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Pod practice > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is rheumatology?

A

the study of rheumatism, arthritis, and other disorders of the joints, muscles and ligaments.

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2
Q

What characterizes a charcot foot?

A

Uncontrolled inflammation that leads to osteolysis and progressive fracture and dislocation.

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3
Q

What are the predisposing factors for charcot foot?

A

PVD and neuropathy. Also a strong link with diabetes.

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4
Q

What are the two main theories surrounding charcot foot?

A

Neurotraumatic: neuropathy and repetitive trauma.
Neurovascular: increased blood flow and osteoclast activity leads to osteopenia and bony collapse; glycolization of soft tissue leads to joint collapse.

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5
Q

What do you look for in diagnosing a charcot foot?

A

Heat, pain, signs of inflammation.

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6
Q

How is charcot foot treated?

A

Hospitalise, apply cooling packs to foot, and put patient in a boot. Want to cast in correct position as bone turns very soft and plasticine-like.

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7
Q

What is the definition of rheumatoid arthritis?

A

A non-supportive, inflammatory symmetrical polyarthritis involving the peripheral joints.

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8
Q

What is the epidemiology of Rheumatoid arthritis?

A
  • avg age is 27 y.o.
  • higher prevalence in indigenous north americans
  • socioeconomic status does not affect prevalence, does affect prognosis
  • gender bias is 3:1 female to male
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9
Q

How is rheumatoid arthritis diagnosed?

A
  • morning stiffness >1 hr
  • arthritis in >3 joint areas
  • arthritis of hand joints
  • symmetric arthritis
  • rheumatoid nodules
  • serum rheumatoid factor
  • radiographic changes
    4 OF 7 CRITERIA MUST BE PRESENT FOR >6 WEEKS
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10
Q

What is the aetiology of Rheumatoid Arthritis?

A
  • UNKNOWN
  • theories include racial, climatic, diet, psycho-somatic, traumatic, endocrine, biomechanical, genetic, auto-immune and infective.
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11
Q

What is rheumatoid factor?

A

Rheumatoid factor is present within the serum of 80% of RA sufferers - it is an autoantibody that initiates and helps sustain the inflammatory response.

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12
Q

What is the main reason behind the infectious theory of rheumatoid arthritis?

A

A small study found Rubella virus particles in the synovial fluid of rheumatoid arthritis sufferers.

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13
Q

Is rheumatoid arthritis genetic?

A

A twin study found some indications of heritability. It is thought multiple genes are significant in RA, specifically in the HLA region.

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14
Q

What is the current thinking around the cause of Rheumatoid arthritis?

A

RA is triggered by exposure of an immunogenetically susceptible host to an arthritogenic microbial antigen.

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15
Q

What is the pathology of rheumatoid arthritis?

A

hyperplasia of the synovium

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16
Q

What is stage 1 of Rheumatoid Arthritis?

A

Synovitis

  • Synovial membrane becomes inflamed and thickened.
  • x-ray shows soft tissue swelling with possible osteoporotic joint changes
17
Q

What is stage 2 of Rheumatoid Arthritis?

A

Destruction

  • persistant inflammation cause tissue destruction
  • articular cartilage is eroded and tendon fibres rupture
  • xray shoes narrowing of joint space and bony erosions
18
Q

What is stage 3 of Rheumatoid Arthritis?

A

Deformity

  • combination of articular destruction, capsular stretching and tendon rupture leads to progressive instability and deformity
  • x-ray shows articular destruction and joint deformity
  • pannus can be seen
19
Q

What are rheumatoid nodules?

A
  • affect 20-25% of sufferers
  • large extra-articular granulomatic growths that appear over bony prominences, tendons, in the sclera or viscera, or where mechanical stress or trauma is felt
20
Q

What is the definition of Gout?

A

“A disease caused by defective purine metabolism resulting in the accumulation of monosodium-irate crystals in the tissues”.

21
Q

Is gout considered an arthritis?

A

YES!

22
Q

Is gout biased towards men or women?

A

Predominantly men - but females are more susceptible after menopause.

23
Q

What is secondary gout?

A

Secondary to…

  • injury
  • surgical complications
  • excessive exercise
  • medications
  • renal failure
  • infection
  • psoriasis
24
Q

What is the pathogenesis of gout?

A
  • excessive cell breakdown results in overproduction of urate
  • hyperuricaemia causes a urate crystal build up
  • destruction of cartilage and intro-articular structures by mechanical means
25
Q

What are the clinical features of gout?

A
  • first attack generally involves the 1st MPJ
  • excruciating pain in the hallux with sudden onset
  • instantly debilitating
  • can affect the ankle, foot or knee
  • further complication of other joints
  • untreated attack lasts for around 7 days
  • recurs in shortened time spans with longer and more sever attacks
  • pt usually asymptomatic between attacks
  • tophi
26
Q

What is the second most common spot for gout to occur?

A

The ankle. The 1st MPJ is the most common.

27
Q

What are the triggers of gout?

A
  • diuretic drugs
  • aspirin
  • over-eating
  • drinking alcohol
  • minor injury to a joint
  • drinking insufficient fluid
  • fasting or insufficient food intake
  • purine rich foods
28
Q

What are the differential diagnosis for gout?

A
  • infective arthritis
  • reiter’s syndrome
  • psoriatic arthritis
  • rheumatoid arthritis
  • cellulitis
  • osteomyelitis
  • osteoarthritis
  • pseudogout
29
Q

What is the treatment for gout?

A
  • reduce purine rich foods
  • rest
  • increase fluid consumption
  • management of associated conditions
  • medication
30
Q

What is the pharmacological treatment for gout?

A

Two tier approach.

  • During attacks: NSAIDs, colchicine, corticosteroids.
  • Long term: allopurinol or uricosuric drugs.
31
Q

What is pseudogout?

A

Presence of calcium containing salts in the fibrocartilage and hyaline cartilage affecting one or more joints. Sufferers are plagued with synovitis from the crystal/salt presence in joints.

32
Q

What are the symptoms of pseudogout?

A

Characterized by intense inflammation in one or more joints (usually larger joints such as knee)

33
Q

How does pseudogout present on an x-ray?

A

Multiple punctate deposits along the cartilage.

34
Q

What is the treatment for pseudogout?

A
  • aspiration of the joint
  • intra-articular corticosteroid injections
  • colchicine or NSAIDS

Pod practice (75 decks)

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