Week 7 - Inflammatory Joint Disease Flashcards
What is rheumatoid arthritis?
RA is an autoimmune disorder of unknown characterised by symmetric, erosive synovitis and in some cases extra-articular involvement.
It is a chronic, systemic, long term inflammatory disease in which joint in the body become inflamed.
What are the 4 stages of RA?
- Synovitis
- Pannus
- Fibrous Anklosis
- Bony Anklosis
What is synovitis in RA?
After an external trigger, the synovial membrane becomes inflamed and thickened. The bones and cartilage are gradually eroded.
What is pannus in RA?
As synovitis progresses, there is extensive cartilage loss and bones are exposed and pitted and a granulomatous pannus is formed.
What is fibrous anklosis in RA?
The joint is then invaded by fibrous connective tissue trying to repair the cartilage damage.
What is bony anklosis in RA?
The bones then fuse together
What is IL-1?
An inflammatory cytokine interleukin which plays a pivotal role in the inflammatory and destructive processes of RA
What are the criteria for diagnosis of RA?
Need to meet 3 of the following criteria: Polyarthritis in 3 joints Morning stiffness for 1 hour or greater Hand joint involvement Symmetrical arthritis Rheumatoid nodules Elevated ESR/C-reactive Protein Radiological evidence
What is the second most common form of arthritis?
RA
Are males or females more likely to be affected by RA?
Females 3:1
What age does RA usually appear?
40-60 years
What are associated symptoms of RA?
Fever
Fatigue
Malaise
What are the symptoms of RA?
Symmetric joint pain Swelling of small peripheral joints Morning joint stiffness Other diffuse aching Fatigue Malaise Depression
What are the presenting signs of RA in the hands?
Radial deviation of hand at the wrist
Ulnar deviation of fingers at MCPs
Dorsal subluxation of Ulnar head (due to interruption of radioulnar ligament
How is RA managed?
Medications - NSAIDs, corticosteroids PT OT SP Surgery
What is a fatal complication of RA?
C1-C2 instability
What is gout?
Gout is a build up of uric acid, by either too much being produced or not enough being excreted.
What is the most common joint affected by gout?
The MTP joint of the big toe (hallux)
Can also affect the ankle, knee, foot, hand, wrist and elbow
What us the hallmark characteristic of gout?
The formation of a mass of uric acid crystals or tophi in the joint
How does gout present?
Sudden onset Nil mechanism Intense pain Hot, red, swollen skin Pressure around painful area
What triggers gout?
Acute gout - surgery, heart attack or trauma Alcohol Diuretics Foods Family history
How is gout diagnosed?
Aspiration of joint fluid
24 hour urine test showing uric acid concentration
How is gout managed?
Medication - NSAIDs, Colchicine, Cortisone injection Exercise Maintain joint ROM Maintain muscle strength Education Decrease joint stiffness Pain management strategies Assistive devices
What is fibromyalgia?
Widespread muscle pain and tenderness with no known cause. It has gradual onset and usually occurs after a trigger.
Does fibromyalgia affect more men or women?
Women 4:1
What age is fibromyalgia usually diagnosed?
Over 50 years
How is fibromyalgia diagnosed?
Diagnosis of exclusion including X-rays and blood tests
What are the clinical features of fibromyalgia?
Widespread pain for a period of 3 months or longer
Pain above and below the waist on both left and right sides
Existence of at least 11 of 18 distinct sites of deep muscle tenderness that hurt when touched firmly
What are the signs of fibromyalgia?
Stiffness in morning
Pain in muscles and joints all over the body
Disruption to sleep pattern
Fatigue and lethargy
Numbness in muscles and joints
Poor memory and concentration
Depression, tension, migraines, headaches and jaw pain
How is fibromyalgia managed?
Medication
Exercise
Pain relief
Lifestyle management
What is polymyalgia rheumatica?
An inflammatory disorder causing muscle pain and stiffness around the shoulders and hips.
What are the symptoms of polymyalgia rheumatica?
Low energy and fatigue Night sweats Loss of appetite Slight fever Anaemia Depression Giant Cell Arteritis
What is Giant Cell Arteritis?
An inflammation of blood vessels, called arteries, in and around the scalp.
What are the signs of Giant Cell Arteritis?
Tenderness of the forehead
Redness and swelling of the blood vessels on the side of the head
Blurred vision, blind spots, seeing double
Pain in the jaw, often while chewing food
Diziness
Problems with hearing
Sore throat and coughing
How is polymyalgia rheumatica managed?
Medication - NSAIDs, oral cortisone
Joint pain & ROM - Exercise, hot/cold, electrotherapy/accupuncture
Protect joints - pacing, position, gait aids and bracing, healthy weight.
What is spondyloarthropathies?
Spondyloarthropathies are forms of arthritis that usually strike the bones in your spine and nearby joints. They can cause pain and sometimes damage joints like your backbone, shoulders, and hips.
What are the 5 Spondyloarthopathies?
- Reactive arthritis
- Juvenile Spondyloarthropathy
- Undifferentiated Spondyloarthropathy
- IBD Associated Arthritis
- Psoriatic Arthritis
True or false, all spondyloarthropathies share similar predisposing genetic factors and clinical features?
True
What is Ankylosing spondylitis?
An inflammatory arthritis affecting the spine and large joints.
How does Ankylosing spondylitis occur?
- Inflammation of the ligaments and joints of the spine
- Syndesmophytes form causing bony protuberances
- These cause a restriction in movement, and gradual fusion of the disc.
How is Ankylosing spondylitis diagnosed?
Using the Modified New York Criteria for ankylosing spondylitis
Low back pain for 3 months or more that improves with exercise not rest.
Limited lumbar spine motion in the sagittal and frontal plane
Chest expansion reduced compared to norm
Radiological evidence of sacroiliitis
What is Psoriatic arthritis?
A form of arthritis that affects some people who have the skin condition psoriasis.
What age group is predominantly diagnosed with psoriatic arthritis?
20-50 years
How many joints are involved in psoriatic arthritis?
Only one or a few, usually knees, small joints of the hands and feet
What causes psoriatic arthritis?
Genetic and environmental factors
What are the signs and symptoms of psoriatic arthritis?
Pain and swelling in the fingers or toes
Fingernails or toenails lifting up from the skin or pitting
Pain and swelling over tendons and ligaments
Reduced range of motion
Morning stiffness and tiredness
What is Reactive arthritis?
Aseptic arthritis causing joint pain and swelling triggered by an infection in another part of the body.
