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Musculoskeletal System > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

what is the definition of rheumatoid arthritis?

A

symmetrical polyarthritis of small joints

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2
Q

which joints are most commonly affected by RA?

A

metacarpophalangeal (MCP)
proximal interphalangeal (PIP)
metatarsophalangeal (MTP)

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3
Q

which gender is most likely to present with RA, and how much more likely?

A

females 3x more likely than males

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4
Q

what age does RA commonly present?

A

40s/50s

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5
Q

what is the main genetic factor involved in RA?

A

changes in HLA-DRB1

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6
Q

what is the genetic evidence of RA?

A

twins up to 30% more likely to both have RA compared to general population

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7
Q

what is the main biochemical trigger to the immune cascade in RA?

A

presence of citrullinated proteins in the joint

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8
Q

which cytokines involved in RA are released by T-cells?

A

Interferon Gamma

Interleukin 17

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9
Q

what cytokines involved in RA are released by macrophages in the synovium?

A

Interleukin-6

TNF-alpha

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10
Q

what process causes bone destruction in RA?

A

T-cell activating osteoclasts by triggering RANKL cascade

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11
Q

what is Rheumatoid Factor?

A

it’s an IgM antibody that binds to the FC portion of IgG

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12
Q

what are the four main physiological features of RA in a joint?

A
  • pannus (eg thickened synovium)
  • inflammatory infiltration
  • neoangiogenesis
  • cartilage/bone destruction
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13
Q

what are the common symptoms of RA?

A
  • pain
  • stiffness
  • loss of function
  • immobility
  • systemic symptoms (fever, malaise, loss of appetite, nodules, SoB from fibrosis)
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14
Q

what are the common signs of RA?

A
  • symmetrical joint presentation
  • synovitis
  • swelling
  • tenderness
  • heat
  • redness
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15
Q

what investigations should be carried out to diagnose RA?

A
  • blood test for RF and anti-CCP
  • xray of joint
  • ultrasound of joint
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16
Q

what are the medical treatment options for RA?

A
  • NSAIDS
  • DMARDS
  • biologics
  • corticosteroids
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17
Q

which three DMARDS are most commonly used in RA?

A
  • methotrexate
  • hydroxychloroquine
  • sulfasalazine
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18
Q

name a few biologic treatments for RA and what they target

A
  • rituximab (B cells)
  • abatacept (T cells)
  • infliximab/adalimumab/etanercept (TNF-alpha)
  • anakinra (IL-1)
  • tocilizumab (IL-6)
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19
Q

what is a recognised benefit of dual therapy of biologics + methotrexate in RA?

A

enhanced response to drug

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20
Q

what process leads to cartilage destruction in RA?

A

production of proteases by fibroblast-like synoviocytes (FLS)

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21
Q

which two main autoantibodies are associated with RA?

A
  • rheumatoid factor

- anti-citrullinated peptide antibodies (ACPA)

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22
Q

give a few examples of the proteins which may undergo citrullination in RA, resulting in an inflammatory cascade

A
  • type 2 collagen
  • vimentin
  • fibrinogen
  • fibronectin
  • alpha enolase
  • keratin
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23
Q

what is the main downside to prescribing methotrexate for RA?

A

it’s teratogenic (anti-folate)

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24
Q

what is meant by the term seronegative arthritis?

A

a type of arthritis with negative result for Rheumatoid Factor

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25
Q

which gene are seronegative arthritides commonly associated with?

A

HLA-B27

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26
Q

which two criteria are used to diagnose ankylosing spondylitis?

A

> 3month back pain, <45yo plus either:

  1. sacroiliitis on imaging + 1 AS feature
  2. HLA-B27 + 2 AS features
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27
Q

name a few features of ankylosing spondylitis

A
  • persistent back pain
  • reduced axial skeleton movement
  • reduced chest expansion
  • dactylitis
  • enthesitis
  • arthritis
  • uveitis
  • IBD (crohn’s, ulcerative colitis)
  • sacroiliitis/spondylophytes on imaging
  • good response to NSAIDS
  • HLA-B27
  • seronegative
  • elevated CRP
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28
Q

name the management options for ankylosing spondylitis

A
  • physiotherapy
  • NSAIDS
  • DMARDs
  • biologics
  • surgery (joint replacement)
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29
Q

which triad of symptoms is common in reactive arthritis, and what is it called?

A 
Reiter's syndrome, triad of:
- arthritis
- urethritis
- conjunctivitis
"can't see, can't pee, can't climb a tree"
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30
Q

name a few common pathogens which may cause reactive arthritis

A 
chlamydia trichomatis
neisseria
shigella
salmonella
campylobacter
streptococci
31
Q

how can ankylosing spondylitis present in different systems?

A 
heart - aortic regurgitation, heart block
lungs - pulmonary fibrosis
GI - IBD (crohn's, UC)
kidneys - secondary amyloidosis
nervous system - cauda equina syndrome
skeletal - osteoporosis/fractures
32
Q

what feature of psoriatic arthritis can be seen on xray imaging?

A

pencil in cup deformity

33
Q

what feature of psoriatic arthritis can be visible in patients’ nails?

A

nail pitting

34
Q

name some features of reactive arthritis

A 
keratoderma blenorrhagica
balanitis
uveitis
iritis
conjunctivitis
urethritis
arthritis of big joints
35
Q

how is reactive arthritis treated acutely and chronically?

A

acute - NSAIDS, antibiotics if needed, joint injection if no infection
chronic - NSAIDS and DMARDs

36
Q

what are the management options for psoriatic arthritis?

A 
physiotherapy
NSAIDs
DMARDs
biologics
occupational therapy
corticosteroids
37
Q

which patient population is more likely to develop ankylosing spondylitis?

A

males in 20s/30s

38
Q

which symptom (including duration and age) is often key in seronegative arthritis?

A

inflammatory back pain, longer than 3 months in patients younger than 45

39
Q

which seronegative arthritis is not normally treated with a trial of NSAIDs?

A

enteropathic arthritis

40
Q

what types of infection normally cause reactive arthritis?

A

GI infections
genitourinary tract infections
throat infections

41
Q

what specific symptom associated with reactive arthritis can present on the skin?

A

keratoderma blennorrhagica

42
Q

what is enteropathic arthritis?

A

arthritis associated with underlying IBD

43
Q

what are the criteria for diagnosing juvenile idiopathic arthritis?

A
  • symptoms for >6 weeks
  • age of patient <16
  • 2+ inflammatory features in joint
44
Q

what are the three main subsets of juvenile idiopathic arthritis? what defines them?

A

pauciarthritis - less than 4 joints affected
polyarthritis - more than 5 joints affected
systemic - other systems affected before arthritis sets in

45
Q

what specific eye condition is commonly associated with juvenile idiopathic arthritis?

A

anterior uveitis

46
Q

how many subtypes of pauciarticular JIA are there?

A

3 types

47
Q

how is polyarticular JIA subclassified?

A

RF+ve and RF-ve polyarticular JIA

48
Q

which type of pauciarticular JIA is associated with younger age, involvement of LL joints and more commonly in girls?

A

Type 1 pauciarticular JIA

49
Q

what characterises Type 2 pauciarticular JIA?

A

age 8/9
boys>girls
hips more commonly affected, sometimes severely

50
Q

which type of pauciarticular JIA presents with similar involvement of UL and LL joints but also dactylitis and psoriasis?

A

Type 3 pauciarticular JIA

51
Q

which type of JIA doesn’t normally present with systemic symptoms?

A

pauciarticular JIA

52
Q

which type of JIA can present with low grade fever and malaise?

A

polyarticular

53
Q

name a few symptoms which can differentiate systemic JIA from the other subtypes

A

high fever
salmon rash
hepatosplenomegaly
lymphadenopathy

54
Q

what are the management options for JIA?

A
  • painkillers
  • NSAIDS
  • DMARDS (methotrexate)
  • biologics (anti-TNF, anti IL-1 and anti IL-6)
  • physiotherapy/occupational therapy
  • surgery (synovectomy, joint replacement)
55
Q

when are systemic steroids used for JIA?

A

sometimes used for severe systemic JIA or to treat serious complications

56
Q

what are the effects of JIA on development?

A
  • uneven digit/limb length
  • underdeveloped jaw
  • short stature
  • delayed puberty
57
Q

why is it sometimes difficult to diagnose systemic JIA?

A

because the main features (high fever and rash) can come and go very quickly, so they can be hard to spot

58
Q

which subtype of JIA is the most common?

A

pauciarticular JIA

59
Q

what is the prevalence of RA?

A

1% of population

60
Q

what is the difference between spondyloarthropathies and rheumatoid arthritis in terms of joint involvement?

A

RA tends to affect the small peripheral joints; spondyloarthropathies normally affect axial joints (spine, sacroiliac joint)

61
Q

what is the acute management of reactive arthritis?

A

NSAIDS
steroid injection
antibiotics

62
Q

what is the chronic management of reactive arthritis?

A

NSAIDS

DMARDs

63
Q

which type of crystals are involved in pseudogout and where do they build up respectively?

A

pyrophosphate crystals in joints

apatite crystals in tendons

64
Q

which type of crystals are involved in gout?

A

urate crystals

65
Q

what is a useful diagnostic indicator of whether stiffness is due to osteoarthritis or rheumatoid arthritis? explain the difference

A

duration of stiffness and pain in the morning

  • in RA, pain lasts longer than 30 mins
  • in OA, pain lasts less than 30 mins
66
Q

what are three factors which are thought to lead to osteoarthritis?

A
  • damage
  • inflammation
  • repair
67
Q

what are the main symptoms of osteoarthritis?

A

pain
loss of function
short-lived morning stiffness

68
Q

name a few signs that can be seen in an osteoarthritic joint xray

A
  • loss of joint space
  • osteophytes
  • subchondral sclerosis
69
Q

name a few non-pharmacological treatments for osteoarthritis

A

mechanical aids
heat packs
electrotherapy
physiotherapy

70
Q

name a few pharmacological treatments for osteoarthritis

A

NSAIDS/paracetamol
hyaluronic acid injections
steroid injections

71
Q

what is the surgical option for osteoarthritis?

A

partial or total joint replacement

72
Q

when is surgery considered for patients with osteoarthritis?

A

when disease is affecting QoL

if non-surgical options have failed

73
Q

what are the three key features to diagnose osteoarthritis?

A

over 45
activity-related joint pain
no morning stiffness/less than 30mins

Musculoskeletal System (4 decks)

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