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Rheumatological conditions > Rheumatoid arthritis, Septic Arthritis, Psoriatic Arthritis & Ankylosing Spondylitis > Flashcards

Rheumatoid arthritis, Septic Arthritis, Psoriatic Arthritis & Ankylosing Spondylitis Flashcards

1
Q

What is rheumatoid arthritis?

A

An autoimmune disease that effects that joints, causing them to become painful, swollen and destructed long term.

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2
Q

What is the most common gender and age for someone to be diagnosed with rheumatoid arthritis?

A
  • Females are 3:1 to males

- Peak incidence occurs around 40 years old

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3
Q

What is the pathophysiology of rheumatoid arthritis?

A
  • A person needs to have the specific HLA-DR1/4 gene and then an environmental trigger such as smoking or a pathogen
  • This trigger changes a protein compound on cell membranes around the body which the persons immune system now recognises this as an antigen
  • Immune cells through the blood enter the joint and recognise these proteins and initiate an immune response that brings more inflammatory mediators to the area
  • These inflammatory mediators begin to swell the synovial cells and membrane (pannus)
  • From the pannus proteases are released and over time this destroys this joint
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4
Q

What are the clinical features of joint rheumatoid arthritis?

A
  • Insidious onset of pain and stiffness that begins in the smalls joints of the hands/feet
  • Pain is usually worst on wakening that can disturb sleep
  • Morning stiffness that can last for hours
  • Tenderness to palpate or move the joint
  • Fever, malaise, weakness and weightloss
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5
Q

What type of deformities can occur in rheumatoid arthritis?

A
  1. Butonniere deformity - flexion of the PIP and hyperextension of the DIP
  2. Swan neck - hyperextension of PIP and flexion of the DIP
  3. Z deformity
  4. Ulnar deviation
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6
Q

What are the clinical features of systemic rheumatoid arthritis?

A
  1. Blood - anaemia
  2. Skin - nodules & vasculitis
  3. Eye - scleritis & dry eyes/mouth
  4. Lung - pleural effusion and nodules
  5. Cardiac - pericarditis, myocarditis and atherosclerosis
  6. Renal - amyloidosis
  7. Neurological - peripheral neuropathy
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7
Q

How is rheumatoid arthritis diagnosed clinically?

A
  • Presence of stiffness lasting more than 30 minutes
  • Symmetrical involvement of MCP/MTP joints
  • At least 3 joints that are painful, red and swollen
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8
Q

How is rheumatoid arthritis diagnosed via investigations?

A
  • ESR/CRP
  • Rheumatoid factor
  • Anti-CCP
  • Plain film x-ray
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9
Q

How is rheumatoid arthritis managed?

A
  • Education
  • Diagnosing it as early as possible
  • Simple analgesics and NSAID’s (Early stage)
  • Disease modifying anti-rheumatic drugs (DMARDs)
  • Rest in acute flare ups
  • Exercise and movement - low weight bearing
  • Functional capacity by keeping them moving
  • Dietary advice
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10
Q

What is ankylosing spondylitis?

A

-A seronegative spondyloarthropathy that primarily causes restriction and fusion at the SIJ and Tx spine

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11
Q

What is a seronegative spondyloarthropathy?

A

-An arthritis affecting the spinal joints which have no known causing factor from a serology test for e.g. a specific auto-antibody linked to the disease

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12
Q

What is the most common gender and age presenting with AS?

A
  • Usually first symptoms occur before age 30 (20% younger than 20)
  • Men are more affected about 2:1
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13
Q

What is the genetic link found in AS patients?

A
  • More likely to develop if a 1st degree relative has AS

- Around 5% of people with +HLA-B27 develop AS (upto 90% of AS patients have this gene)

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14
Q

What is the pathophysiology of AS?

A
  • Still largely unclear
  • Involves HLA-B27 typically and an immune response leading to an influx of inflammatory cytokines which eventually cause tissue destruction
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15
Q

What are the clinical features of AS?

A
  • LBP that is characteristic with inflammatory nature (more insidious, improves with exercise, persisting stiffness and inflammatory markers present)
  • SIJ/Buttock pain
  • Movement restriction
  • Pain will fluctuate with flare ups
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16
Q

What occurs in chronic AS?

A
  • Bony ankylosing of SIJ
  • Marginal syndesmophytes
  • Severe movement restriction and deformity
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17
Q

What are some extra-articular/systemic symptoms that can arise from AS?

A
  • Enthesitis (usually at achilles and/or plantar fascia)
  • Anterior uveitis
  • Peripheral arthritis
  • Bowel inflammation
  • Osteoporosis
  • Pulmonary fibrosis
  • Aortic valve incompetance
18
Q

How is AS diagnosed?

A
  • Plain film x-ray
  • MRI
  • ESR/CRP
19
Q

What can be seen on an x-ray in AS?

A
  • Initial stage = joint widening due to acute inflammation
  • Reactive sclerosis and erosion
  • Syndesmophyte formation
  • Bony ridging
20
Q

How is AS managed?

A

Symptom management:

  • Education
  • Support groups
  • Keep active to slow movements and stretching

Medications:

  • NSAIDs
  • TNF inhibitors
  • DMARDs
21
Q

What is Psoriatic Arthritis?

A

An autoimmune disease characterized by red scaly patches, also classed as a seronegative spondyloarthropathy as all patients with PsA must have psoriasis

22
Q

What are some common triggers that have caused arthritis in psoriatic patients?

A
  • Stress
  • Skin injuries
  • Infections
23
Q

What is the pathophysiology of PA?

A
  • Many people with Psoriasis have an altered version of the gene HLA-B27 present in everyone, however this gene alone isnt enough to cause PA
  • This alteration however is more susceptible and when an environmental trigger such as an infection occurs it can cause the immune system to suddenly think the self-antigens the gene presents around the body are actually foreign, causing PA.
24
Q

How many classifications of PA are there?

A

Five

25
Q

What occurs in the distal predominant classification?

A
  • Effects the DIPs and sometimes PIPs

- Dactylitis (sausage fingers)

26
Q

What occurs in the oglioarticular classification?

A
  • Most common
  • Usually involves less than 5 joints
  • Asymmetrical
27
Q

What occurs in the polyarticular classification?

A
  • Similar to RA patterns
  • Often affects more than 5 joints
  • Symmetrical
28
Q

What occurs in the spondylitis classification?

A
  • Mimics AS pattern

- Symmetrical through SIJ and Cx spine fusion

29
Q

What occurs in the arthritis mutilans classification?

A
  • Chronic form of the distal predominant classification

- High levels of bone erosion cause deformity

30
Q

What are the clinical features of PA?

A
  • Peripheral arthritis (gradual and effects multiple joints that are usually asymmetrical)
  • Axial arthritis (mimics AS =- can progress to full ankylosing)
  • Dactylitis
  • Enthesitis
  • Tendonitis/tenosynovitis
31
Q

How is PA diagnosed?

A
  • If the patient has psoriasis and arthritis then should be suspected (note that psoriasis patients can have OA)
  • Blood test (rheumatoid factor & anti-CCP)
  • Xray
32
Q

How is PA managed?

A
  • Control of skin lesions (topical steroids, education about good skin health; cool showers and moisturiser use)
  • Decrease stress, smoking and poor diet
  • Increase exercise
  • Referral to dermatologist - DMARD’s, UV therapy and biologic medications
33
Q

What is Septic Arthritis?

A

A bacterial infection within the joint that could be present in any location around the body

34
Q

What are the risk factors for Septic arthritis?

A
  • Age over 60
  • Immunocompromised (HIV, Chemotherapy etc)
  • Surgical procedures (artificial joint replacement)
  • Joint trauma
  • Osteomyelitis
  • Rheumatoid arthritis
35
Q

What is the pathophysiology of Septic Arthritis?

A
  • Somehow bacteria passes from the external environment into the joint this can be via:
    1. Hematogenous spread: passing via the blood stream from the lungs from example
    2. From a direct puncture wound around the joint which can pierce bacteria in the joint from an object or living on the skin
36
Q

What are the clinical features of Septic Arthritis?

A
  • Red, hot swollen joint
  • Restricted ROM
  • Systemic features: Fever, malaise and weakness
37
Q

What us the most commonly effected joint from septic arthritis?

A

Knee

38
Q

What is a complication of septic arthritis?

A

Joint destruction can occur if it is missed

39
Q

How is septic arthritis diagnosed?

A
  • Synovial fluid aspirate (looks for exact culture for antibiotics)
  • ESR/CRP
  • Xray/MRI (evaluate joint destruction)
40
Q

How is septic arthritis treated?

A
  • Medical intervention required immediately
  • Fluid aspiration & surgical drainage
  • Antibiotic washout and post surgical IV antibiotics

Rheumatological conditions (3 decks)

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