Flashcards in arthritis Deck (25):
what does valgum and varum mean?
Valgus , where the distal bone is deviated laterally (e.g. knock-knees or genu valgum)
Varus where the distal bone is deviated medially (bow-legs or genu varum)
what might you think if you felt 'boggy' swellings in the joints?
what might you think if you felt 'bony' swellings in the joints?
Tell me about rheumatoid factor
Rheumatoid factors are detected by enzyme linked immunoabsorbent assay (ELISA).
RFs are antibodies (usually IgM, but also IgG or IgA) against the Fc portion of IgG. They are detected in 70% of people with rheumatoid arthritis (RA), but are not diagnostic.
RFs are detected in many autoimmune rheumatic disorders (e.g. SLE), in chronic infections, and in asymptomatic older people
tell me the characteristics of normal synovial fluid aspirated from a joint?
Normal fluid is clear and straw coloured and contains less than 3000 WBC/mm 3
tell me the characteristics of synovial fluid aspirated from a joint that may indicate inflammation?
Inflammatory fluid is cloudy and contains >3000 WBC/mm 3
tell me the characteristics of synovial fluid aspirated from a joint that may indicate septic arthritis?
Septic fluid is opaque and less viscous and contains up to 75 000 WCC/mm 3
what is first line pharmacological treatment of OA/
what are DMARDs?
disease modifying anti rheumatic drugs- to reduce severity of disease and improve prognosis= early intervention medication
what cytokines are principally involved in RA?
TNFa and IL1
what is often used to indicate progression from RA to chronic erosive RA?
antibodies to anti cyclic citrullinated peptides
what are the general temporal patterns of pain for degenerative OA and inflammatory RA?
OA- pain gets worse through the day and is relieved by rest'
RA- pain is worst in the morning, then gets better through the day with movement
general medical management of inflammatory arthritis?
NSAIDs, corticosteroids and DMARDs like methotrexate
what DMARDs would we use for mild to moderate RA, and for moderate to severe RA
mild to moderate= sulfasalazine or hydroxychloroquine
For moderate to severe= mono therapy of methotrexate or combination methotrexate, hydroxychloroquine and sulfasalazine
what are the diseases that comprise of spondyloarthritides?
-enteropathic arthritis associated with Crohn's disease and -ulcerative colitis
-juvenile-onset ankylosing spondylitis.
what are biological disease modifying anti rheumatic drugs?
TNFa inhibitors like rituximab
quick definition of RA
chronic systemic inflammatory disease characterised by symmetrical, deforming peripheral polyarthritis
what is palindromic RA?
what type of arthritis is reactive arthritis?
immune complex mediated arthritis
if you have a patient with RA and a patient with reactive arthritis, how would their symptoms differ?
both would present the same- as inflammatory arthritis
what are some symptoms of mechanical joint pain?
chronic pain, slowly worsening, worse with movement, improved by rest, not much swelling, little bit of stiffness
what the symptoms of inflammatory joint pain?
acute or subacute pain, may worsen quickly, better after movement, worse after rest, swelling often noticeable and may be prominent, stiffness may be prolonged (hours) and worse in the morning
how can you feel synovitis?
get the patient to make a fist and then look between the metacarpal heads.
what investigations would you do to test for RA?
serology! FBE, CRP, ESR, RF, ANA, anti CPA