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Week A11 - MSK > The Posters > Flashcards

The Posters Flashcards

1
Q

Define rheumatoid arthritis [1]

A

A chronic systemic inflammatory condition causing a symmetrical polyarthropathy affecting the small joints

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2
Q

Systemic Consequences of Rheumatoid Arthritis: what are the general systemic complications of RA? [3]

A
  1. malaise
  2. weight loss
  3. fever
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3
Q

Systemic Consequences of Rheumatoid Arthritis: what are the skin complications of RA and who is at increased risk of developing these manifestations? [6]

A
  1. subcutaneous nodules occurring on
    • elbows
    • finger joints
    • Achilles tendon
    • bony prominence
  2. more common in smokers
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4
Q

Systemic Consequences of Rheumatoid Arthritis: what is vasculitis and what does it cause? [2]

A
  1. small vessel inflammation leads to micro-infarction in peri-ungual area
  2. in fingers and toes, it can cause rheumatoid ulcers
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5
Q

Systemic Consequences of Rheumatoid Arthritis: what are the haematological complications of RA? [5]

A
  1. anaemia, usually of chronic disease
  2. B12 deficiency may occur with pernicious anaemia
  3. folic acid deficiency may occur with poor diet
  4. iron deficiency may be dietary or secondary to blood loss
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6
Q

Systemic Consequences of Rheumatoid Arthritis: what are the clinical signs of Felty’s syndrome? [5]

A
  1. lymphadenopathy
  2. splenomegaly
  3. leucopenia
  4. thrombocytopenia
  5. increased risk of infection and lymphoproliferative disease
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7
Q

Systemic Consequences of Rheumatoid Arthritis: what are the pulmonary complications of RA? [5]

A
  1. effusions = exudates with lymphocytes
  2. rheumatoid nodules can mimic bronchial Ca on x-ray
  3. nodules in coal miners (Caplan’s syndrome)
  4. pulmonary fibrosis with progressive alveolar scarring
  5. pulmonary hypertension can follow pulmonary fibrosis
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8
Q

Systemic Consequences of Rheumatoid Arthritis: what are the cardiac complications of RA? [4]

A
  1. nodule formation
  2. amyloidosis
  3. pericarditis
  4. valve fibrosis
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9
Q

Systemic Consequences of Rheumatoid Arthritis: what are the ocular complications of RA? [3]

A
  1. kerato-conjunctivitis sicca
    • ​​more common with longstanding RA
  2. scleromalacia
    • thinning of sclera
  3. scleritis
    • acute pain and redness
    • normal visual acuity
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10
Q

Systemic Consequences of Rheumatoid Arthritis: what are the neurological complications of RA? [2]

A
  1. peripheral neuropathy caused by vasculitis of vasa-nervorum
  2. mononeuritis multiplex - if many nerves are involved
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11
Q

What are the typical clinical presentation of rheumatoid arthritis in the joints? [5]

A
  1. small joint synovial swelling:
    • which shows signs of inflammation
    • is boggy
    • soft to palpate
  2. the swollen metacarpophalangeal and proximal interphalangeal joints are common
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12
Q

Describe the pathophysiology of rheumatoid arthritis [5]

A
  1. the disease process in RA is one of synovitis
  2. the synovium is swollen and infiltrated with activated macrophages with T cells and plasma cells
  3. the inflamed synovial tissue is the source of destructive enzymes (collagenases) and cytokines (interleukins, tumour necrosis factor etc) which are made by macrophages in the lining layer
  4. the site of the damage to the joint is at the junction between the cartilage, which is overlaid with the inflamed synovium.
    • this is called the pannus
  5. the macrophages that predominate at this site eventually erode through the cartilage into the underlying bone producing the erosions on X-Ray
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13
Q

What are the 4 typical features that are found on x-ray in a patient with rheumatoid arthritis? [4]

A
  1. Soft tissue swelling
  2. Peri-articular osteopenia
  3. Joint erosions
  4. Loss of joint space
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14
Q

What are the pathological features of rheumatoid nodules that can be seen on biopsy? [4]

A

rheumatoid nodules are composed of macrophages, giant cells and T cells surrounding an area of necrosis

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15
Q

What is rheumatoid factor and why is it not 100% specific to rheumatoid arthritis? [2]

A
  1. Rheumatoid factor is an IgM antibody directed against the Fc portion of an IgG molecule
  2. It’s not 100% specific since everyone has the ability to produce RF (e.g. after severe viral infections such as infectious mononucleosis)
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16
Q

What investigations would you carry out on a patient with suspected rheumatoid arthritis? [5]

A
  1. RF/anti-CCP antibody
  2. Radiographs hands and feet
  3. ESR/CRP
  4. +/- uss/MRI
  5. And in consideration of alternative diagnoses:
    • Urate
    • Vitamin D
    • CK
    • TFTs
    • HLA B27
    • ANA
17
Q

What features may be found in blood during the active flare up of rheumatoid arthritis? [7]

A
  1. Anaemia – usually nomocromic, nomocytic
  2. Thrombocytosis – high platelet count
  3. Elevated acute phase response = ESR and CRP.
  4. Occasionally eosinophilia and lymphopenia.
  5. Rheumatoid factor
  6. Abnormal liver function tests.
  7. Alkaline phosphatase and g-GT commonly raised
18
Q

What are the treatment options for rheumatoid arthritis? [3]

A
  1. NSAIDs/analgesics
  2. steroids
  3. DMARDs
    • Methotrexate
    • Sulphasalazine
    • Hydroxychloroquine
  4. Biologics
    • Anti-TNF therapy:
      • Etanercept
      • Adalumimab
      • Infliximab
    • Anti-B cell therapy:
      • Rituximab
    • Inhibition of interleukins:
      • Tocilizumab (IL-6 receptor)
      • Anakinra (IL-1)
19
Q

What are the potential side effects of steroids? [8]

A
  1. Adrenal suppresion
  2. Risk of infection including opportunistic infection
  3. Osteoporosis
  4. Diabetes mellitis
  5. Cataracts
  6. Bruising/thinning of skin
  7. CVS disease
  8. Hypertension
20
Q

What is osteoarthritis? [1]

A

A degenerative condition of weight-bearing joints characterised by loss of articular cartilage

21
Q

What are the signs and symptoms of osteoarthritis? [7]

A
  1. Pain occuring on movement, at rest, at night.
  2. Stiffness – difficulty in moving particularly after rest
  3. Swelling – due to effusion into the joint
  4. Joint contractures – reduced range of movement
  5. Giving way – instability
  6. Deformity – related to joint collapse / erosion / effusion
  7. Impaired function – gait, activities of daily living
22
Q

What features would typically be found on examination in a patient with osteoarthritis?

  1. look? [4]
  2. feel? [2]
  3. move? [3]
  4. special tests? [2]
  5. gait? [3]
A
  1. Look:
    • deformity,
    • muscle wasting,
    • swelling
    • nodules
  2. Feel:
    • tender,
    • swollen
  3. Move:
    • limited range of motion,
    • pain,
    • crepitus
  4. Special tests:
    • Thomas,
    • Trendelenberg
  5. Gait
    • antalgic,
    • Trendelenberg,
    • short leg
23
Q

What features would be found on x-ray in a patient with osteoarthritis? [4]

A
  1. Narrowing or loss of joint space
  2. Osteophyte formation
  3. Subchondral sclerosis
  4. Cyst formation

Week A11 - MSK (13 decks)

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