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Musculoskeletal > Reactive Arthritis > Flashcards

Reactive Arthritis Flashcards

1
Q

Define reactive arthritis.

A

Sterile inflammation in joints following infection, especially urogenital and gastrointestinal infections

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2
Q

State a urogenital infection that can cause reactive arthritis.

A

Chlamydia trachomatis

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3
Q

Give some examples of gastrointestinal infections that are associated with reactive arthritis.

A

Shigella
Salmonella
Campylobacter

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4
Q

What subset of the population does reactive arthritis tend to occur in?

A

It occurs mainly in young adults with a genetic predisposition and an environmental trigger

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5
Q

How long after the infection does the reactive arthritis tend to appear?

A

1-4 weeks

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6
Q

Describe the features of the arthritis in reactive arthritis.

A

It is an asymmetrical arthritis that occurs in relatively few joints

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7
Q

Reactive arthritis can cause enthesopathy. Which entheses are likely to get affected and what symptoms will that cause?

A

Achilles tendonitis
Dactylitis
Metatarsalgia (painful feet because of inflammation of the palmar fascia)

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8
Q

What is a very common feature of seronegative spondyloarthropathies?

A

Sacro-iliitis

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9
Q

State some extra-articular features of reactive arthritis?

A

Sterile conjunctivitis
Sterile urethritis
Circinate balanitis
Keratoderma blennorhagicum

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10
Q

What is the triad of symptoms that can be used to describe reactive arthritis?

A

Reiter’s syndrome – joint inflammation + urethritis + conjunctivitis

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11
Q

Where can you get spondylitis in rheumatoid arthritis?

A

At the atlanto-axial joint – there is synovium her

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12
Q

Describe the main differences between rheumatoid arthritis and reactive arthritis.

A 
Rheumatoid Arthritis
F>M 
Symmetrical, Polyarticular, Small&Large Joints - 
NO Enthesopathy
Spondylitis only at atlanto-axial joint in cervical spine
NO Urethritis
Subcutaneous nodules 
Rheumatoid factor: 
HLA-DR4 associated 
Reactive Arthritis
M>F 
Asymmetrical, Oligoarticular, Large joints 
Enthesopathy
Spondylitis
Urethritis
K.blennorhagicum, Circinate balanitis 
NO Rheumatoid factor
HLA-B27
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13
Q

What is the main danger in septic arthritis?

A

The bacteria produce metalloproteinases that can rapidly degrade the articular cartilage

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14
Q

What are the main differences between septic arthritis and reactive arthritis?

A

Septic arthritis has a positive synovial fluid culture

It is treated with antibiotics and may even require joint lavage

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15
Q

Describe the treatment of reactive arthritis.

A

It usually resolves by itself

NSAIDs to control pain and symptomatic treatment of extra-articular manifestations

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16
Q

Define osteoarthritis.

A

Chronic slowly progressive disorder due to failure of articular cartilage that typically affects the hands (especially those involved in the pinch grip), spine and weight-bearing joints (hips and knees)

17
Q

Which joints are most commonly affected in osteoarthritis?

A 
DIP 
PIP 
First metacarpophalangeal joint 
Spine 
Knees 
Hips 
First metatarsophalangeal joint
18
Q

What are the names given to the osteophytes found on the hand in osteoarthritis?

A

Bouchard’s Nodes – PIP

Heberden’s Nodes – DIP

19
Q

What are some other associations of osteoarthritis?

A 
Joint pain (worse with activity) 
Joint crepitus 
Joint instability 
Joint enlargement 
Joint stiffness after immobility 
Limitation of motion
20
Q

What are some radiographic features of osteoarthritis?

A

Joint space narrowing
Osteophytes
Subchondral bony sclerosis
Subchondral cysts

21
Q

Describe the differences between the radiographic features of rheumatoid arthritis and osteoarthritis.

A

Rheumatoid arthritis also has joint space narrowing but it doesn’t have subchondral sclerosis or osteophytes
There is osteopenia and there are bone erosions in rheumatoid arthritis but not in osteoarthritis

22
Q

What can the osteoarthritis be caused by?

A

Abnormal cartilage

Abnormal stress

23
Q

What is the most important component of articular cartilage?

A

Aggrecan

24
Q

What is aggrecan made up of?

A

Chondroitin sulphate – glucuronic acid + N-acetyl galactosamine
Keratan sulphate – galactose + N-acetyl glucosamine

25
Q

What is a proteoglycan?

A

Glycoproteins that contain one or more sulphated glycosaminoglycan (GAG) chains

26
Q

What is special about hyaluronic acid?

A

It is the only non-sulphated GAG

27
Q

What are the disaccharides in hyaluronic acid?

A

Glucuronic acid

N-acetyl glucosamine

28
Q

How is osteoarthritis managed?

A

Physiotherapy – strengthening the muscle around the joint improves joint stability
Analgesia – paracetamol, NSAIDs, intra-articular corticosteroid injections
Joint replacement
Weight loss where appropriate

Musculoskeletal (8 decks)

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