Rheumatology - Inflammatory Arthritis Flashcards
What is Rheumatoid Arthritis?
Features
Most common inflammatory arthritis leading to joint destruction, forms granulomas in lungs and synovium
More common in females, young (30-40)
2+ symmetrical small swollen joints - MCPs, wrist, knees
Ulnar styloid process prominent
Z thumb
Ulnar deviation, swan neck deformity
Skin manifestations of RA?
Erythema Nodosum
Pyoderma Gangrenosum
Nodules - extensors, elbows, dorsal hand, achilles tendon
Investigation findings in RA?
RF + sensitive
Anti CCP + specific
ESR raised
CRP raised
X Ray findings in RA?
Loss of Joint space, Erosions, Osteopenia, Soft Tissue Swelling
Early changes = Soft tissue swelling
How do you treat RA?
DMARDs
anti-TNFs after DAS-26
Joint replacement or fusion Synovectomy Nerve decompression (CTS)
General investigations in inflammatory arthritis?
X Ray
Bloods – HLA, CRP, ESR, WCC, RA, Anti-CCP
Other: LFTs, U&Es (for treatment and other organ involvement)
Joint Aspiration
What is PA?
Who gets it?
Seronegative Inflammatory oligoarthritis
Equal in men and women, FHx, post-trauma (Kobner)
5% of people with psoriasis go on to develop
Can get before the rash 4 Different types: • DIP type • RA mimicking • Spondylitic • Arthritis Mutilans
Features of PA?
Assymetrical
Oligoarthritis
Affects DIP joints and small joints – toes, knee
Dactylitis – sausage digit
Enthesis – Achilles Tendon often affected
Nail pitting
Investigation findings in PA?
Negative CCP and RF
HLA linked, CRP and ESR raised
USS achilles tendon
X Ray in PA?
Destruction of joints
Distal joints
Pencil in cup
Periosteal Reaction
How do you treat PA?
Treat: Emollients, Vit D, Steroid cream for rash NSAIDs Methotrexate best for PA Anti-TNFs
How do you treat PA?
Treat: Emollients, Vit D, Steroid cream for rash NSAIDs Methotrexate best for PA Anti-TNFs
What is Ankylosing Spondylitis?
Who gets it?
Arthritis affecting the spine and the sacroiliac joints
Inflammation causes granulation tissue which erodes bone and cartilage leading to sclerosis
Seen in young, male, FHx
Features of Ankylosing Spondylitis?
Systemic features (fever, weight loss) Iritis, anterior uveitis
Night pain and stiffness of back – have to get up and move around
Crohn’s
Enthesis
Investigation findings in Ankylosing Spondylitis?
Loss of lumbar lordosis SI joint tenderness on stress test ? posture Wall stand test – cannot put head, shoulder, hip, legs against wall at same time Modified Schober’s failed (under 10cm)
Rule out malignancy
HLA
CRP and ESR not nec. raised
