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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 things 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
Q

Which type of arthritis has the strongest genetic component?

A

rheumatoid arthritis

a Fx of RA makes it more likely

26
Q

which joints does RA typically affect ?

A
  • PIPs (proximal interphalangeal)
  • MCPs (metacarpophalangeal)
  • wrists
27
Q

which joints does osteoarthritis typically affect ?

A

symmetrical DIPs (distal interphalangeal)

28
Q

what are the differentials for distal interphalangeal stiffness ?

A

osteoarthritis
- nodules
- symmetrical

psoriatic
- no nodules
- asymmetrical

29
Q

what is
a) swan neck deformity ?
b) boutonnière deformity ?

A

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
Q

If suspecting RA, what investigations would you do ?

A
  • blood (FBC, LFTs, U+Es, TFTs)
  • inflammatory markers (ESR, CRP)
  • immunology (RhF, CCP, ANA)
  • XR of hands and feet
31
Q

what would positive RhF and anti-CCP antibody indicate ?

A

rheumatoid arthritis

32
Q

what would positive ANA (antinuclear antibody) indicate ?

A

connective tissue disease

33
Q

which immunology test is best to diagnose RA ?

A

Anti-CCP antibody

more sensitive and specific than RhF

34
Q

Does a positive test for RhF (rheumatoid factor) alone allow a diagnosis of RA ?

A

No it is not specific enough !

it can be present in the normal population, sjogrens, malignancies and chronic infection!

35
Q

what abnormalities may be found in blood work in patients with non-specific inflammation?

A
  • raised platelets
  • raised LFTs
  • raised ferritin
36
Q

what percentage of patients with RA will have a negative RhF test ?

A

20%

37
Q

what is a common infection that can cause reactive arthritis ?

A

chlamydia

38
Q

is the big toe classed as a small or large joint ?

A

large joint

all other toe joints are small

39
Q

which types of arthritis have a genetic component ?

A

pretty much all !

  • sero positive (RA, CTDs)
  • sero negative
  • crystal
  • osteoarthritis
40
Q

what is the usual progression pattern of inflammatory arthritis?

A

gradually gets worse over weeks/months

41
Q

what are the most important questions to ask in response to back pain ?

A
  • 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
Q

what is felt on movement of an inflammatory arthritic joint ?

A

‘boggy’ feeling = sinusitis

can also have crepitus, but could be normal or osteoarthritis too!

43
Q

what eye problems are common in inflammatory arthritis ?

A

conjunctivitis (reactive)
uveitis (all others!)

44
Q

what result of a modified schobers test is considered normal ?

A

5cm or more

45
Q

who is mostly affected by gout ?

A
  • men
  • post menopausal women
46
Q

What respiratory complications are associated with RA ?

A
  • pulmonary fibrosis
  • lung nodules
  • pleural effusions
47
Q

what is the name of the classification criteria for rheumatoid arthritis ?

A

2010 ACR/EULAR RA classification criteria

48
Q

Describe RA to a patient :

A

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
Q

How is the disease activity/severity of RA measured ?

A

using the DAS 28 calculator

  • remission
  • low
  • moderate
  • high/severe
50
Q

What is the ‘intensive’ treatment for new RA patients ?

A
  • monthly monitoring and DAS 28 calculation
  • steroid treatment

escalation of treatment in patients that have not reached remission yet

51
Q

What investigation is best at detecting synovitis (boggy joints)?

A

USS

52
Q

What is the treatment for RA ?

A
  1. use of steroids (intra articolar, IM or oral)
  2. DMARTs (methotrexate, sulphasalazine)
  3. Biologics if DMARTs don’t work
53
Q

what medication should be taken concurrently with methotrexate ?

A

folic acid (5mg PO once weekly)

take on a different day to methotrexate i.e methotrexate on monday, folic acid on fridays

54
Q

For RA patients, how common are the extraarticular symptoms such as dry eyes etc ?

A

40% of patients will have some form of extra articular symptoms.

55
Q

What are the extra articular symptoms seen in RA patients ?

A
  • 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
Q

name some biologics used to treat stubborn RA …

A
  • anti-TNF
  • rituximab
  • abatacept
57
Q

Which types of arthritis can have sacroiliac joint involvement?

A
  • psoriatic
  • ankylosing spondylitis
58
Q

What is arthritis mutilans ?

A

an extremely severe form of psoriatic arthritis causing bone resorption and soft tissue collapse

= telescopic finger

59
Q

What is the initial treatment for RA, when the patient is otherwise fit and healthy ?

A

methotrexate and IM steroid

steroid = short term relief
DMARD = mid term relief

60
Q

what screening do all patients on hydroxychloroquine need ?

A

annual ophthalmology screening for retinopathy

Y4 MSK (11 decks)

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