Spondyloarthropathies and Rheumatic Diseases of the spine

Question 1

Rheumatoid Arthritis - Clinical features

Answer 1

1. Morning stiffness
2. Arthritis of three or more joint areas
3. Arthritis of hand joints
4. Symmetrical
5. Rheumatoid nodules
6. Serum rheumatoid factor
7. radiographic changes

Question 2

Rheumatoid Arthritis - constitutional manifestations

Answer 2

• fatige
• weight loss
• malaise
• rheumatoid nodules
• vasculitis
• visceral involvement

Question 3

Psoriatic Arthritis-definition (COMPARE TO GOUT AND RYTERS)

Answer 3

common skin disorder associated with joint disease and characterised by peripheral joint destruction and deformity, sacroiliitis and non-marginal syndesmophyte formation

Question 4

Psoriatic Arthritis - clinical features (COMPARE TO GOUT AND RYTERS)

Answer 4

• 20-50 years
• male = female
• skin lesions usually on extensor surfaces such as knees, elbows, back, scalp, abdomen and genital region (dry, raised, red, well defined, silvery, scaly patches)
• severity and duration not related to the onset of arthritis
• nail changes seen in 80% of patients
• athritis usually affects peripheral joints, especially DIPS
• sausage digits are common
• rarely results in severe arthritis mutilans
• NEGATIVE RA PROFILE
• POSITIVE HLA-B27 IN 75% of patients

Question 5

Osteitis Condensans Illi

Answer 5

A bilateral, symmetric sacroiliac disorder predominantly found in multiparous females

Question 6

Osteitis Condensans Illi - Clinical features

Answer 6

• 20-40 years
• 9:1 female predominance
• wide variation from asymptomatic to chronic low back and leg pain
• usually self-limiting over a protracted period
• no positive laboratory findings
• combination of hormone-induced ligamentous laxity and increased mechanical joint stress results in low-grade inflammatory and sclerotic changes of the iliac subchondral base

Question 7

Gout - Definition

Answer 7

• A disease resulting from the deposition of monosodium urate crystals in synovial fluid and other tissues or the formation of uric acid stones in the kidney

Question 8

Gout- clinical features (COMPARE TO RYTERS AND PSORIATIC ARTHRITIS)

Answer 8

• initially monoarthritic => polyarthritic
• 75% of acute cases affect joints of lower extremities, especially 1st metatarsal joint
• acute attack on gout on big toe accounts for 50% of cases
• men = women
• typically middle aged, uncommon before 30
• bilateral, symmetric sacroiliac disorder mainly in multiparous women
• recurrent attacks= longer duration of illness
• other areas affected include instep,heels, ankles, knees, fingers, wrists, elbows
• chief complaint pain and inflammation

Question 9

Gout- modifiable risk factors

Answer 9

• alcohol consumption
• obesity
• hypertension
• environmental and occupational exposure to lead

Question 10

Topheous Gout - Definition

Answer 10

• nodular masses of monosodium urate crystals deposited in the soft tissues
• a late complication of hyperuricemia
• most common sites are base of great toe, fingers, wrists, hand, olecranon process, Achilles tendon
• pain, soft tissue damage, deformity, joint destruction, nerve compression (carpal tunnel)

Question 11

Gout- Diagnosis

Answer 11

• Labatory tests:
• full blood cell count
• urinalysis
• serum creatinine
• blood urea nitrogen
• serum uric acid
  ( radio not good for diagnosis initial attacks)

Question 12

Systemic Lupus Erythematosus - Definition

Answer 12

• Chronic, recurrent, potentially fatal multi-system inflammatory disorder
• women more prevalent 18-65 years

Question 13

Systemic Lupus Erythematosus - clinical features

Answer 13

• mixture of constitutional symptoms with skin, musculoskeletal and hematologic involvement, however some patients present with predominantly hematologicic, renal or neuropsychiatric manifestation

Question 14

Systemic Lupus Erythematosus - Diagnosis

Answer 14

• Malar rash on cheeks
• discoid rash (red, scaly patches)
• pleurisy or pericarditis
• oral ulcers
• arthritis (non erosion of 2 or more peripheral joints)
• photosensitivity
• haematological disorders
• renal disorders (> 0.5g of protein in urine per day)
• ANTINUCLEAR ANTIBODY TEST POSITIVE
• immunological disorder
• neurological disorders e.g. seizures and psychosis

Question 15

Rhuematoid arthritis- definition

Answer 15

• a chronic inflammatory disease of unknown aetiology and complex multifactorial pathogenesis, affecting joints and other tissues
• progressive and irreversible damage of the synovial lined joint causing loss of joint space, of bone and of function as well as deformity
• symmetrical
• affects up to 1-3% of the population
• 3:1 female predominance
• genetic predisposition