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Y2 Musculoskeletal > Reactive arthritis and Osteoarthritis > Flashcards

Reactive arthritis and Osteoarthritis Flashcards

1
Q

What is reactive arthritis

A

Sterile inflammation in joints following infection especially urogenital and GIT infections

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2
Q

Give examples of infections that may cause reactive arthritis

A

Urogenital - Chlamydia trachomatis

GI - Salmonella, Shigella, Campylobacter infections

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3
Q

What family does reactive arthritis belong to

A

Inflammatory arthritic syndromes termed ‘seronegative spondyloarthropathies’

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4
Q

What are the musculoskeletal symptoms of reactive arthritis

A

Arthritis
Enthesitis
Spondylitis

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5
Q

Describe the arthritis of reactive arthritis

A

Asymmetrical
Oligoarthritis (<5 joints)
Lower limbs typically affected

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6
Q

Describe enthesitis of reactive arthritis

A 
Heel pain (Achilles tendonitis)
Swollen fingers (dactylitis)
Painful feet (metatarsalgia due to plantar fasciitis)
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7
Q

Describe spondylitis of reactive arthritis

A

Sacroiliitis (inflammation of the sacro-iliac joints)

Spondylitis (inflammation of the spine)

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8
Q

What are the important extra-articular manifestations of reactive arthritis

A

Enthesopathy
Skin inflammation
Eye inflammation

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9
Q

What are some extra-articular features of reactive arthritis

A

Ocular
Genito-urnary
SKin

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10
Q

Describe the ocular features of reactive arthritis

A

Sterile conjunctivitis

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11
Q

Describe the genito-urinary features of reactive arthritis

A

Sterile urethritis

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12
Q

Describe the skin features of reactive arthritis

A

Circinate balanitis

Psoriasis-like rash on hands and feet

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13
Q

How is diagnosis of reactive arthritis established

A

Clinical diagnosis
Investigations to exclude other causes of arthritis e.g. septic arthritis
Microbiology, immunology, synovial fluid examination

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14
Q

Describe the use of microbiology in reactive arthritis diagnosis

A

Microbial cultures – blood, throat, urine, stool, urethral, cervical
Serology e.g. HIV, hepatitis C

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15
Q

Describe the use of immunology in reactive arthritis diagnosis

A

Rheumatoid factor

HLA-B27

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16
Q

Describe the use of synovial fluid examination in reactive arthritis diagnosis

A

Especially if only single joint affected

17
Q

What distinguishes septic arthritis from reactive arthritis

A

Sterile synovial fluid culture
No antibiotic therapy
No joint lavage

18
Q

How long does it take for reactive arthritis resolve

A

2-6 months

19
Q

What are the treatment s for articular manifestations of reactive arthritis

A

NSAIDs

Intra-articular corticosteroid therapy

20
Q

What are the treatments for the extra-articular manifestations of reactive arthritis

A

Typically self-limiting, hence symptomatic therapy

e.g. topical steroids & keratolytic agents in keratoderma

21
Q

What are the treatment for refractory disease

A

oral glucocorticoids steroid-sparing agents e.g. sulphasalazine

22
Q

What is osteoarthritis

A

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

23
Q

What are the 3 main types of joint that osteoarthritis affects

A

Hand
Spine
Weight-bearing lower limb joints

24
Q

Which hand joints are affected by osteoarthritis

A

Distal interphalangeal joints (DIP)
Proximal interphalangeal joints (PIP)
First carpometacarpal joint (CMC)

25
Q

Which weight-bearing lower limb joints are affected by osteoarthritis

A

esp. knees and hips

First metatarsophalangeal joint (MTP)

26
Q

What kind of nodes are present in osteoarthritis

A

Heberden’s nodes

Bouchard’s nodes

27
Q

What symptoms can osteoarthritis be associated with

A 
Joint pain
Joint crepitus
joint
Joint instability
Joint enlargement (nodes)
Joint stiffness after immobility (‘gelling’)
Limitation of motion
28
Q

What are the radiographic features of osteoarthritis

A

Joint space narrowing
Subchondral bony sclerosis
Osteophytes
Subchondral cysts

29
Q

Describe the pathogenesis of osteoarthritis

A

Defective and irreversible articular cartilage and damage to underlying bone

due to excessive loading on joints and/or abnormal joint components

30
Q

What are the cartilage changes in osteoarthritis

A

reduced proteoglycan
reduced collagen
chondrocyte changes e.g. apoptosis

31
Q

What are the bone changes in osteoarthritis

A

Proliferation of superficial osteoblasts results in production of sclerotic bone e.g. subchondral sclerosis
Focal stress on sclerotic bone can result in focal superficial necrosis

New bone formation at joint margins (osteophytes)

32
Q

How is osteoarthritis managed

A 
Education
Physical therapy 
Occupational therapy
Weight loss where appropriate
Exercise
Analgesia
Joint replacement

Y2 Musculoskeletal (9 decks)

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