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Int Spec (Rheumatology) > Arthropathies > Flashcards

Arthropathies Flashcards

1
Q

What type of infections commonly cause reactive arthritis? How long after the infection does the arthropathy occur?

A

GU (e.g. chlamydia/gonorrhoea) or GI (e.g. campylobacter/salmonella) - the arthropathy typically occurs 1-3 weeks after the infection

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2
Q

The diagnosis of rheumatoid arthritis is based on what 3 things?

A

Clinical presentation, serological analysis (inflammatory markers, autoantibodies, routine bloods) and radiographic findings

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3
Q

Name the 4 main symptoms of osteoarthritis?

A

Mechanical pain, crepitus, joint stiffness (usually < 30 minutes), bony swellings and deformities

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4
Q

How is psoriatic arthritis treated?

A

Symptomatic relief with painkillers, DMARD/biologic, often physiotherapy

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5
Q

Which joints of the hands are affected by rheumatoid arthritis?

A

PIPs and MCPs

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6
Q

Pain which is worse on activity, worse by the end of the day and relieved by rest is most likely to be caused by which type of arthropathy?

A

Non-inflammatory, typically osteoarthritis

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7
Q

Which antibody is specific for rheumatoid arthritis?

A

Anti-CCP

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8
Q

‘Pencil in cup appearance’ on x-ray is typical of which type of arthritis?

A

Psoriatic arthritis

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9
Q

Enteropathic arthritis is related to what condition? There may also be skin involvement, this is known as what?

A

IBD, skin involvement is known as pyoderma gangrenosum

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10
Q

What lifestyle advice should be given to someone suffering from gout?

A

Restrict alcohol/shellfish/red meat, keep hydrated, weight loss

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11
Q

Rheumatoid arthritis typically affects which joints?

A

Small joints of the hands and feet

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12
Q

In which joint does septic arthritis most commonly occur?

A

The knee

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13
Q

Which joints of the hands can be affected by osteoarthritis?

A

DIPs, PIPs and the first CMC

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14
Q

What are some of the nail changes mostly associated with psoriatic arthritis?

A

Pitting and onycholysis

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15
Q

Name some examples of extra-articular manifestations of rheumatoid arthritis?

A

Rheumatoid nodules, lung disease (interstitial fibrosis, pulmonary nodules), increased CV morbidity, eye disease (episcleritis, scleritis, uveitis)

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16
Q

What is the gold standard investigation for septic arthritis?

A

Joint aspirate for culture and gram stain (this should be taken before treatment is commenced)

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17
Q

How is ankylosing spondylitis treated?

A

Physiotherapy and NSAIDs for pain relief (anti-TNF biologics may be used in more severe disease)

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18
Q

What type of arthritis could typically be described as ‘asymmetrical oligoarthritis’?

A

Seronegative inflammatory arthropathies

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19
Q

What is the most common site to be affected by gout? What is this known as?

A

The first MTP- known as Podagra

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20
Q

When is the best time to measure serum urate?

A

2 weeks after an acute attack of gout

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21
Q

How is reactive arthritis treated?

A

Most cases are self-limiting- treat the underlying infectious cause and give symptomatic relief (DMARDs may be required in chronic cases)

22
Q

How is septic arthritis treated?

A

IV antibiotics and joint aspiration

23
Q

Ankylosing spondylitis is an inflammatory disease typically affecting where?

A

The spine and sacroiliac joints

24
Q

How is osteoarthritis managed?

A

Pain control (simple analgesics, mild opioids, IA steroids), physiotherapy and lifestyle factors e.g. weight loss and exercise. Surgery can be used as a last resort.

25
Q

What makes pseudogout different to gout?

A

It is caused by calcium pyrophosphate crystal deposition

26
Q

Pain from osteoarthritis of the hip can be felt where? Hip pain is often actually caused by osteoarthritis of where?

A

Pain from the hip is typically felt in the groin or radiating to the knee; pain in the hip is often actually coming from the lower back

27
Q

What is the most common organism causing septic arthritis? In a younger, sexually active individual, what other cause should always be considered?

A

Staph Aureus is most common overall, Neisseria Gonorrhoeae should always be considered

28
Q

What are some risk factors for the development of gout?

A

Renal failure, diuretic use, high alcohol/red meat/seafood intake

29
Q

What are some features of ankylosing spondylitis which may be seen on examination?

A

‘Question mark spine’ due to loss of lumbar lordosis and increased thoracic kyphosis, and a decreased Schober’s test

30
Q

What investigations are used in suspected reactive arthritis, which would not be necessary in the investigation of other seronegative inflammatory arthropathies?

A

Urine, blood and stool cultures, joint fluid analysis

31
Q

What are the 4 typical x-ray findings of osteoarthritis?

A

Loss of joint space, osteophytes, sclerosis, subchondral cysts

32
Q

Rheumatoid arthritis is an autoimmune disease which is mediated by which HLA type?

A

HLA-DR4

33
Q

The seronegative inflammatory arthropathies are related to which HLA type?

A

HLA-B27

34
Q

How is osteoarthritis usually diagnosed?

A

History, examination and typical x-ray findings

35
Q

Gout usually presents with a hot, tender, red, swollen joint. What is the most important differential of this and what is the gold standard investigation to differentiate the two?

A

Septic arthritis, requires joint aspirate for cultures, gram stain and polarised microscopy

36
Q

How is rheumatoid arthritis treated?

A

Symptomatic relief with painkillers, DMARD/biologic, often physiotherapy

37
Q

How is pseudogout treated?

A

NSAIDs, steroids and sometimes colchicine (there is no medication to prevent recurrence)

38
Q

How would uric acid crystals be described when seen under polarised microscopy?

A

Needle shaped crystals which display negative birefringence

39
Q

What are the 4 main features of seronegative inflammatory arthropathies?

A

Sacroiliitis, dactylitis, uveitis, enthesitis

40
Q

What triad of symptoms makes up Reiter’s syndrome?

A

Uveitis/conjunctivitis, reactive arthritis and urethritis

41
Q

What are the 4 seronegative inflammatory arthropathies?

A

Ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis, reactive arthritis

42
Q

What are 3 key features of septic arthritis?

A

High fever, non-weight bearing, raised inflammatory markers

43
Q

Bony enlargements can be seen on the hands of people with osteoarthritis. What are these known as and where are each of them found?

A

Heberden’s nodes (DIPs) and Bouchard’s nodes (PIPs)

44
Q

‘Peri articular erosions’ is an x-ray finding in which disease?

A

Rheumatoid arthritis (usually later stage)

45
Q

If there has been 2 or more attacks of gout in 6 months, a person usually qualifies for urate lowering therapy. What two drugs can be used for this?

A

Allopurinol or febuxostat

46
Q

How is enteropathic arthritis treated?

A

Usually with immunosuppressants which control both conditions at once

47
Q

Which type of arthritis could be described as an ‘autoimmune symmetric polyarthropathy’?

A

Rheumatoid arthritis

48
Q

Which condition will show rhomboid/envelope shaped crystals with weakly positive birefringence on joint aspirate?

A

Pseudogout

49
Q

What are the treatments for acute gout?

A

NSAIDs (usually naproxen) or colchicine if NSAIDs are contraindicated (there may also be a role for IM/IA steroids)

50
Q

What is Felty’s syndrome?

A

A triad of rheumatoid arthritis, splenomegaly and neutropenia

51
Q

How should an acute flare up of rheumatoid arthritis be treated?

A

Oral or IM steroids (methylprednisolone)

Int Spec (Rheumatology) (6 decks)

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