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MSK > R: Inflammatory Arthritis > Flashcards

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
Q

mx of ank spon?

A

NSAIDs, DMARDs, anti-TNFa
physio/ preventative exercises
early diagnosis key- may lead to muscle wasting and kyphosis

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26
Q

what is psoriatic arthritis?

A

inflammatory arthritis associated with psoriasis

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27
Q

what percentage of people with psoriasis will have psoriatic arthritis?

A

30%

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28
Q

sites of psoriatic arthritis?

A

hips, knees, hands/wrists- DIPs

29
Q

psoriatic arthritis is an _______, ____ arthritis

A

asymmetric, monoarhtritis (oligoarthritis)

30
Q

what does arthritis mutilans mean?

A

arthritis that causes periarticular osteolysis

31
Q

s/s of psoriatic arthritis?

A

psoriasis, nail pitting, dactylitis, enthesitis, onchylosis

32
Q

ix for PA?

A

bloods- -ve RF

imaging- pencil in cup

33
Q

mx for PA?

A

NSAIDs, DMARDs (MTX), anti-TNFa

34
Q

what is reactive arthritis?

A

sterile synovitis that occurs in a single joint following infection

35
Q

epi of reactive arthritis?

A

1-4 weeks following an infection, young people

36
Q

aetiology of reactive arthritis?

A

acute attack of dysentery or sexually transmitted (gonococcal- n.gonorrhoea. chlamydia)

37
Q

s/s pf reactive arthritis?

A

pyrexia, asymmetrical mono-arthritis- usually large joint, enthesitis, skin lesions/ oral ulcer/ conjunctivitis

38
Q

Reiter’s syndrome is a triad of…

A

urethritis, conjunctivitis, arthritis

39
Q

ix for reactive arthritis?

A

bloods- CRP/ESR, FBCs, U&Es
stool/ urine cultures
aspirate synovial fluid
x-ray

40
Q

mx for reactive arthritis?

A

abx, most self-resolve within 3 months

10% require immunosuppression- MTX

41
Q

what is enteropathic arthritis?

A

arthritis involving peripheral joints and sometimes spine in patients with IBD

42
Q

enteropathic arthritis is associated with ____

43
Q

s/s of enteropathic arthritis

A

large joint asymmetrical mono arthritis
systemic: wt loss, uveitis, pyoderma gangrenosum, enthesitis, ulcers
sites- knees, elbow, ankle, wrists, sacroliliitis/spondylitis may occur

44
Q

which limb is most commonly affected with anteripathic arthritis?

A

lower limb

45
Q

ix for enteropathic arthritis

A

GI endoscopy & biopsy to dx IBD
joint aspiration*
bloods for inflammatory markers
x-ray/MRI for sacroiliitis, USS for synovitis

46
Q

mx for enteropathic arthritis?

A

IBD tx, NSAIDs, DMARDs (sulfasalzine), TNF-a

47
Q

when would you consider using TNF-a?

A

in severe disease

48
Q

what are the 2 crystal arthritides?

A

GOUT and pseudo gout

49
Q

what is GOUT (aka. crystal arthritis)?

A

inflammation of joint triggered by uric acid crystal deposition

50
Q

epi for GOUT?

A

obese men, >60s

51
Q

common sites for GOUT?

A

big toe (1st metatarsalphalangeal jt- podagra), ankle, knees

52
Q

pathophysiology of GOUT?

A

hyperuricaemia causing progressive damage to joints

53
Q

aetiology of GOUT can be divided into inc rate production and dec urate excretion- provide some examples of each

A

inc urate production: enzyme defects, psoriasis, haemolytic disorders, alcohol, high purine intake
reduced urate excretion: renal impairment, volume depletion (HF), thiazide diuretics

54
Q

types of GOUT?

A

acute: settles in 10 days

chronic trophaceous GOUT: often diuretic associated, high serum uric acid

55
Q

s/s of gout

A

severe pain, red hot swollen joint, gouti trophi (white painless accumulations of uric acid that erupt through skin)

56
Q

ix for GOUT?

A

bloods- raised inflammatory markers, inc serum uric acid

aspirate synovial fluid *

57
Q

what would you see on cytology and histology of a gout synovial fluid aspirate?

A

cytology: needle shaped -ve bifringement monosodium urate crystals in polarising microscopy
histology: giant cells

58
Q

mx of GOUT?

A

acute: NSAIDs, colchicine, glucocorticoid steroids, opioid analgesia
chronic prophylaxis: allopurinol, febuxostat, NSAID cover

59
Q

red, hot, swollen joint rings bells for which emergency?

A

septic arthritis

60
Q

what is pseudogout (Ca pyrophosphate deposition disease)

A

inflammation of joint caused by calcium pyrophosphate crystal deposition

61
Q

aetiology of pseudogout?

A

idiopathic, hypercalcaemia, haemochromatosis, hypomagnesaemia, hypothyroid, hyperthyroid

62
Q

types of pseudo gout

A

acute (Ca pyrophosphate crystals), Ca Hydroxy apatite crystals

63
Q

s/s of pseudo gout

A

asymptomatic- often incidental finding

64
Q

ix for pseudogout

A

dense deposits on x-ray, often synovial joints involved

aspirate: +ve birefringent crystals on polarising microscopy

65
Q

T/F: GOUT has +ve birefringent crystals on polarising microscopy

A

F: GOUT has -ve birefringent, pseudo gout has +ve birefringent

66
Q

mx for acute pseudogout

A

NSAIDs, colchicine, steroids, rehydration

67
Q

mx for Ca Hydroxy Apatite crystals

A

NSAIDs, intra-articular steroid injections, physio, arthroplasty

68
Q

main complication of peudogout?

A

chonedrocalcinosis= Ca Pyrophosphate deposits in cartilage

MSK (26 decks)

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