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CP3 MDD > Rheumatoid Arthritis + Sero negative spondyloarthropathies > Flashcards

Rheumatoid Arthritis + Sero negative spondyloarthropathies Flashcards

1
Q

% of women affected by RA

A

3%

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2
Q

% of men affected by RA

A

1%

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3
Q

Genetic link - RA

A

HLA - DR4

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4
Q

What is the most important environmental factor in RA?

A

Smoking

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5
Q

WHEN IS IT NOT RA (5)

A 
Never involves DIPs 
Never involves lower back 
Never involves big toes in isolation 
Doesn't cause plantar fascitis or achilles tendonitis 
Doesn't cause isolated neck pain
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6
Q

typical age of onset

A

30-50 y/o

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7
Q

PS RA

A 
Symmetrical polarthritis 
Of small joints 
Red, warm + painful joints 
Worse in AMs + stiff 
Malaise, W loss + disturbed sleep 
\+/- extra-articular features
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8
Q

What % of pt w/ RA have rapid onset

A

15%

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9
Q

O/E RA

A

Warm, swollen + tender joints
+ve squeeze sign
Reduced grip strength bilaterally

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10
Q

DDx RA (4)

A

Reactive arthritis
Sero -ve
Polymyalgia rheumatica
Nodal RA

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11
Q

Where is the most common place to get RA?

A

Hands

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12
Q

Characteristic hand deformities RA

A 
Ulnar deviation at MCPJ 
Radial deviation at wrist 
Boutonniers 
Swan neck deformity 
Z deformity thumb 
Subluxation (late
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13
Q

What is a Boutonniere deformity (RA)

A

PIP hyperflexed

DIP hyperextended

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14
Q

What is a Swan Neck deformity (RA)

A

PIP hyperextended

DIP hyperflexed

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15
Q

progression of RA in the feet

A

MTPJ swelling –> hammer toe deformity

+/- ulcers/callouses

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16
Q

Which large joint is most commonly affected by RA?

A

knee

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17
Q

Clinical assessment tool RA

A

DAS 28

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18
Q

What are the 4 domains of the DAS 28

A

Joint distribution
Serology
Sx duration
Acute phase reactants

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19
Q

Ix bloods - RA (5)

A 
RF 
Anti-CCP
ANA
FBC
CRP/ESR
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20
Q

other Ix RA (apart from bloods - 2)

A

Joint aspiration

Xray

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21
Q

Xray findings RA (5)

A 
Uniform joint space narrowing 
Periarticular erosions 
subluxation/dislocation 
soft tissue swelling 
Juxta-articular osteopenia
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22
Q

1st changes RA

A

Rheumatoid synovitis –> villious pattern in synovium+ neutrophil infiltration

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23
Q

What does the pannus do in RA

A

Destroys articular cartilage
Focal destruction of bone –> erosions
L term - destroys + replaces whole cartilage –> 2’ OA

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24
Q

1st line Mx RA

A

DMARD ASAP
Methotrexate + hydroxychloroquine
+NSAIDS

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25
Q

indication - biologics in RA

A

if 2 DMARDs have already been tried

If DAS >5.5

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26
Q

Extra Mx RA (5)

A 
Give up smoking 
Flu jb 
Importance of monitoring/reg blood tests 
Sick day rules 
Pregnancy
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27
Q

What % of pt w/ RA have Rh nodules

A

20%

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28
Q

typically where are rheumatoid nodules found

A

Olecranon
Calcaneum
MCPJ

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29
Q

What is the most common pulmonary sequalae in RA

A

Pulmonary fibrosis

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30
Q

Which RA Tx can cause pulmonary fibrosis

A

methotrexate

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31
Q

Where do you find vasculitis caused by RA (3)

A

nail-fold infarcts
Bowel infarction
Widespread cutaneous vasculitis

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32
Q

what % of RA pt have peri-cardial involvement

A

30-40%

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33
Q

nervous system impact - RA (2)

A

Entrapment neuropathies e.g. carpal tunnel

Glove + stocking sensory loss

34
Q

Effect on eyes of RA

A

Dry eyes

SScleritis/episcleritis

35
Q

Effect on kidneys of RA

A

Amyloidosis –> nephrotic syndrome + RF

36
Q

Haemotological effect - RA (2)

A

Felty’s syndrome

Normocytic normochromic anaemia

37
Q

What % w/ RA of the cervical spine get A-A subluxation

A

50-80%

38
Q

What occurs in Atlanto-axial subluxation

A

transverse + apical ligaments are destroyed by pannus

39
Q

PS A-A subluxation (3)

A

Localised pain
Deformity
Cervical radiculopathy

40
Q

Ix A-A subluxation (2)

A

XR- AP, lat + Odontoid peg

MRI C spine

41
Q

Mx A-A subluxation (2)

A

Surgical decompression spinal cord

Stabilise segment spine

42
Q

Which genetic linkage do Seronegative spondyloarthropathies all have in common

A

HLA B27

43
Q

Seronegative spondyloarthropathies (4)

A

Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis
IBD related arthropathy

44
Q

PS Ankylosing spondylitis

A

Episodic inflammation of SIJ in young adults
Pain/stiffness lower back/bum - worse in AM + relieved by exercise
Asymp between episodes

45
Q

Who gets ankylosing spondylitis?

A

M 3:1

20-40 y/o

46
Q

LFM ankylosing spondylitis

A

L:Question mark posture
F: Pain on P over SIJ
M: Limited lateral + forward flexion of lumbar spine

47
Q

WHy do pt w/ AS get the question mark posture?

A

Lumbar lordosis + paraspinal mm wasting

48
Q

Tests AS (3)

A

Schober
Sacroiliac stress test
Tragus to wall

49
Q

Schober test

A

With pt standing, mark the skin overlying 5th spinous process, and also 10cm above i. On forward flexion, this should increase to >15cm

50
Q

Joints involved - AS

A

SIJ
Hip + shoulder
Costochondral joints

51
Q

Extra-articular manifestations AS (The A’s) (6)

A 
Apical fibrosis 
Anterior uveitis 
Aortic regurg 
Amyloidosis 
AV node blood 
Achilles Tendonitis
52
Q

Clinical assessment of AS

A

BAS DAI

53
Q

Ix AS (3)

A

ESR (norm 50%)
Pelvic XR -
Spinal XR -

54
Q

Pelvic XR findings AS

A

Bilateral sacroilitis

55
Q

Spinal XR findings AS

A

Bamboo spine (square vertebral bodies)
ossification of ligaments
Straightening of anterior line

56
Q

Mx AS

A

NSAIDs 6w

57
Q

2nd line Mx AS

A

If no improvement after 2 NSAIDS

Biologics

58
Q

When should biologics be stopped in AS

A

If after 12 weeks there is no improvement

59
Q

What are the 5 subtypes of psoriatic arthritis

A 
Symmetrical polyarthritis 
Asymmetrical oligoarhtritis 
DIPJ predominant 
Spondylitis 
Arthritis mutilans
60
Q

Psoriatic arthritis - symmetrical polyarthritis

A

Similar to RA

But DIPJ involvement + < severe

61
Q

Psoriatic arthritis - asymmetrical oligoarthritis

A

<5 joints

62
Q

Psoriatic arthritis - DIPJ predominant (3)

A

Ttpical
Assoc w/ signif nail changes
–> Dactylitis

63
Q

Psoriatic arthritis - spondylitis

A

Affects spine +/- SIJ

64
Q

Psoriatic arthritis - arthritis mutilans

A

Severe

–> joint destruction + deformity

65
Q

XR appearance sporiatic arthritis (6)

A 
Minimal osteopenia 
Proliferative erosions
Uniform narrowing 
Soft tissue swellings 
DIPJ 
Pencil in cup deformities
66
Q

Clinical assessment psoriatic arthritis

A

DAS 66/68

67
Q

Mx psoriatic arthritis - 1 joint

A

Full dose NSAID +/- injection

68
Q

Mx psoriatic arthritis - mulitiple joints

A

Mx like RA incl methotrexate

69
Q

Another name for reactive arthritis

A

Reiter’s syndrome

70
Q

What does Reactive arthritis occur because of ?

A

Infection - GI/GUM

71
Q

How long after infection does reactive arthritis occur

A

4-40 days

72
Q

Pathogens that cause reactive arthritis (4)

A

Chlamydia
Salmonella
Campylobacter
Gonococcus

73
Q

Gender predominance reactive arthritis

A

Males

74
Q

Triad - reactive arthritis PS

A

Can’t see, pee or climb a tree

Conjunctivitis
Dysuria
Lower limb oligoarthritis

75
Q

What can reactive arthritis develop into?

A

Chronic arthritis

76
Q

Skin lesions common w/ reactive arthritis (2)

A

Keratoderma blenorrhagica

Balanitis

77
Q

Mx (1st line) reactive arthritis

A

NSAID + steroid injection

78
Q

2nd line Mx reactive arthritis

A

Sulfasalazine

79
Q

What % of people w/ IBD develop arthropathy

A

10-15%

80
Q

PS IBD-related arthropathy

A

Symmetrical arthritis of lower limbs

5% = spinal

81
Q

Arhtropathy + UC

A

If in remission –> remission of joint disease

82
Q

Arthropathy + Chrons

A

Even if chrons well controlled, arthropathy can persist

CP3 MDD (13 decks)

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