti-CCP

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8
Q

pathogenesis of RA?

A

mutations convert arginine AA to citrulline mimicking antigen > anti-CCP antibodies activated which causes inflammatory reaction

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9
Q

which type of hypersensitivity reaction is RA?

A

T3/T4

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10
Q

site of RA?

A

hands, wrists, feet, ankles, elbows, cervical spine

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11
Q

s/s of RA?

A

pain and stiffness >30mins in morning, swollen, reduced strength symmetrical

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12
Q

rheumatoid nodules are present in ___ RA and are due to intense inflammatory changes in ______ regions

A

chronic severe, extensor

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13
Q

T/F: DIPs are involved in RA

A

F: MCP, PIP, MTPs, not DIPs

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14
Q

which ix for RA?

A

bloods- inflammatory markers (CRP, ESR, plasma viscosity)
serology- anti-CCP, RF
imaging- x-ray, USS (synovitis)

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15
Q

what is the scoring systems for RA?

A

DAS28 score

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16
Q

mx for RA?

A

DMARDs= methotrexate, sulfasalazine, HCQ
analgesia
steroids
biologics= anti-TNFa, rituximab

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17
Q

complications of RA

A

systemic inflammation
extraarticular presentation- rheumatoid nodules, Caplan’s syndrome
Tendon Rupture
cervical spine instability

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18
Q

what are seronegative spondyloarthropathies?

A

inflammatory arthritides characterised by spine and peripheral joints involvement with HLA B27 association

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19
Q

what are the 4 types of seronegative arthritides?

A

ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis

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20
Q

what is ankylosing spondylitis?

A

systemic inflammatory disorder that affects spine and scar-ilaic joints

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21
Q

epi of ankspon?

A

early adulthood-20-40, M

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22
Q

what is the common endpoint of ankspon?

A

fusion of vertebral joints

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23
Q

s/s of ankspon?

A

back pain, sacral inflammation, stiffness, pain in buttocks, ‘?’ spine
non-spinal: uveitis, costochondiritis, aortosis, amyloidosis

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24
Q

ix for ankspon?

A

bloods- CRP, ESR, HLAB27
exam- targus to wall, chest expansion
imaging: bamboo appearance (syndesmophwytes), erosion of scar-ilac joints

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25
mx of ank spon?
NSAIDs, DMARDs, anti-TNFa physio/ preventative exercises early diagnosis key- may lead to muscle wasting and kyphosis
26
what is psoriatic arthritis?
inflammatory arthritis associated with psoriasis
27
what percentage of people with psoriasis will have psoriatic arthritis?
30%
28
sites of psoriatic arthritis?
hips, knees, hands/wrists- DIPs
29
psoriatic arthritis is an _______, ____ arthritis
asymmetric, monoarhtritis (oligoarthritis)
30
what does arthritis mutilans mean?
arthritis that causes periarticular osteolysis
31
s/s of psoriatic arthritis?
psoriasis, nail pitting, dactylitis, enthesitis, onchylosis
32
ix for PA?
bloods- -ve RF | imaging- pencil in cup
33
mx for PA?
NSAIDs, DMARDs (MTX), anti-TNFa
34
what is reactive arthritis?
sterile synovitis that occurs in a single joint following infection
35
epi of reactive arthritis?
1-4 weeks following an infection, young people
36
aetiology of reactive arthritis?
acute attack of dysentery or sexually transmitted (gonococcal- n.gonorrhoea. chlamydia)
37
s/s pf reactive arthritis?
pyrexia, asymmetrical mono-arthritis- usually large joint, enthesitis, skin lesions/ oral ulcer/ conjunctivitis
38
Reiter's syndrome is a triad of...
urethritis, conjunctivitis, arthritis
39
ix for reactive arthritis?
bloods- CRP/ESR, FBCs, U&Es stool/ urine cultures aspirate synovial fluid x-ray
40
mx for reactive arthritis?
abx, most self-resolve within 3 months | 10% require immunosuppression- MTX
41
what is enteropathic arthritis?
arthritis involving peripheral joints and sometimes spine in patients with IBD
42
enteropathic arthritis is associated with ____
IBD
43
s/s of enteropathic arthritis
large joint asymmetrical mono arthritis systemic: wt loss, uveitis, pyoderma gangrenosum, enthesitis, ulcers sites- knees, elbow, ankle, wrists, sacroliliitis/spondylitis may occur
44
which limb is most commonly affected with anteripathic arthritis?
lower limb
45
ix for enteropathic arthritis
GI endoscopy & biopsy to dx IBD joint aspiration* bloods for inflammatory markers x-ray/MRI for sacroiliitis, USS for synovitis
46
mx for enteropathic arthritis?
IBD tx, NSAIDs, DMARDs (sulfasalzine), TNF-a
47
when would you consider using TNF-a?
in severe disease
48
what are the 2 crystal arthritides?
GOUT and pseudo gout
49
what is GOUT (aka. crystal arthritis)?
inflammation of joint triggered by uric acid crystal deposition
50
epi for GOUT?
obese men, >60s
51
common sites for GOUT?
big toe (1st metatarsalphalangeal jt- podagra), ankle, knees
52
pathophysiology of GOUT?
hyperuricaemia causing progressive damage to joints
53
aetiology of GOUT can be divided into inc rate production and dec urate excretion- provide some examples of each
inc urate production: enzyme defects, psoriasis, haemolytic disorders, alcohol, high purine intake reduced urate excretion: renal impairment, volume depletion (HF), thiazide diuretics
54
types of GOUT?
acute: settles in 10 days | chronic trophaceous GOUT: often diuretic associated, high serum uric acid
55
s/s of gout
severe pain, red hot swollen joint, gouti trophi (white painless accumulations of uric acid that erupt through skin)
56
ix for GOUT?
bloods- raised inflammatory markers, inc serum uric acid | aspirate synovial fluid *
57
what would you see on cytology and histology of a gout synovial fluid aspirate?
cytology: needle shaped -ve bifringement monosodium urate crystals in polarising microscopy histology: giant cells
58
mx of GOUT?
acute: NSAIDs, colchicine, glucocorticoid steroids, opioid analgesia chronic prophylaxis: allopurinol, febuxostat, NSAID cover
59
red, hot, swollen joint rings bells for which emergency?
septic arthritis
60
what is pseudogout (Ca pyrophosphate deposition disease)
inflammation of joint caused by calcium pyrophosphate crystal deposition
61
aetiology of pseudogout?
idiopathic, hypercalcaemia, haemochromatosis, hypomagnesaemia, hypothyroid, hyperthyroid
62
types of pseudo gout
acute (Ca pyrophosphate crystals), Ca Hydroxy apatite crystals
63
s/s of pseudo gout
asymptomatic- often incidental finding
64
ix for pseudogout
dense deposits on x-ray, often synovial joints involved | aspirate: +ve birefringent crystals on polarising microscopy
65
T/F: GOUT has +ve birefringent crystals on polarising microscopy
F: GOUT has -ve birefringent, pseudo gout has +ve birefringent
66
mx for acute pseudogout
NSAIDs, colchicine, steroids, rehydration
67
mx for Ca Hydroxy Apatite crystals
NSAIDs, intra-articular steroid injections, physio, arthroplasty
68
main complication of peudogout?
chonedrocalcinosis= Ca Pyrophosphate deposits in cartilage

MSK (26 decks)

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