Reactive arthiritis and osteoarthirits Flashcards
What does seronegative arthiritis mean?
Doesnt have rheumathoid factor
What is reactive arthirits caused by?
Reaction to an infection-even mild ones, hepC, HIV
A few weeks after infection, joint blows up-but joint never gets infected (septic arthirits)
has a few extra articular manifestations-skin enflammation, eye inflammation
has some genetic predisposition-HLA-b27-class I HLC
What us the MSK response to reactive arthiritis?
Only a few joints arthiritis-non symetrical
Often lower limbs on the big joints
Soft tissue inflammed (not synovial joint)
Sacrolilliatis and spondolytis (spine)
What are the main extra articular features of arthiritis?
Eye-eyerhitis or conjuctivitis
Skin-circinate balantis-skin lesions on penis
Feet rash-
Gentio-urinary infection-pain on urine
What are the difference bwteen rhumatoid and reactive arhtititis?
Rhuma-F>M, age 30-50-symatrical, polyarticular, small and large joints-no extra atricular featues except subucatenous modules. has rhumathoid factor
reactive-M>F, 20-40, asymetrical, oligo, large
how do you make a diagnosis of reactive arthiritis?
History-from source of infection
if patient has one swollen one-need to rule out sceptic arthiritis-so ne`ed to take a sample-should have other features but need to be sure not to miss
Other important investigation-microbial samples, serology
Rhumathoid factor
Synovial fluid examination
How do you treat reactive arthiritis?
settle down without treatment
if very symptomatic-NSAIDs
IF more problems or 1 joint-steroid injection + drain of fluid
If doesnt settle-similar to Rhumathoid drugs
What are the main join affected by osteoarthiritis?
Hips knees, spine, hands-pinch grib, DIPj, PIPj, CMC-base of thumb Metatarsalphalangeaol J-big toe rarer in elbow and shoulder
What is the difference bewteen OA and RA?
OA IS NOT inflammatory-not an immune disease
happens often in weight bearing joints
leads to bony swelling around the hand -in RA would be spongy and OA are hard-bony overgrowth
OA spares the knuckles
How would you call OA bone overgrwoths
at DIP-heberdens nodes
At pip-bouchards nodes
What are the symptoms of OA?
Joint pain-worse with activity, better with rest (RA is worse morning-worse with inactivity) Joint creptius-cracking grinding sound-cracks dont worsen the joint Joint instability-pain leasd to loss of mucle around joint Join enlargmenet (Heberdens nodes) Joint stillness after immobility-gelling Limiation of motion-hip intenal rotation
What are the features of OA on Xray? How compare to RA?
Join space narrowing
Sbuchondral bony sclerosis (whiter margins)
Osteophytes (bony spures)
Subchondral cyst
in RA-get narrowing but nothing else similar
What is the anatomical difference bwteeen a normal joint and a OA joint?
Loss of the cartilage at surface of bone-fragments floating
Bone erosion as they contact
Is OA genetic?
element of genetics but not fully
seems to be equal genders
mechanical factors seem to have a lot more
trauma, obesity, handywork, badly fixed fractures
What is normal synovial fluid and How does synovial fluid change in OA?
synovial fluid-hylaruinic acid-maintain viscossities-
cartilage has type II collagen and agrecan-very negative and absorb water to give compression resistance-main one to remember of the GAGs
cartilage has no blood or nerve supply-not painful
In OA-reduced proteoglycansm reduced collagen
Chondrocyte changes-apoptosis
Bone also change-osteoblasts produce sclerotic bone, necrosis with focal stress
is it an attempt at healing or not? unsure
