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Clinical Medicine - OT > Week 7 - Inflammatory Joint Disease > Flashcards

Week 7 - Inflammatory Joint Disease Flashcards

1
Q

What is rheumatoid arthritis?

A

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.

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2
Q

What are the 4 stages of RA?

A
  1. Synovitis
  2. Pannus
  3. Fibrous Anklosis
  4. Bony Anklosis
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3
Q

What is synovitis in RA?

A

After an external trigger, the synovial membrane becomes inflamed and thickened. The bones and cartilage are gradually eroded.

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4
Q

What is pannus in RA?

A

As synovitis progresses, there is extensive cartilage loss and bones are exposed and pitted and a granulomatous pannus is formed.

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5
Q

What is fibrous anklosis in RA?

A

The joint is then invaded by fibrous connective tissue trying to repair the cartilage damage.

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6
Q

What is bony anklosis in RA?

A

The bones then fuse together

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7
Q

What is IL-1?

A

An inflammatory cytokine interleukin which plays a pivotal role in the inflammatory and destructive processes of RA

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8
Q

What are the criteria for diagnosis of RA?

A 
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
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9
Q

What is the second most common form of arthritis?

A

RA

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10
Q

Are males or females more likely to be affected by RA?

A

Females 3:1

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11
Q

What age does RA usually appear?

A

40-60 years

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12
Q

What are associated symptoms of RA?

A

Fever
Fatigue
Malaise

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13
Q

What are the symptoms of RA?

A 
Symmetric joint pain
Swelling of small peripheral joints
Morning joint stiffness 
Other diffuse aching
Fatigue
Malaise
Depression
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14
Q

What are the presenting signs of RA in the hands?

A

Radial deviation of hand at the wrist
Ulnar deviation of fingers at MCPs
Dorsal subluxation of Ulnar head (due to interruption of radioulnar ligament

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15
Q

How is RA managed?

A 
Medications - NSAIDs, corticosteroids
PT
OT
SP
Surgery
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16
Q

What is a fatal complication of RA?

A

C1-C2 instability

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17
Q

What is gout?

A

Gout is a build up of uric acid, by either too much being produced or not enough being excreted.

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18
Q

What is the most common joint affected by gout?

A

The MTP joint of the big toe (hallux)

Can also affect the ankle, knee, foot, hand, wrist and elbow

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19
Q

What us the hallmark characteristic of gout?

A

The formation of a mass of uric acid crystals or tophi in the joint

20
Q

How does gout present?

A 
Sudden onset
Nil mechanism
Intense pain
Hot, red, swollen skin
Pressure around painful area
21
Q

What triggers gout?

A 
Acute gout - surgery, heart attack or trauma
Alcohol
Diuretics
Foods
Family history
22
Q

How is gout diagnosed?

A

Aspiration of joint fluid

24 hour urine test showing uric acid concentration

23
Q

How is gout managed?

A 
Medication - NSAIDs, Colchicine, Cortisone injection
Exercise
Maintain joint ROM
Maintain muscle strength
Education
Decrease joint stiffness
Pain management strategies
Assistive devices
24
Q

What is fibromyalgia?

A

Widespread muscle pain and tenderness with no known cause. It has gradual onset and usually occurs after a trigger.

25
Q

Does fibromyalgia affect more men or women?

A

Women 4:1

26
Q

What age is fibromyalgia usually diagnosed?

A

Over 50 years

27
Q

How is fibromyalgia diagnosed?

A

Diagnosis of exclusion including X-rays and blood tests

28
Q

What are the clinical features of fibromyalgia?

A

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

29
Q

What are the signs of fibromyalgia?

A

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

30
Q

How is fibromyalgia managed?

A

Medication
Exercise
Pain relief
Lifestyle management

31
Q

What is polymyalgia rheumatica?

A

An inflammatory disorder causing muscle pain and stiffness around the shoulders and hips.

32
Q

What are the symptoms of polymyalgia rheumatica?

A 
Low energy and fatigue
Night sweats
Loss of appetite
Slight fever
Anaemia
Depression
Giant Cell Arteritis
33
Q

What is Giant Cell Arteritis?

A

An inflammation of blood vessels, called arteries, in and around the scalp.

34
Q

What are the signs of Giant Cell Arteritis?

A

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

35
Q

How is polymyalgia rheumatica managed?

A

Medication - NSAIDs, oral cortisone
Joint pain & ROM - Exercise, hot/cold, electrotherapy/accupuncture
Protect joints - pacing, position, gait aids and bracing, healthy weight.

36
Q

What is spondyloarthropathies?

A

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.

37
Q

What are the 5 Spondyloarthopathies?

A
  1. Reactive arthritis
  2. Juvenile Spondyloarthropathy
  3. Undifferentiated Spondyloarthropathy
  4. IBD Associated Arthritis
  5. Psoriatic Arthritis
38
Q

True or false, all spondyloarthropathies share similar predisposing genetic factors and clinical features?

A

True

39
Q

What is Ankylosing spondylitis?

A

An inflammatory arthritis affecting the spine and large joints.

40
Q

How does Ankylosing spondylitis occur?

A
  1. Inflammation of the ligaments and joints of the spine
  2. Syndesmophytes form causing bony protuberances
  3. These cause a restriction in movement, and gradual fusion of the disc.
41
Q

How is Ankylosing spondylitis diagnosed?

A

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

42
Q

What is Psoriatic arthritis?

A

A form of arthritis that affects some people who have the skin condition psoriasis.

43
Q

What age group is predominantly diagnosed with psoriatic arthritis?

A

20-50 years

44
Q

How many joints are involved in psoriatic arthritis?

A

Only one or a few, usually knees, small joints of the hands and feet

45
Q

What causes psoriatic arthritis?

A

Genetic and environmental factors

46
Q

What are the signs and symptoms of psoriatic arthritis?

A

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

47
Q

What is Reactive arthritis?

A

Aseptic arthritis causing joint pain and swelling triggered by an infection in another part of the body.

Clinical Medicine - OT (35 decks)

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