Rheumatoid Flashcards
Gout
Triggers: high temp, alcohol, fatty meal, dehydration, injury, meds
Increase risks: ACE I , diuretics, high cholesterol, overweight
Sudden attacks
Urate crystals from purines (seafood, spinach and beer)
Fructose also bad - fizzy pop
Diagnosis: joint fluid, bloods, X-ray
Tx: attacks: NSAIDS (avoid in renal failure or GI bleeding), corticosteroids, colchicine
Prevent: allopurinol
Ankylosing spondylitis
Part of the seronegative spondyloarthropathy group
HLA B27 gene
Sacroiliac joints and joins in vertebral column
Progress to fusion - bamboo spine on X-ray
Pres: young man 20’s, gradual development over 3months, lower back stiffness, worse at rest and night, at least 30mins to improve in morning, Sx can fluctuate with flares.
Complication: vertebral fractures
Can affect other organs: weight loss, fatigue, chest pain (costovertebral joints), Enthesitis (insertion point), anaemia, uveitis, aortitis, pulmonary fibrosis
Schobers test: L5 mark 5cm below 10cm above
Tests: CRP, HLA B27, X-ray, MRI - bone marrow edema before X-ray changes
Tx: NSAIDs, steroids, anti-TNF
Lupus (SLE)
Presentation : myalgia, weight loss, photosensitive butterfly rash, fever, lymphadenopathy, hair loss, arthralgia.
Anti-nuclear ABs
Relapsing remitting course - CVS disease and infection leading Cause of death
Tests: auto antibodies (ANA), C3 C4 low in active disease, CRP, immunoglobulins, proteinuria, renal biopsy (nephritis)
Diagnosis: SLICC criteria or ACR
Tx: immunosuppression - prednisolone, NSAIDs, hydroxychloroquine
Other: methotrexate , biological therapy (severe disease) - rituximab
Pseudo gout
Crystal arthropathy - calcium pyrophosphate
Chondrocalcinosis - X-ray thin white lines in joint space (pathognomonic)
Often knee but can be hips, wrists, shoulders.
Milder than gout
Aspirate- positively birefringent of polarised light, rhomboid shapped crystals
Other joint changes: LOSS
Management: symptomatic- NSAIDs, colchicine, steroids
Chronic - no Tx
Joint wash out (arthrocentesis) in severe cases
What causes rheumatic fever
Group A streptococcus
Osteoarthritis hand sign
Heberdens nodes
Bouchards nodes
Sign of more severe arthritis - often OA
Rheumatoid hand signs
Boutonnière deformity of thumb
Ulnar deviation
Swan neck of fingers
Hot swollen acutely painful joint with restricted movement
Septic arthritis until proven otherwise
Synovial fluid sample, bloods and cultures
Do not aspirate prosthetic joint
Commonly staph aureus
Antibiotics
Diffs: OA, psoriatic A, gout, P gout, bursitis, cellulitis.
Bursitis
Acute or chronic - sac between tendon and skin or bone - friction buffer and facilitate movement
From repetitive stress, infection , autom I, trauma
Conservative treatment
For septic bursitis- aspiration and ABs
RA genetic risk factors
HLA - DR1
HLA- DR4
Human leukocyte antigen
Citrullination and consequences
Type 2 collagen and vimentin
Amino acid change of arginine to citrulline
Antigens picked up by APC and activate CD4 helper cells
Autoantibodies
Cytokines = inflammation
= PANNUS - thick swollen synovial membrane
Can damage cartilage and bone
RANKL
This is a protein expressed on T cells when RA is present. This is caused by inflammatory cytokines and allows T cells to bind Rank which is on osteoclasts therefore breaking down bone.
RANKL aids damage
Rheumatoid factor
Antibody - IgM
Targets fc domain of autoantibodies IgG
Another is Anti-CCP. Immune complex
Activate complement system = inflammation and injury
Other RA systemic problems
Brain : interleukin 1/6 - pyrogens - fever
Skeletal muscles : protein breakdown
Skin : rheumatoid nodules - central area of necrosis
Vessels : vasculitis and atheromatous plaques
Liver : increase hepcidin - causes low iron by inhibiting absorption and trapping in macrophages and liver cells.
Lung : fibroblasts -fibrotic tissue (scar) decreasing gas exchange, Plural effusion.
Sx : fever,low appetite, malaise , weakness
Rheumatoid nodules, heart attacks,stroke
Anaemia, interstitial lung fibrosis, PE
