Week 7 - Inflammatory Joint Disease

Question 1

What is rheumatoid arthritis?

Answer 1

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.

Question 2

What are the 4 stages of RA?

Answer 2

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

Question 3

What is synovitis in RA?

Answer 3

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

Question 4

What is pannus in RA?

Answer 4

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

Question 5

What is fibrous anklosis in RA?

Answer 5

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

Question 6

What is bony anklosis in RA?

Answer 6

The bones then fuse together

Question 7

What is IL-1?

Answer 7

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

Question 8

What are the criteria for diagnosis of RA?

Answer 8

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

Question 9

What is the second most common form of arthritis?

Answer 9

RA

Question 10

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

Answer 10

Females 3:1

Question 11

What age does RA usually appear?

Answer 11

40-60 years

Question 12

What are associated symptoms of RA?

Answer 12

Fever
Fatigue
Malaise

Question 13

What are the symptoms of RA?

Answer 13

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

Question 14

What are the presenting signs of RA in the hands?

Answer 14

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

Question 15

How is RA managed?

Answer 15

Medications - NSAIDs, corticosteroids
PT
OT
SP
Surgery

Question 16

What is a fatal complication of RA?

Answer 16

C1-C2 instability

Question 17

What is gout?

Answer 17

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

Question 18

What is the most common joint affected by gout?

Answer 18

The MTP joint of the big toe (hallux)

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

Question 19

What us the hallmark characteristic of gout?

Answer 19

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

Question 20

How does gout present?

Answer 20

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

Question 21

What triggers gout?

Answer 21

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

Question 22

How is gout diagnosed?

Answer 22

Aspiration of joint fluid

24 hour urine test showing uric acid concentration

Question 23

How is gout managed?

Answer 23

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

Question 24

What is fibromyalgia?

Answer 24

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

Question 25

Does fibromyalgia affect more men or women?

Answer 25

Women 4:1

Question 26

What age is fibromyalgia usually diagnosed?

Answer 26

Over 50 years

Question 27

How is fibromyalgia diagnosed?

Answer 27

Diagnosis of exclusion including X-rays and blood tests

Question 28

What are the clinical features of fibromyalgia?

Answer 28

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

Question 29

What are the signs of fibromyalgia?

Answer 29

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

Question 30

How is fibromyalgia managed?

Answer 30

Medication Exercise Pain relief Lifestyle management

Question 31

What is polymyalgia rheumatica?

Answer 31

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

Question 32

What are the symptoms of polymyalgia rheumatica?

Answer 32

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

Question 33

What is Giant Cell Arteritis?

Answer 33

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

Question 34

What are the signs of Giant Cell Arteritis?

Answer 34

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

Question 35

How is polymyalgia rheumatica managed?

Answer 35

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

Question 36

What is spondyloarthropathies?

Answer 36

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.

Question 37

What are the 5 Spondyloarthopathies?

Answer 37

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

Question 38

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

Answer 38

True

Question 39

What is Ankylosing spondylitis?

Answer 39

An inflammatory arthritis affecting the spine and large joints.

Question 40

How does Ankylosing spondylitis occur?

Answer 40

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.

Question 41

How is Ankylosing spondylitis diagnosed?

Answer 41

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

Question 42

What is Psoriatic arthritis?

Answer 42

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

Question 43

What age group is predominantly diagnosed with psoriatic arthritis?

Answer 43

20-50 years

Question 44

How many joints are involved in psoriatic arthritis?

Answer 44

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

Question 45

What causes psoriatic arthritis?

Answer 45

Genetic and environmental factors

Question 46

What are the signs and symptoms of psoriatic arthritis?

Answer 46

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

Question 47

What is Reactive arthritis?

Answer 47

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