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Y4 MSK > Rheum week 1 - swollen hand joints > Flashcards

Rheum week 1 - swollen hand joints Flashcards

1
Q

How long does morning stiffness last in inflammatory arthritis ?

A

> 30mins

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2
Q

Does the pain of inflammatory arthritis improve with
a) rest ?
b) activity ?

A

activity

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3
Q

what are the 3 broadest categories of arthritis ?

A
  • inflammatory
  • non inflammatory
  • septic
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4
Q

what is the only type of non-inflammatory arthritis ?

A

osteoarthritis

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5
Q

what are the types of inflammatory arthritis ?

A

Seropositive
- Rheumatoid arthritis
- connective tissue diseases (SLE)

Seronegative
- reactive
- ankalosing spondylitis
- psoriatic
- enteropathic (IBD)

Crystal
- gout
- pseudo gout

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6
Q

How is vasculitis related to arthritis?

A

vasculitis = complication of RA

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7
Q

Give some examples of connective tissue disorders …

A
  • SLE
  • Sjögren’s
  • antiphospholipid syndrome
  • scleroderma
  • polymyositis
  • dermatomyositis
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8
Q

what is the common joint pattern of seropositive arthritis ? (RA, CTDs)

A
  • small joint
  • symmetrical
  • poly arthritis
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9
Q

what is the common joint pattern of seronegative arthritis ? (psoriatic, reactive..)

A
  • large joint
  • asymmetrical
  • mono/oligo arthritis
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10
Q

what is the common joint pattern of crystal arthritis ? (gout, pseudo gout )

A
  • large joint
  • asymmetrical
  • mono arthritis
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11
Q

what is the common joint pattern of osteoarthritis ?

A
  • small and large joint
  • symmetrical
  • oligo/poly arthritis
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12
Q

what is meant by…
- monoarthritis ?
- oligoarthritis ?
- polyarthritis ?

A

mono = 1 joint involved

oligo = 2-4 joints involved

poly = 5+ joints involved

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13
Q

what onset of arthritic symptoms is classed as…
a) acute ?
b) chronic ?

A

acute <6weeks
chronic 6+ weeks

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14
Q

what are some underlying risk factors for septic arthritis ?

A
  • diabetes
  • immunosuppression
  • recent infection
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15
Q

how long does morning stiffness last for patients with osteoarthritis ?

A

<30 minutes

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16
Q

Is stiffness associated with osteoarthritis made better or worse by activity ?

A

worse

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17
Q

what is the classic triad of symptoms for reactive arthritis?

A

“Can’t pee, can’t see, can’t climb a tree”

  • balanitis/urethritis
  • conjunctivitis
  • arthritis
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18
Q

What are some common symptoms of psoriatic arthritis ?

A
  • PMHx of psoriasis
  • recent skin changes/rash
  • dactylitis (swollen finger)
  • enthesitis (tendon inflammation)
  • spinal involvement
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19
Q

name 3 examples of acute arthritis …

A
  • gout
  • reactive
  • septic
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20
Q

name some lifestyle factors that could worsen gout …

A
  • diet high in purine (alcohol, fish, meat, beans, lentils)
  • beer is worst, red wine better, white wine better still, spirits are best
  • diuretics (thiazide and loop diuretics)
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21
Q

what body system is linked to gout - can be a cause or a result ?

A

kidneys due to uric acid build up/poor purine clearance

  • kidney stones
  • CKD
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22
Q

what type of arthritis is linked to raynauds ?

A

sero positive

  • RA
  • CTDs (SLE, sjogrens…)
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23
Q

what type of arthritis can cause SOB ?

A
  • RA
  • connective tissue disorders (SLE, sjogrens etc)
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24
Q

What symptoms are associated with connected tissue diseases ?

A
  • raynauds
  • skin rashes (SLE)
  • SOB
  • photosensitivity
  • mouth ulcers
  • dry eyes/mouth (sjogrens)
  • hair loss
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25
Which type of arthritis has the strongest genetic component?
**rheumatoid arthritis** *a Fx of RA makes it more likely*
26
which joints does RA typically affect ?
- PIPs *(proximal interphalangeal)* - MCPs *(metacarpophalangeal)* - wrists
27
which joints does osteoarthritis typically affect ?
symmetrical DIPs *(distal interphalangeal)*
28
what are the differentials for distal interphalangeal stiffness ?
**osteoarthritis** - nodules - symmetrical **psoriatic** - no nodules - asymmetrical
29
what is a) swan neck deformity ? b) boutonnière deformity ?
swan neck: - hyper extension of PIPs - flexion of DIPs *fingers look very bent at end* boutonnière: - flexion of PIPs - hyper extension of DIPs *fingers look very bent in middle* **both are associated with RA**
30
If suspecting RA, what investigations would you do ?
- blood *(FBC, LFTs, U+Es, TFTs)* - inflammatory markers *(ESR, CRP)* - immunology *(RhF, CCP, ANA)* - XR of hands and feet
31
what would positive RhF and anti-CCP antibody indicate ?
rheumatoid arthritis
32
what would positive ANA *(antinuclear antibody)* indicate ?
connective tissue disease
33
which immunology test is best to diagnose RA ?
Anti-CCP antibody *more sensitive and specific than RhF*
34
Does a positive test for RhF (rheumatoid factor) alone allow a diagnosis of RA ?
**No** it is not specific enough ! *it can be present in the normal population, sjogrens, malignancies and chronic infection!*
35
what abnormalities may be found in the blood work of patients with non-specific inflammation?
- raised platelets - raised LFTs - raised ferritin
36
what percentage of patients with RA will have a negative RhF test ?
20%
37
what is a common infection that can cause reactive arthritis ?
chlamydia
38
is the big toe classed as a small or large joint ?
large joint *all other toe joints are small*
39
which types of arthritis have a genetic component ?
pretty much all ! - sero positive (RA, CTDs) - sero negative - crystal - osteoarthritis
40
what is the usual progression pattern of inflammatory arthritis?
gradually gets worse over weeks/months
41
what are the most important questions to ask in response to back pain ?
- morning stiffness (improved with activity?) - effect on ADLs *can’t ask much more cos the spine is so buried it won’t be hot or look inflamed etc*
42
what is felt on movement of an inflammatory arthritic joint ?
‘boggy’ feeling = sinusitis *can also have crepitus, but could be normal or osteoarthritis too!*
43
what eye problems are common in inflammatory arthritis ?
conjunctivitis (reactive) uveitis (all others!)
44
what result of a modified schobers test is considered normal ?
5cm or more
45
who is mostly affected by gout ?
- men - post menopausal women
46
What respiratory complications are associated with RA ?
- pulmonary fibrosis - lung nodules - pleural effusions
47
what is the name of the classification criteria for rheumatoid arthritis ?
2010 ACR/EULAR RA classification criteria
48
Describe RA to a patient :
RA is a chronic auto immune condition which means that the immune system has become activated in response to our own tissues and this can cause inflammation where it isn’t needed - in joints! This leads to the pain and swelling and stiffness. it is quite common but we don’t fully know what causes it yet, but it is likely a combination of genes, smoking and the environment !
49
How is the disease activity/severity of RA measured ?
using the DAS 28 calculator - remission - low - moderate - high/severe
50
What is the ‘intensive’ treatment for new RA patients ?
- monthly monitoring and DAS 28 calculation - steroid treatment *escalation of treatment in patients that have not reached remission yet*
51
What investigation is best at detecting synovitis (boggy joints)?
USS
52
What is the treatment for RA ?
1. use of steroids (intra articolar, IM or oral) 2. DMARDs (methotrexate, sulphasalazine) 3. Biologics if DMARDs don’t work
53
what medication should be taken concurrently with methotrexate ?
folic acid (5mg PO once weekly) *take on a different day to methotrexate i.e methotrexate on monday, folic acid on fridays*
54
For RA patients, how common are the extraarticular symptoms such as dry eyes etc ?
40% of patients will have some form of extra articular symptoms.
55
What are the extra articular symptoms seen in RA patients ?
- dry eyes and mouth *(keratoconjunctivitis sicca)* - palmar erythema - pleural effusion - pericarditis, interstitial lung disease, pericardial effusion - carpal tunnel syndrome - vasculitis - lymphadenopathy - splenomegaly - feltys syndrome *(RA + neutropenia + splenomegaly)* - normochromic normocytic anaemia
56
name some biologics used to treat stubborn RA …
- anti-TNF - rituximab - abatacept
57
Which types of arthritis can have sacroiliac joint involvement?
- psoriatic - ankylosing spondylitis
58
What is arthritis mutilans ?
an extremely severe form of psoriatic arthritis causing bone resorption and soft tissue collapse = telescopic finger
59
What is the initial treatment for RA, when the patient is otherwise fit and healthy ?
methotrexate and IM steroid *steroid = short term relief* *DMARD = mid term relief*
60
what screening do all patients on hydroxychloroquine need ?
annual ophthalmology screening for retinopathy

Y4 MSK (11 decks)

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