Arthritis

Question 1

What is the most common form of arthritis?

Answer 1

osteoarthritis

Question 2

What type of disorder is OA?d

Answer 2

degenerative due to imbalance between wear and repair of cartilage

Question 3

What may put people at a higher risk of OA?

Answer 3

previous fractures
Perthes disease
SUFE (slipped capital femoral epiphysis )
congenital disclocation of hip
cartilage injury
crystal arthropathy
Inflammatory arthritis
Meniscal tears
Genu varum or valgum

Question 4

Name the 4 typical radiographic findings of an osteoarthritic joint. (LOSS)

Answer 4

Loss of joint space
Osteophytes
Sclerosis
Subchondral cysts

Question 5

What is the most common seropositive inflammatory arthropathy?

Answer 5

RA

Question 6

What does RA most commonly affected?

Answer 6

small joints of hands and feet as well as cervical spine

Hipes, kneses shoulders and elbows can also be affected

Question 7

Is RA more common in men or women and by how much?

Answer 7

women are 2-3 times more likely

Question 8

What are CRP and ESR usually in RA?

Answer 8

raised

Question 9

List clinical features of RA.

Answer 9

morning stiffness
synovitis (doughy swelling)
pain
deformity
loss of function

Question 10

What can occur on the skin in RA?

Answer 10

cutaneous rheumatoid nodules

Question 11

How can internal organs be affected in RA?

Answer 11

rheumatoid lung, ischaemic heart disease

Question 12

What do X rays show in RA?

Answer 12

hypotrophic artritis:
no osteophytes, sclerosis or bone cysts
Instead - PERIARTICULAR EROSIONS

Question 13

What is seen on X ray in OA (what is the pictre type called)?

Answer 13

hypertrophic

Question 14

What operations may be performed for rheumatoid arthritis?

Answer 14

synovectomy
joint replacement
joint excision
tendon transfers
arthrodesis (fusion)
cervical spine stabilisation

Question 15

Which joints tend to be affected in SLE?

Answer 15

hands and knees

Question 16

What type of arthritis are spongyloarthropathies?

Answer 16

seronegative

Question 17

In what are patients often HLA-B27 positive on serological testing?

Answer 17

spongyloarthropathies

Question 18

What is ankylosing spondylitis?

Answer 18

chronic inflammatory disease of spine and sacro-iliac joints leading to eventual fusion of intervertebral joints and Sacro iliac joints

Question 19

Who is more likely be affected by AnkSpon, men or women?

Answer 19

men (3:1)

Question 20

What conditions are associated with AnkSpon?

Answer 20

aortitis, pulmonary fibrosis and amyloidosis

Question 21

What do X rays show in AnkSPon?

Answer 21

bony spures known as syndesmophytes which can make a bridge over the intervertebral disc, resulting in fusion, known as BAMBOO SPINE

Question 22

Is surgery commonly used in AnkSpon?

Answer 22

NO

Question 23

Is kyphoplasy to straighten the spine in AnkSpon commonly used?

Answer 23

No - iss controversial and carries considerable risk

Question 24

How common is psoriactic arthritis in people with skin psoriasis?

Answer 24

30%

Question 25

In what type of arthritis are there normally nail changes including pitting and onycholysis?

Answer 25

psoriatic

Question 26

What is the very aggressive type of psoriatic arthritis that 5% of patients have?

Answer 26

arthritis mutilans

Question 27

What does enteropathic arthritis involve?

Answer 27

spine and peripheral joints, occurring in patients with IBD, coeliac, bowel resections and some GI infections

Question 28

How many IBD sufferers will get enteropathic arthritis?

Answer 28

10-20%

Question 29

What is reactive arthritis?

Answer 29

occurs in response to infection in other part of body, eg GI or genitourinary Large joints around the KNEE become inflamed 1-3 weeks after the infection

Question 30

What is the triad of symptoms which may occur in reactive arthritis?

Answer 30

Reiter's syndrome: 1. urethritis 2. uveitis 3. arthritis

Question 31

What is gout?

Answer 31

a crystal arthropathy caused by deposition of urate crystals within a joint, usually due to hyperuricaemia

Question 32

What is uric acid the final compound in the breakdown of?

Answer 32

purines in DNA metabolism

Question 33

What may cause the yperuricaemia in gout?

Answer 33

``` renal underexcretion (eg caused by diuretics/renal failure) seafood, red meat, alcohol ```

Question 34

What can trigger the formation of uric acid crystals?

Answer 34

dehydration, trauma, surgery, chemotherapy

Question 35

What is the classic site of gout?

Answer 35

first MTP joint (known as Podagra)

Question 36

What are the two next most common sites of gout?

Answer 36

ankle and knee

Question 37

How does gout present?

Answer 37

intensely painful red hot swollen joint

Question 38

What are gouty tophi?

Answer 38

painless white accumulations of uric acid occurring in soft tissues and erupting through skin

Question 39

What can chronic gout result in?

Answer 39

destructive erosive arthritis

Question 40

What is the treatment for gout?

Answer 40

NSAIDs, corticosteroids, apioid analgesics and colchicine (if you can't tolerate NSAIDs)

Question 41

How is a definitive diagnosis of gout made?

Answer 41

``` polarized microscopy (uric acid crystals are needle shaped and display negative birefringence - change from yellow to blue) ```

Question 42

What can prevent recurrent attacks in gout?

Answer 42

allopurinol or probenecid (don't start until acute attack has settled)

Question 43

What is pseudogout?

Answer 43

crystal arthropathy causing acute arthritis caused by CALCIUM PYROPHOSPHATE crystals

Question 44

What term is used when calcium pyrophosphate deposition occurs in cartilage and other soft tissues in absence of acute inflammation?

Answer 44

chondrocalcinosis

Question 45

What is the umbrella term for chrondocalcinosis and pseudogout?

Answer 45

CPPD

Question 46

What does CPPD tend to affect?

Answer 46

knee, wrist and ankle

Question 47

What are the treatments for pseudogout?

Answer 47

NSAIDs, steroids, occassionly colchicine