Rheumatology Flashcards
What are the different divisions of arthritis?
Osteoarthritis: degeneration of joint cartilage and associated bone abnormalities; joint fluid typically has no inflammatory cells present
- primary: idiopathic, associated with aging
- secondary: caused by previous injury to affected joint
Inflammatory arthritis: chronic inflammatory conditions of body associated with arthritis but typically with other systemic symptoms
- rheumatoid arthritis: autoimmune, chronic inflammation of synovium of different joints on both sides of the body
- psoriatic arthritis: autoimmune, associated with psoriasis, involves mutiple joints
- gout: monosodium urate mono-hydrate crystals
- pseudogout: calcium pyrophosphate
How is osteoarthritis diagnosed?
Diagnosed by X-ray:
- presence of osteophytes
- subarticular sclerosis
- bone cysts
- joint space narrowing
How is osteoarthritis treated?
NSAIDs
Paracetamol
Opioid analgesics
What are the characteristics of osteoarthritis?
Pain increases with movement
Asymmetric spread
Slow progression
Affects larger joints more often
Morning stiffness lasting 30min and gets worse as day goes on
Swellings at PIPJ (Bouchard’s nodes) and DIPJ (Heberden’s nodes)
Starts distally and moves proximally
How is rheumatoid arthritis diagnosed?
BLOODS:
- rheumatoid factor
- anti-CCP
- CRP/ESR
X-ray:
- soft tissue swelling
- periarticular osteopenia
- joint space narrowing
- erosions
- deformity
MRI: synovitis and early erosions
How is rheumatoid arthritis treated?
NSAIDs Analgesics TNF inhibitors Steroids COX-2 inhibitors Immunosuppressants DMARDs
What are the characteristics of rheumatoid arthritis?
Pain decreases with movement
Symmetric spread
Rapid progression
Affects smaller joints more often
Morning stiffness lasts 1hr+ and worse after periods of rest
Systemic symptoms
Ulnar deviation, swan-neck deformity (DIP flexion and PIP hyper-extension), Boutonniere’s deformity (hyperextension of DIP and MCP, flexion of PIP), Z deformity of thumbs, piano key deformity of wrists
What are the differentials for acute monoarthritis?
Inflammatory:
- septic arthritis
- vasculitis
- gout
- pseudogout
- systemic rheumatic disease
Non-inflammatory:
- juxta-articular fracture
- trauma
- haemarthrosis
- osteonecrosis
- loose body
- osteochondritis dissecans
- overuse
- avascular necrosis
What are the differentials for chronic monoarthritis?
Inflammatory:
- chronic infectious arthritis
- Lyme disease
- gout
- pseudogout
- JIA
- RA
- systemic rheumatic disease
Non-inflammatory:
- OA
- avascular necrosis
- haemarthrosis
- Paget’s disease
- stress fracture
- osteomyelitis
- osteosarcoma
- mets
What are the differentials for acute polyarthritis?
- acute rheumatic fever
- gonococcal arthritis
- polyarticular gout and pseudogout
- viral arthritis
- bacterial endocarditis
- RA
- JIA
- SLE
- reactive arthritis
- sarcoidosis
What are the differentials for chronic polyarthritis?
Inflammatory:
- RA
- SLE
- viral arthritisi
- psoriatic arthritis
- reactive arthritis
- Behcet’s disease
- ankylosing spondylitis
Non-inflammatory:
- OA
- trauma
- haemochromatosis
- amyloidosis
- acromegaly
etc.
Contrast the definitions of osteopenia, osteoporosis, and osteomalacia.
Osteopenia = reduced bone mass (-1s.d. from norm)
Osteoporosis = reduced bone mass (-2.5s.d. from norm, on steroids limit is changed to -1.5s.d.), normal mineralisation
Osteomalacia = bone mass variable, reduced mineralisation
Give some risk factors of osteoporosis.
Genetics = ethnicity, FHx, low BMI
Medical = RA, Cushing’s, chronic diseases,hypothyroidism
Drugs = corticosteroids, anti-convulsants, chemotherapy, alcohol, smoking
Describe the procedure of a DEXA scan.
Radiation: 5 days background radiation, trans-atlantic flight
Unilateral hip (usually right) and lumbar spine (T12-L5) - elevate legs to eliminate lumbar lordosis and maximise vertebral space
Usually offered for 50yrs-80yrs
Remove potential artifacts
T-score = s.d. from ideal bone mass Z-score = age-matched t-score
What is the management for osteoporosis?
Bisphosphonates e.g. alendronic acid (weekly, PO), risedronate, zoledronic acid (yrly, IV)
- ADRs: osteonecrosis of the jaw, increased risk of atypical fractures, oesophageal reactions, anaemia
Strontium ranelate
Denosumab
- ADRs: hypocalcaemia, osteonecrosis of jaw, atypical fractures
