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Rheumatology > Rheumatology Concepts and Inflammatory arthropathies > Flashcards

Rheumatology Concepts and Inflammatory arthropathies Flashcards

1
Q

Define arthropathy

A

disease of the joint

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2
Q

Define arthritis

A

inflammation of the joint

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3
Q

Define arthralgia

A

Pain in a joint

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4
Q

List Seropositive inflammatory arthritides

A 
Rheumatoid
Lupus
Scleroderma
Vasculitis 
Sjogrens
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5
Q

List Seronegative inflammatory arthritides

A

Ankylosing Spondylitis
Psoriatic Arthritis
Reactive Arthritis
Inflammatory Bowel Disease

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6
Q

What are the other types of inflammatory arthritis?

A

Infectious

Crystal induced

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7
Q

What is a seropositive condition?

A

Auto-antibodies found in serum

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8
Q

What causes the failure of immune regulation in auto-immune disease?

A

Genetic Predisposition
Environmental Insults
-infection
-chemical exposure

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9
Q

What is Anti-CCP antibody associated with?

A

Rheumatoid Arthritis

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10
Q

What is Anti-nuclear antibody (ANA) antibody associated with?

A

SLE, Sjogrens, Systemic Sclerosis, Mixed connective tissue disease, autoimmune liver disease

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11
Q

What is Anti-double stranded DNA antibody associated with?

A

SLE

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12
Q

What is Anti-Sm antibody associated with?

A

SLE

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13
Q

What is Anti-Ro antibody associated with?

A

SLE, Sjogrens

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14
Q

What is Anti-La antibody associated with?

A

Sjogrens Syndrome

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15
Q

What is Anti-centromere antibody associated with?

A

Systemic sclerosis (limited)

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16
Q

What is Anti-Scl-70 antibody associated with?

A

Systemic sclerosis (diffuse)

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17
Q

What is Anti-RNP antibody associated with?

A

SLE, Mixed connective tissue disease

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18
Q

What is Anti-Jo-1 antibody associated with?

A

Myositis

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19
Q

What is Anti-cardiolipin antibody and lupus anticoagulant associated with?

A

Anti-phospholipid syndrome

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20
Q

What is Anti-neutrophil cytoplasmic antibody associated with?

A

Small vessel vasculitis (GPA, EGPA, MPA)

21
Q

List causes of secondary osteoarthritis?

A 
Congenital Dislocation of the hip
Perthes
SUFE
Previous intra-articular fraction
Extra-articular fracture with malunion
Osteochondral/hyaline cartilage injury 
Crystal arthropathy 
Inflammatory arthritis 
Meniscal tears
Genu Varum
Genu Valgum
22
Q

What are typical radiographic findings of OA

A

L- oss of joint space
O- steophytes
S- clerosis
S- ubchondral cysts

23
Q

What is the management of OA

A

Pain control

  • analgesia, mild opiates
  • physiotherapy
  • weight loss
  • exercise

Replacement depending on joint affected

24
Q

What is the treatment of inflammatory arthropathies?

A

Simple analagesia

Anti-inflammatories

  • steroids
  • NSAIDs

Steroid injections

DMARDs

25
Q

Describe the distribution of rheumatoid arthritis?

A 
Cervical vertebrae
Shoulder Joints
Elbow Joints 
Hip
Wrist
MCP
PIP

NOT DIPs

Knee
Ankles
Tarsal joints
MTP

26
Q

Describe the distribution of psoriatic arthritis?

A

Not symmetrical

Elbow
DIP
Wrist
Knee
Ankle 
DIP
27
Q

Describe the distribution of inflammatory spondylitis?

A 
Spine
Shoulders
SI Joint
Hip 
Knee
28
Q

Describe the distribution of osteoarthritis?

A 
Cervical spine
Lumbar spine
Hip
Thumb
DIP
Knee
toes
29
Q

What are the features suggestive of joint inflammation?

A
  • Joint pain with associated swelling
  • Morning Stiffness
  • Improvement with exercise
  • Synovitis on examination
  • Raised inflammatory markers (CRP and PV)
  • Extra-articular symptoms
30
Q

Who is most likely to be affected by RA?

A

Women : men 3/2:1
35-50 yrs
People with affected 1st degree relatives 3x

31
Q

Describe the pathogenesis of RA?

A

Immune response against synovium lining joints and some tendons

Triggers
-smoking, infection, trauma

Formation of inflammatory panus, attacks and denudes articular cartilage leading to joint destruction

Tendon ruptures and soft tissue damage can lead to subluxation

32
Q

How is RA diagnosed?

A

Based on clinical presentation, radiographic findings and serological analysis

33
Q

Describe extra-articular manifestations of RA?

A

Rheumatoid nodules (25%) on site of mechanical irritation

Lung involvement

  • pleural effusions
  • interstitial fibrosis
  • pulmonary nodules

Cardiovascilar morbidity and mortality

Occular involvement is common

  • keratoconjunctivitis sick
  • episcleritis
  • uveitis
  • nodular scleritis
  • scleromalacia
34
Q

What might you see on early X-ray of RA?

A

No joint abnormalities

Peri-articular osteopenia

35
Q

Describe the treatment of RA?

A

Aim to start DMARD within 3 month of symptom onset

Methotrexate usually first line

Biologic agents

  • anti-TNF alpha
  • tocluzimab
  • rituximab
  • abatacept

MUST HAVE DAS 28 + FOR BIOLOGICS

36
Q

Which surgeries can be performed in RA?

A 
Synovectomy
Joint replacement 
Joint excision 
Tendon transfer
Arthrodesis 
Cervical Spine stabilisation
37
Q

What are individuals with seronegative arthropathies often positive for?

A

HLA-B27

CRP and ESR elevation

38
Q

Describe ankylosing spondylitis?

A

Chronic inflammatory disease of the spine and sacroiliac joints

Lead to fusion of intervertebral joints and SI joints

39
Q

Who is more affected by ankylosing spondylitis?

A

Male : female
3:1
20-40 years

40
Q

How can lumbar spine flexion be tested

A

Schobers test

41
Q

Which conditions are associated with ankylosing spondylitis?

A

Uveitis
Aortitis
Pulmonary fibrosis
Amyloidosis

42
Q

What is the treatment for ankylosing spondylitis?

A

Physiotherapy
Exercise
NSAIDs
Anti-TNF

DMARDs have no effect unless peripheral joint inflammation

43
Q

What surgery can be done in ankylosing spondylitis?

A

Kyphoplasty to straighten spine is controversial

44
Q

What commonly occurs on psoriatic arthritis?

A

Spondylitis, dactylitis, enthesitis

Nail changes

  • pitting
  • oncholysis
45
Q

What is the destructive form of psoriatic arthritis?

A

Arthritis mutilans

46
Q

What is the treatment for psoriatic arthritis?

A

DMARDs

Anti-TNF

47
Q

Describe enteropathic arthritis?

A

Involves peripheral joints and sometimes spine in patients with IBD

48
Q

Describe reactive arthritis

A

Occurs in response to an infection in another part of the body

  • GU infection
  • GI infection

Occurs 1-3 weeks following infections

49
Q

What triad of symptoms can be present in reactive arthritis?

A

Urethritis, Uveitis or conjunctivitis, arthritis

Reiters syndrom

Rheumatology (12 decks)

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