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MBBS - Year 1 > Clinical skills - Infl Arthritis > Flashcards

Clinical skills - Infl Arthritis Flashcards

1
Q

Polyarticular pain

A

Pain in at least 4 joints

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2
Q

Arthralgia

A

Aching in joints without swelling

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3
Q

Characteristics of infl arthritis

A

Early morning and inactivity stiffness - generally >1 hr, averages 3 hrs in RhA and parallels degree of joint infl
Systemic symptoms e.g lethargy, wt loss, pyrexia

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4
Q

Why we distinguish between infl and non-infl

A

Infl is potentially more serious
Many forms have systemic manifestations
Early recognition & intervention improves outcome

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5
Q

Common types of arthritis

A

Acute (self-limiting) infl

Chronic infl

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6
Q

Acute (self-limiting) infl arthritis

A

Infection related, viral e.g Rubella, Hep B, Streptococcus

Goes away by itself

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7
Q

What does acute infl arthritis present with

A

Sudden onset
Fever and systemic upset
Variable severity
6-12 weeks duration

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8
Q

Types of chronic infl arthritis

A 
RhA (lasts more than 6 weeks)
SpA - psoriatic, axial SpA
Crystal arthritis - Gout, CPPD
Connective tissue disease e.g. SLE, polymyostis
Others e.g sarcoid
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9
Q

OA aetiology - secondary

A 
Trauma 
Congenital disorders 
Metabolic 
Endocrine 
Neuropathic 
Paget's 
Infl arthritis
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10
Q

Clinical features of OA

A 
Pain - activity related 
Transient morning/ inactivity stiffness 
Joint enlargement 
Limitation of movement 
Muscle atrophy 
Crepitus
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11
Q

OA distribution

A 
DIP > PIP > MCP (v common)
CMC thumb - squaring 
AC shoulder 
Hips 
Knees 
MTP Feet 
Facet
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12
Q

Classification criteria for RhA

A

4/7 criteria = RhA

Morning stiffness > 1hr
Arthritis of >3 joint areas 
Hand involvement 
Symmetry 
Nodules 
Radiographic erosions 
RhF +ve

First 4 need to have been for 6 weeks

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13
Q

Clinical features of spondylarthrosis

A 
Uveitis 
Psoriasis 
Hip arthritis 
Peripheral arthritis 
Dactylitis 
Enthesitis 
Psoriatic nail changes
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14
Q

Epidemiology of SpA

A

Slightly less common than RhA
Prevalence 0.5-1%
Caucasion > Asian > Afro-Caribbean

Proportional to freq of HLA-B27

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15
Q

Psoriatic arthritis

A

Arthritis usually follows but may precede psoriasis
Severity of joint and skin disease independent
Nail involvment in 80% and only 20% of psoriasis alone
Good prognosis esp in pauciarticular disease

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16
Q

Clinical subsets of arthritis

A 
Monoarthritis/ oligoarthritis 
Asymmetrical polynarthritis (DIP predominant)
'Rheumatoid' polyarthritis 
Psoriatic spondylitis 
Arthritis mutilans
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17
Q

Hx in polyarthritis

A 
Age 
Sex 
Mode of onset 
Severity of joint infl - intensity and no. swollen joints 
Temporal pattern of joint involvement 
Distribution of joint involvement
Rheumatology hx
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18
Q

Distribution of joint involvement in polyarthritis

A

Small joint: MCP - RhA, DIP and PIP - OA

Large joint: Hip and foot - SpA or crystal

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19
Q

Lab investigations in polyarthritis

A 
FBC 
ESR and CRP 
RhF, ANA, anti-CCP, HLA-B27
Uric acid 
Synovial fluid analysis
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20
Q

Radiology for polyarthritis

A

X-ray
Ultrasound
MRI

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21
Q

Classification of spondylarthrosis

A 
Axial SpA
Reactive arthritis 
Psoriatic arthritis
Enteropathic arthritis
Undifferentiated spondylarthritis
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22
Q

Concepts of familial disease in poly arthritis

A

Most of the arthritis “run in families”
Very few directly inherited
Many associated w/ HLA e.g. DR4 - RA, GCA & B27 - AS, spondyloarthritidies

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23
Q

HLA-B27 associated SpA’s

A 
Ankylosing spondylitis 
Psoriatic arthritis 
Juvenile SpA
Arthritis associated w/ IBD
Reactive arthritis 
Undifferntiated SpA
Acute Anterior Uveitis
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24
Q

Criteria for ankylosing spondylitis/ Axial SpA

A

Sacroilitis at least grade 2 bilaterally or grades 3/4 unilaterally
Low back pain and stiffness for <3 months that improves w/ exercise but isn’t relieved by rest
Limitation of motion of the lumbar spine in both the sagittal and frontal planes
Limitation of chest expansion relative to normal values correlated for age and sex

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25
Q

Infl back pain (spondylitis) clinical features

A 
Gradual onset 
Early morning/ rest stiffness 
Better w/ movement 
No radical signs 
Usually at young(er) age 
Good response to NSAID
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26
Q

Long term features and complications of ankylosing spondylitis

A

Lung, heart, renal complications and osteoporosis usually late (>20yrs)
Slowly evolving, progressive spinal stiffness causing functional difficulties

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27
Q

Constitutional symptoms of ankylosing spondylitis

A 
Fatigue 
Pyrexia 
Wt loss 
Anaemia 
Increased ESR (20%)
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28
Q

Pathogenesis and radiology findings of SpA

A

Infl - bone marrow, oedema, erosions

New bone: shiny corners, fusion by syndesmophytes, ossification

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29
Q

Ossification

A

Natural process of bone formation

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30
Q

Investigations of ankylosing spondylitis

A

FBC, ESR/CRP
X-ray of SI joint
MRI

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31
Q

Treatments of ankylosing spondylitis

A

Diagnosis and monitoring disease activity to prevent development of deformities
Patient + physiotherapist to treat
NSAIDs biologic
DMARDs for peripheral joints only

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32
Q

Axial SpA treatment

A 
NSAIDs
Exercise 
Limited DMARD use 
Anti-TNF
Secukinumab AS only 
BASDAI, BASMI, BASFI
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33
Q

BASDAI

A

Determines effectiveness of drug being used to treat

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34
Q

BASMI

A

Assesses spinal mobility

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35
Q

BASFI

A

Assesses functional limitations

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36
Q

ReA

A

Reactive arthritis - a sterile joint infl that develops after a distant infection
Systemic
Triggering infections usually in throat, urogenital or GI tracts
May be no preceding infection

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37
Q

Clinical features of ReA

A

Hx of infection up to 2 weeks prior
Family Hx
Infections

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38
Q

Infections seen in ReA

A

GI
Urogenital
Others e.g. meningococci, streptococci, staph

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39
Q

GI infections seen in ReA

A

Salmonella
Shigella
Yersinia
Campylobacter

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40
Q

Urogenital infections seen in ReA

A

Chlamydia

Neisseria

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41
Q

Systemic symptoms of ReA

A

Malaise
Fatigue
Pyrexia

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42
Q

Joint and muscle symptoms of ReA

A

Arthralgia –> disabling polyarthritis
Asymmetric
Mono/ oligo arthritis (in 85% of pts)
Large joints

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43
Q

Extra-articular MSK manifestations of ReA

A

Tenosynovitis
Enthesopathy
Plantar fasciitis
Achilles tendinitis

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44
Q

Examination of joints in ReA

A

Red and warm
Shifting pattern
Dactylitis
Low back pain in chronic disease

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45
Q

Investigations of ReA

A 
FBC 
Urea and electrolytes (U&E)
Liver function tests (LFT)
CRP
ESR 
RhF
Urinalysis 
Blood cultures
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46
Q

Investigation of synovial fluid in ReA

A

Gram stain
Polarised light microscopy
Culture
PCR

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47
Q

GI symptoms in ReA

A

Abdo pain

Diarrhoea

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48
Q

Management of acute ReA

A 
Analgesia 
NSAIDs
Steroids
Abx?
Rest 
Splinting 
Rehab
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49
Q

Management of chronic ReA

A

Arthralgia - NSAIDs
Physio
DMARDs

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50
Q

Differential diagnosis of ReA

A

Septic arthritis
Crystal arthritis
Psoriatic spondyloarthropathies

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51
Q

Psoriatic arthropathy presentation

A 
Asymmetrical oligoarthritic: 30-40%
Symmetrical polyarthritis: 30%
DIP joint predominant: 10-15% 
Spondoarthritis: 10-20% 
Mutilans: <10%
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52
Q

Treatment of psoriatic arthritis

A

NSAIDs
SZP, MTX, LFN, CyA, apremilast
Biologics incl anti TNF, use kunumab
Physio/ OT/ Education

In some patients skin activity mirrors joint activity, therefore treat skin, joints improve

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53
Q

Enteropathic arthritis

A

Mainly ulcerative colitis and Crohn’s disease
Often arthritis and gut symptoms linked
Associated w/ extra-intestinal manifestations of iBD

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54
Q

Lab tests for RhA

A

FBC
ESR, CRP
RhF - found in 80%
Anti-CCP

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55
Q

Predictive variables for erosions in RhA

A

RhF
2 or more swollen large joints
Disease duration > 90 days

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56
Q

Risk factors for development of RhA

A 
Cigarette smoking 
Obesity 
Immunisation 
Blood transfusion 
Previous termination of pregnancy
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57
Q

Treatment of mild RhA

A

NSAIDs

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58
Q

Treatment of moderate RhA

A

DMARDs

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59
Q

Treatment of severe RhA

A

Combination therapy

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60
Q

Effective DMARDS

A 
Methotrexate 
Salazopyrine (SZP)
Hydoxychloroquinone
Leflunomide 
Corticosteroids 
Ciclosporin 
Gold 
Azathioprine
Cyclophophamide
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61
Q

Predictors of a poor prognosis in RhA

A 
RhF 
Anti-CCP 
Baseline radiological score 
Nodules 
Acute phase proteins 
HAQ score 
Grip strength 
Swollen joint count
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62
Q

Biologics used to treat RhA

A 
Anti - TNF 
Rituximab 
Abatacept 
Tocilizumab 
JAK inhibitors
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63
Q

When will you be eligible for biologic treatment for RhA

A

2 or more DMARDs incl methotrexate must be proven inadequate

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64
Q

Surgeries to treat RhA

A 
Arthroplasty 
Synovectomy 
Tendon rupture
Entrapment neuropathy 
Cervical decompression for myelopathy
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65
Q

DMARDS for spondyloarthropies

A

Effectivity has only been proven in the legs - not for use in the spine of sacroiliac joints

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66
Q

Examples of TNF Alpha blockers

A

Infliximab
Etanercept
Adalimumab
Certolizumab peg

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67
Q

Dosage of inflliximab

A

5mg/Kg Iv for 6-8 weeks

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68
Q

Dosage of Etanecerpt

A

25mg subcutaneously 2x a week

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69
Q

Dosage of Adalimumab

A

40 mg via injections every 2 weeks

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70
Q

Surgeries used to spondyloarthropies

A

Total hip replacement
Surgical spine fusion
Correction of spine deformities

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71
Q

Physical therapies used to treat spondyloarthropies

A 
Physio
Flexibility training 
Spa - exercise 
Swimming 
Walking
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72
Q

Causes of chronic infl

A

Persistent infections
Hypersensitivity diseases
Exposure to toxic agents
Primary granulomatous disease

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73
Q

Cell mediators involved in chronic infl

A 
Histamine 
Serotonin 
Prostaglandin 
Leukotrienes 
Platelet-activating factor 
ROS 
Nitric oxide 
Cytokines 
Chemokines
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74
Q

Histamine in chronic infl

A

Vasodilation
Increased vascular permeability
Endothelial activation

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75
Q

Serotonin in chronic infl

A

Vasoconstriction

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76
Q

Prostaglandins in chronic infl

A

Vasodilation
Pain
Fever

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77
Q

Examples of growth factors

A 
EGF 
TGF - alpha and beta 
PDGF 
FGF
ILGF
TNF
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78
Q

EGF

A

Epidermal growth factor

Regenberation of epithelial cells

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79
Q

TGF - alpha

A

Transforming growth factor - alpha

Regeneration of epithelial cells

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80
Q

TGF - beta

A

Transforming growth factor - beta
Stimulates fibroblast proliferation and collagen synthesis
Controls epithelial regeneration

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81
Q

PDGF

A

Platelet derived growth factor

Mitogenic and chemotactic for fibroblasts and smooth muscle cells

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82
Q

FGF

A

Fibroblast growth factor
Stimulates fibroblast proliferation
Angiogenesis
Epithelial cel regeneration

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83
Q

ILGF

A

Insulin like growth factor

Synergistic effect with other growth factors

84
Q

TNF

A

Tumour necrosis factor

Stimulates angiogenesis

85
Q

Granulomas

A

Multinucleate giant cell

Macrophages and lymphocytes combined

86
Q

Types of granulomas

A

Immune granulomas

Foreign body granulomas

87
Q

Immune granulomas

A

Produced when the agent can’t be readily eliminated

Macrophages active T cell cells to produce IL2 and interferon gamma

88
Q

Foreign body granulomas

A

Response to foreign bodies without T-cell mediated immune response
Form around materials e.g. sutures, fibres
Giant cells attach to the surface of the foreign body

89
Q

Reiter’s syndrome

A

Conjunctivitis, uveitis and arthritis

Presents in ReA

90
Q

Enthesitis

A

An infl of the ligament, tendon, joint capsule or fascia insertion site into the bone
Hallmark of SpA

91
Q

What does enthestis cause

A

Heel pain
Metatarsalgia
Iliac spine pain

92
Q

Dactylitis

A

‘Sausage fingers and toes’

Caused by arthritis, ethesitis and tendinitis

93
Q

Circulate balanitis

A

Painless, ulceration of the glans penis which rupture to form superficial erosions - some w/ circular patterns
Can accompany uveitis

94
Q

Keratoderma blennorrhagia

A

Psoriasform lesions occurring on the palms of the hands and soles of feet

95
Q

X rays in ReA

A

Fluffy periostitis
Plantar spurs
Periarticular osteoporosis

96
Q

Examples of corticosteroids

A

Prednisolone

Methylpredisolone

97
Q

Cautions when taking corticosteroids

A

Blurry vision

Suppression of immune system

98
Q

How can methotrexate be administered

A

Orally or via a subcutaneous injection

99
Q

Prescription of methotrexate

A

Fixed once weekly dose of 7.5mg and can be increased to 20mg

100
Q

What is prescribed alongside methotrexate

A

Folic acid - don’t take on same days

Counteracts strong effects of MTX - reduced absorption of vit B

101
Q

What has to be reduced when taking methotrexate

A

Alcohol intake

Both are processed in the liver –> overworking

102
Q

Side effects of methotrexate

A 
Myelosuppression
GI problems e.g nausea, vomiting, diarrhoea
Pneumonitis 
Mucositis 
Affects liver function (carry out LFT)
Pulmonary fibrosis
103
Q

Sulfasalazine dosage

A

Start with one tablet 500mg daily —> increase 500mg each week until 2-3g daily is reached (2-4 weeks)

104
Q

Half life of SSZ

A

Relatively short, 4-5 hrs

Doesn’t cause large immunosuppressive response and can be used perioperatively

105
Q

SSZ facts

A

Can be found in liquid and tablet form (enteric coated)
Often prescribed alongside MTX in combination therapy
6-8 weeks to notice effects of drug
Can be used during pregnancy, unlike MTX
Monthly blood tests and LFT’s required

106
Q

Side effects of SSZ

A 
Hypersensitivity 
GI problems *
Nausea *
Proteinuria
Skin rash 
Headaches 
Reduced sperm count
Can cause orange staining of contact lenses
107
Q

Proteinuria

A

Bright, orange urine

108
Q

Prodrug

A

Remains inactive until its taken e.g leflunomide

109
Q

Mechanism of LEF

A

Affects the rate limiting step in the synthesis of pyrimidines preventing activate lymphocytes progressing from the G1 to S phase in cell division —> cell apoptosis

110
Q

Initial prescription of LEF

A

10-20mg daily
Take 4-6 weeks to have effect
Requires FBC every 2 weeks

111
Q

Side effects of LEF

A 
Diarrhoea 
Increased liver enzymes 
Increased bp 
Shortness of breath 
Skin reactions
112
Q

Pros of biologics

A

Treatments specialised to a spp drug target

113
Q

Cons of biologics

A

V expensive

114
Q

Biologics

A

Protein-formed drugs which have the ability to block the activity of certain mediators involved in infl
Administered via subcutaneous or iv methods (increases risk of infection)

115
Q

Eligibility for biologics

A

Patient must score 5.1 or higher using DAS 28

Two DMARD treatments must have failed

116
Q

Side effects of biologics

A

Headaches
Abdo pain
Nausea
Adverse skin reactions at site of injection

117
Q

JAK inhibitors

A

Synthetic DMARDS which target tyrosine kinase (TK) –> reduces infl

118
Q

Tyrosine kinase

A

Important mediator of pro-infl cytokines

119
Q

Examples of JAK inhibitors used to treat RhA

A

Tofacitinab

Baricitinib

120
Q

Examples of Anti-TNF drugs

A

Adalimumab
Etanecerpt
Infliximab
Golimumab

121
Q

Extra-articular features of RhA

A

Rh nodules
Tensoynovitis and Bursitis
Carpal Tunnel syndrome
Muscle wasting

122
Q

Rheumatoid nodules

A

Firm subcutaneous nodules found in around 20% of patients with RhA

123
Q

Tenosynovitis and Bursitis

A

Tendon sheaths and bursae are lined with synovium and can therefore become inflamed in RhA

124
Q

Lyme disease

A

Vector-borne disease

Example of zoonosis: pathogen moved from animal to human

125
Q

Cause of lyme disease

A

Bacterial infection (Borrellia) from the bite of an infected tick that has infected another animal

126
Q

Presentation of typical tick bite

A

Red rash

Bullseye appearance

127
Q

Symptoms of Lyme disease

A 
Flu like symptoms 
Pain/ swelling around tick bite mark 
Headaches 
Lethargy 
Muscle pain/ feeling of weakness 
Articular pain
128
Q

Late manifestation of Lyme disease

A

Lyme arthritis - similar to OA and affects large joints

129
Q

Treatment of Lyme disease

A

Doxycycline 200mg daily but can also give amoxicillin and ceftriaxone

130
Q

Where do Rh nodules develop in

A

Areas affected by pressure or friction, such as the DIP, PIP elbows and Achilles tendon and tend to suggest more severe disease.

131
Q

5 common fracture cases

A 
Wrist fracture 
Proximal humerus 
Clavicle 
Ankle fracture 
NOF
132
Q

Colles’ fracture

A

Distal radius fracture
Result of FOOSH
Bone points upward to thumb
Hand points up

133
Q

Smith’s fracture

A

Hand points down
Fracture of distal radius
Forced pronation

134
Q

Jones’ fracture

A

Fracture to base of 5th metatarsal

135
Q

Examination findings of RhA

A

Swelling of 3 or more joint - specificity of 73%
Tenderness largely along the joint line
Synovitis
+ve squeeze test

136
Q

What does synovitis produce

A

A ‘boggy’ or ‘doughy’ swelling which may be subtle

137
Q

Squeeze test

A

Pain on gently squeezing the MCP or MTP joints together

138
Q

What are we aiming for in RhA management

A 
Minimising joint pain and swelling 
Preventing deformity (e.g. ulnar deviation) and radiographic damage (e.g. erosions)
Maintaining quality of life (personal and work)
Controlling extra-articular manifestations
139
Q

Examples of immunosuppressive therapy

A 
Azathioprine 
Cyclophosphamide 
Ciclosporin 
Mycophenate mofetil 
Tacrolimus
140
Q

Features of immunosuprresive therapy

A

Also suppresses arthritis organ involvement in SLE and vasculitis
Many have steroid sparing effects
Musts be taken in pregnancy

141
Q

Role of TNF in RhA

A

Mediates pathologic infl
Mediates joint destruction
Mediates systemic, extra-articular symptoms of infl
Regulates levels of adhesion molecules responsible for leukocyte migration

142
Q

Intra articular injection

A

Combination of corticosteroids and local anaesthesia
Diagnostic and therapeutic as will show pain in knee is caused by hip arthritis
Can last few weeks to few months

143
Q

Screening for infl spine disease

A

Ask about ems >30 mins
Relieved w/ exercise and NOT rest
Alternating buttock pain
2 sero-ve clues and HLA-B27 +ve

144
Q

Age of onset in infl back pain vs mechanical

A

<40 vs any age

145
Q

Symptom duration of infl back pain vs mechanical

A

> 3 months vs <4 weeks

146
Q

Ems in infl back pain vs mechanical

A

> 60 mins vs <30 mins

147
Q

Nocturnal pain in infl back pain vs mechanical

A

Frequent vs infrequent

148
Q

Sacroiliac joint tenderness in infl back pain vs mechanical

A

Frequent vs absent

149
Q

Exercise improvement in infl back pain vs mechanical

A

Improvement vs NO improvement

150
Q

Examination for infl spinal disease - Look

A

Inspection from back - swelling, deformity (scoliosis/ curvature), muscle wasting (spine of scapula becomes v prominent, intercostal muscles), symmetry of chest wall
Inspection from side - curvature of the spine (scoliosis, kyphosis, lordosis)

151
Q

Examination for infl spinal disease - Feel

A

Tenderness in spine
Sacroiliac joint - dimples of Venus (posterior superior iliac spine)
Palpate paraspinal muscles

152
Q

Examination for infl spinal disease - Move

A

Forward flexion of upper thoracic spine and neck
Extension of upper thoracic spine
Lateral flexion
Flexion of neck
Lateral rotation of neck
Lateral rotation of spine (done at end of measurements)

153
Q

Testing extension in infl spinal disease

A

Stand behind patient and fix the pelvis with one hand and the other on shoulder
Patient leans backwards

154
Q

Testing lateral flexion in infl spinal disease

A

Bending with hands by sides, as if trying to touch floor

155
Q

Testing flexion of neck

A

Looking up and down

156
Q

Testing lateral rotation of neck

A

Touching ear to shoulder

157
Q

Testing lateral rotation of spine

A

Patient sitting in the chair with arms in an X-formation and hold them from the shoulders

158
Q

Examination for testing for infl spine disease - Measurements

A

Occipital bone to wall distance
Tragus to wall distance
Chest expansion
Lateral flexion

159
Q

What should the occipital bone to wall distance be

A

0

Higher in those w/ AS

160
Q

What should the tragus to wall distance be

A

<15 cm

161
Q

Measuring chest expansion

A

Find 4th intercostal space (usually at nipple)
Measure circumference of chest before and after patient takes a deep breath
Take 3 measurements and find avg of the differences

162
Q

Measuring lateral flexion

A

From middle finger to floor, normal and flexed

Difference should be >10 cm

163
Q

Schober’s test

A

Tests for lumbar flexion: should be >5 to get -ve result
Place finger at level of posterior iliac spine (approx. L5) and mark 5cm below and 10cm below
Ask patient to bend over and measure difference between two markings

164
Q

Intermallelolar distance

A

Patient stands with legs spread as wide as possible

Distance between both medial malleoli should be >100 cm

165
Q

Main extraskeletal manifestation of AS

A

Aortic insufficiency, ascending aortitis, conduction abnormalities
Pulmonary – upper lobe fibrosis, restrictive changes
Ocular – anterior uveitis

166
Q

Indications of methotrexate

A

Infl arthritis
Psoriasis
Some chemo acute lymphoblastic leukemia

167
Q

Monitoring of methotrexate

A

FBI, U&E and LFTs weekly until therapy stabilised and then every 2-3 months

168
Q

Interactions w/ methotrexate

A

Avoid trimethoprim or co-trimaxozele

High dose aspirin increases the risk of toxicity

169
Q

Myelosuppression

A

Decrease in red blood cells, platelets and white cell (pancytopaenia) and results in myelosuppression
Commonly caused by methotrexate

170
Q

Thrombocytopenia

A

Low levels of platelets

171
Q

Agranulocytosis

A

Reduction in the granulocytes

172
Q

Granulocytes

A

Neutrophils
Eosinophils
Basophils

173
Q

Mechanism of NSAIDs

A

Inhibiting cyclo-oxygenase enzymes thus reducing the production of key mediators of infl (prostaglandins)
Antipyretic action as PGE2 is involved in the thermoregulation centre in the hypothalamus

174
Q

Important and common side-effects of NSAIDs

A

Peptic ulceration

Exacerbation of asthma

175
Q

COX-2 selective NSAIDs

A

Celecoxib

Etoricoxib

176
Q

Aspirin

A

Non-reversible COX 1 and 2 inhibitor

177
Q

Tests helping choose ddx for infl joint pain

A

Anti-CCP antibody – if elevated will increase chance of rheumatoid arthritis
Serum urate/uric acid – if elevated will increase chance of gout
Synovial fluid aspirate for uric acid crystals – if present will confirm diagnosis of gout
Pain radiographs of hands or feet – presence and pattern of erosions may support RA, psoriatic arthritis or gout.
Swabs or blood cultures or stool cultures – to support active distant infection

178
Q

X-rays for ankylosing spondylitis

A

Loss of cortical margins (blurring of vertebral rims at thoracolumbar junction), widening of the joint space, sclerosis, ‘squaring’ of vertebrae, syndemsophytes

179
Q

MRI in ankylosing spondylitis

A

Sclerosis
Ankylosis
Bone marrow oedema (shows active infl)

180
Q

Features of spondyloarthritides

A

Seronegativity; -ve RhF
HLA B27 association ‘Axial arthritis’ Asymmetrical large-joint oligoarthritis (<5 joints) or monoarthrits
Enthesitis
Dactylitis

181
Q

Examples of enthesitis seen in spondyloarthritides

A

Plantar fasciitis
Achilles tendonitis
Costochondritis

182
Q

Cause of dactylitis

A

Soft tissue oedema and tenosynovial and joint infl

183
Q

Squaring of spine - AS

A

Bamboo spine, calcification of ligaments w/ ankylosis

184
Q

Syndesmophytes - AS

A

Bony proliferations due to enthesitis between ligaments and vertebral bodies

185
Q

Disease progression of AS

A

Variable:
Kyphosis
Neck hyperextension (question mark posture)
Spina-cranial ankylosis

186
Q

Prognosis of AS

A

Bad if onset is after 16yrs, early hip involvement or poor response to NSAIDs

187
Q

‘Axial arthritis’

A

Spine and SI joints

188
Q

X-ray features of RhA

A

Juxta-articular osteopenia
Soft tissue swelling
Joint deformity
Loss of joint space

189
Q

X-ray features of gout

A

Periarticular erosions
Normal joint space
Soft tissue swelling

190
Q

Likely causes for back pain in 15-30 age group

A 
Prolapsed disc
Trauma
Fractures
Ankylosing spondylitis
Pregnancy
191
Q

Likely causes for back pain in 30-50 yrs age group

A

Degenerative spinal disease
Prolapsed disc
Malignancy (1’ or 2’ from big 5)

192
Q

Likely causes for back pain in those 50+

A 
Degenerative
Osteoporotic vertebral collapse
Paget’s
Malignancy
Spinal stenosis
Myeloma
193
Q

Spinal stenosis

A

Narrowing of the spine one or more of three parts:
The space at the centre of the spine.
The areas where nerves branch out from the spine to other areas of the body.
The space between the bones of the spin

194
Q

What is spinal stenosis often caused by

A

OA

195
Q

Main symptoms of spinal stenosis

A

Pain
Numbness
Weakness
Tingling sensation in one or both legs - can make walking difficult and painful

196
Q

Abx for septic arthritis

A

Given by IV for 2 week and followed by 4-6 weeks of oral

197
Q

Haemarthrosis

A

Bleeding into joint spaces
Can happen very soon after joint replacement
Presents as warm and erythematous

198
Q

RhA presentation in feet

A

Loss of the longitudinal arch, together with pes planus (caused by valgus deformity of the subtalar joints)

199
Q

Rheumatoid hand

A 
Boutonnieres 
Ulnar deviation of fingers 
Radial deviation of MCPs
Swan neck deformity 
Dorsal subluxation in distal ulnar 
Muscular atrophy
200
Q

Causes of high RhF

A 
SLE 
Sjrogens 
Chromic active hepatitis 
Bacterial endocarditis 
Lymohoma 
TB 
Malaria 
Myeloma
201
Q

Side effect of long term prednisolone

A

Avascular necrosis of femoral head

202
Q

By how much does RhA decrease leg expectancy

A

~ 8-15 yrs

203
Q

When must biologics be stopped

A

Before surgery

Do not restart until off of abx

204
Q

What causes telescoping

A

Arthritis mutilans

PsA

205
Q

Felty’s syndrome

A

Seen in RhA

Splenomegaly and neutropenia

206
Q

Side effects of ciclosporin

A

HTN
Tremulousness
Gingival hypertrophy

MBBS - Year 1 (93 decks)

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