Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Musculoskeletal & Rheumatology > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

Inflammation

A

Physiological response to deal with injury or infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Inflammation clinical manifestation

A

Red (rubor)
Pain (dolor)
Hot (calor)
Swelling (tumour)
Loss of function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Gout

A

Syndrome caused by deposition of urate (uric acid) crystals -> inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Gout risk factor

A

High uric acid level (hyperuricaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Gout causes

A

Genetic tendency
Increased intake of purine rich foods
Reduced excretion (kidney failure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pseudogout

A

Syndrome caused by deposition of calcium pyrophosphate dihydrate (CPPD) crystal deposition crystals -> inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Gouty arthritis symptoms

A

Metatarsophalangeal joint of big joint
-abrupt onset
-extremely painful
-red, warm, swollen, tender
-resolves spontaneously over 3-10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Crystal arthritis signs

A

X-ray juxta-articular ‘rat bite’ erosions at metatarsophalangeal joint of great toe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Crystal arthritis investigation

A

Joint aspiration - synovial fluid analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Crystal arthritis management

A

Acute - colcihine, NSAIDS, steroids
Chronic - allopurinol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Synovial fluid examination for gout and pseudogout

A

Crystal- G: urate P: calcium pyrophosphate dihydrate (CPPD)

Shape- G: needle P: brick shaped

Birefringence- G: negative P: positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Rheumatoid arthritis

A

Chronic autoimmune disease characterised by pain, stiffness and symmetrical synovitis of synovial joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Rheumatoid arthritis pattern of involvement

A

Symmetrical
Affect multiple joints (polyarthritis)
Affect small and large joints, but particularly hands and feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Rheumatoid arthritis commonest affected joints

A

Metacarpophalangeal joints
Proximal interphalangeal joints
Wrists
Knees
Ankles
Metatarsophalangeal joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Psoriatic arthritis

A

Psoriasis is autoimmune disease affecting skin, 10% of patients also have joint inflammation

Rheumatoid factors not present (seronegative)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Psoriatic arthritis symptoms

A

Asymmetrical arthritis affecting IPJs

Can also be
Symmetrical involving small joints
Spinal and sacroiliac joint inflammation
Oligoarthritis of large joints
Arthritis mutilans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Psoriatic arthritis investigation

A

X-ray of affected joint - pencils in cup abnormality
MRI - sacroillitis and enthesis

Bloods - no autoantibodies

18
Q

Reactive arthritis

A

Sterile inflammation in joints following infection especially uro genital and gastrointestinal infections
May be first manifestation of HIV or hepatitis C infection
Symptoms follow 1-4 weeks after infection and this may be mild

19
Q

Reactive arthritis treatment

A

Usually self limiting
Can be managed with NSAIDS or DMARDs

20
Q

SLE epidemiology

A

F:M ratio 9:1
Presentation 15-40 years
Increased prevalence in African and Asian ancestry populations
Prevalence varies 4-280/100000

21
Q

Inflammation physiological changes

A

Increased blood flow
Migration of white blood cells (leukocytes) into the tissues
Activation/differentiation of leukocytes
Cytokine production

22
Q

Causes of joint inflammation

A

Crystal arthritis
-gout
-pseudogout

Immune-mediated (autoimmune)
-rheum arth
-seronegative spondyloarthropathies
-connective tissue disease

Infection
-septic arthritis
-tuberculosis

23
Q

Pseudogout risk factors

A

Background osteoarthritis
Elderly
Intercurrent infections

24
Q

Acute gout

A

Disease in which tissue deposition of monosodium urate (MSU) crystals occurs as a result of hyperuricaemia and leads to gouty arthritis or tophi

25
Rheumatoid arthritis cause
Synovium becomes proliferated mass of tissue (pannus) due to: -neovascularisation -lymphangiogenesis -inflammation cells - activated B and T cells, plasma cells, mast cells, activated macrophages Excess of pro-inflammatory vs anti-inflammatory cytokines
26
TNF alpha
Dominant pro-inflammatory cytokine in rheumatoid synovium
27
TNF alpha effects
From activated macrophages: -osteoclast activation -angiogenesis -proinflammatory cytokine release -chemokine release
28
Rheumatoid arthritis key features
Chronic arthritis -polyarthritis - swelling of small joints of hand and wrist -symmetrical -early morning stiffness in and around joints -joint erosion on radiograph Extra-articular disease can occur -rheumatoid nodules Rheumatoid factor may be detected in blood -autoantibody against IgG
29
Rheumatoid arthritis extra Articular features
Common -fever -weight loss -subcutaneous nodules Uncommon -vasculitis -ocular inflammation -neuropathy -amyloidosis -lung disease -Felty’s syndrome
30
Rheumatoid arthritis subcutaneous nodules
Central area of fibinoid necrosis surrounded by histiocytes and peripheral layer of connective tissue Associated with -severe disease -extra articular manifestations -rheumatoid factor Approx 30%
31
Rheumatoid arthritis autoantibodies
Rheumatoid factor -antibodies that recognise the Fc portion of IgG as their target antigen -typically IgM antibodies: IgM anti-IgG antibody Antibodies to citrullunated protein antigens (ACPA) -arginine to citrulline
32
Rheumatoid arthritis management
Requires early recognition of symptoms, referral and diagnosis, prompt initiation of treatment, aggressive treatment to suppress inflammation Drugs: -disease modifying anti rheumatic drugs (DMARDs) -1st line - methotrexate in combo with hydroxychloroquine or sulfasalazine -2nd line - biological therapy offer potent and targeted treatment strategy
33
Rheumatoid arthritis biological therapies
Proteins that specifically target a protein such as an inflammatory cytokine -inhibition of tumour necrosis factor alpha -b cell depletion - rituximab -modulation of T cell Co stimulation - abatacept -inhibition of interleukin-6 signalling - tocilizumab
34
Ankylosing spondylitis
Seronegative spondyloarthropathy - no positive autoantibodies Chronic sacroillitis - inflammation of sacroiliac joints Results in spinal fusion - ankylosis Associated with HLA B27
35
Ankylosing spondylitis common demographic
20-30 years old, male
36
Ankylosing spondylitis symptoms
Lower back pain and stiffness -early morning -improves with exercise Reduced spinal movements Peripheral arthritis Plantar Fasciitis, Achilles tendonitis Fatigue Hyperextended neck Loss of lumbar lordosis Flexed hips and knees
37
Ankylosing spondylitis investigation
Blood - normocytic anaemia - raised CRP, ESR - HLA B27 Imaging -X Ray -MRI —squaring vertebra bodies, Romanus lesion —erosion, sclerosis, narrowing SIJ —bamboo spine —bone marrow oedema
38
Ankylosing spondylitis management
Physiotherapy Exercise regime NSAIDs Peripheral joint disease - DMARDs
39
Psoriatic arthritis management
DMARDs - methotrexate Avoid oral steroids - risk of pustular psoriasis due to skin lesions
40
Systemic Lupus Erythematous
Multi site inflammation Antibodies to self antigen Autoantibodies directed against components of cell nucleus (nucleus acids and proteins)
41
SLE investigations
Antinuclear antibodies (ANA) -high sensitivity to SLE but not specific -negative rules out SLE Anti double stranded DNA antibodies -high specificity for SLE in context with clinical signs

Musculoskeletal & Rheumatology (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions