Rheumatology Flashcards
What is rheumatology?
the study of rheumatism, arthritis, and other disorders of the joints, muscles and ligaments.
What characterizes a charcot foot?
Uncontrolled inflammation that leads to osteolysis and progressive fracture and dislocation.
What are the predisposing factors for charcot foot?
PVD and neuropathy. Also a strong link with diabetes.
What are the two main theories surrounding charcot foot?
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.
What do you look for in diagnosing a charcot foot?
Heat, pain, signs of inflammation.
How is charcot foot treated?
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.
What is the definition of rheumatoid arthritis?
A non-supportive, inflammatory symmetrical polyarthritis involving the peripheral joints.
What is the epidemiology of Rheumatoid arthritis?
- 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
How is rheumatoid arthritis diagnosed?
- 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
What is the aetiology of Rheumatoid Arthritis?
- UNKNOWN
- theories include racial, climatic, diet, psycho-somatic, traumatic, endocrine, biomechanical, genetic, auto-immune and infective.
What is rheumatoid factor?
Rheumatoid factor is present within the serum of 80% of RA sufferers - it is an autoantibody that initiates and helps sustain the inflammatory response.
What is the main reason behind the infectious theory of rheumatoid arthritis?
A small study found Rubella virus particles in the synovial fluid of rheumatoid arthritis sufferers.
Is rheumatoid arthritis genetic?
A twin study found some indications of heritability. It is thought multiple genes are significant in RA, specifically in the HLA region.
What is the current thinking around the cause of Rheumatoid arthritis?
RA is triggered by exposure of an immunogenetically susceptible host to an arthritogenic microbial antigen.
What is the pathology of rheumatoid arthritis?
hyperplasia of the synovium
What is stage 1 of Rheumatoid Arthritis?
Synovitis
- Synovial membrane becomes inflamed and thickened.
- x-ray shows soft tissue swelling with possible osteoporotic joint changes
What is stage 2 of Rheumatoid Arthritis?
Destruction
- persistant inflammation cause tissue destruction
- articular cartilage is eroded and tendon fibres rupture
- xray shoes narrowing of joint space and bony erosions
What is stage 3 of Rheumatoid Arthritis?
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
What are rheumatoid nodules?
- 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
What is the definition of Gout?
“A disease caused by defective purine metabolism resulting in the accumulation of monosodium-irate crystals in the tissues”.
Is gout considered an arthritis?
YES!
Is gout biased towards men or women?
Predominantly men - but females are more susceptible after menopause.
What is secondary gout?
Secondary to…
- injury
- surgical complications
- excessive exercise
- medications
- renal failure
- infection
- psoriasis
What is the pathogenesis of gout?
- 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
What are the clinical features of gout?
- 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
What is the second most common spot for gout to occur?
The ankle. The 1st MPJ is the most common.
What are the triggers of gout?
- diuretic drugs
- aspirin
- over-eating
- drinking alcohol
- minor injury to a joint
- drinking insufficient fluid
- fasting or insufficient food intake
- purine rich foods
What are the differential diagnosis for gout?
- infective arthritis
- reiter’s syndrome
- psoriatic arthritis
- rheumatoid arthritis
- cellulitis
- osteomyelitis
- osteoarthritis
- pseudogout
What is the treatment for gout?
- reduce purine rich foods
- rest
- increase fluid consumption
- management of associated conditions
- medication
What is the pharmacological treatment for gout?
Two tier approach.
- During attacks: NSAIDs, colchicine, corticosteroids.
- Long term: allopurinol or uricosuric drugs.
What is pseudogout?
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.
What are the symptoms of pseudogout?
Characterized by intense inflammation in one or more joints (usually larger joints such as knee)
How does pseudogout present on an x-ray?
Multiple punctate deposits along the cartilage.
What is the treatment for pseudogout?
- aspiration of the joint
- intra-articular corticosteroid injections
- colchicine or NSAIDS
