Arthritis Flashcards
(206 cards)
1
Q
‘Symmetrical inflammatory arthritis affecting the peripheral joints’ is what?
A
Rheumatoid arthritis
2
Q
What problems occur if RA is left untreated?
A
Deformities, joint damage and loss of function
3
Q
As well as the joints, RA can also cause inflammation in organs. True or false?
A
True
4
Q
Which sex is more likely to suffer from RA? By how many times?
A
Women are 3 times more commonly affected than men
5
Q
What age group does RA affect?
A
Any age group
6
Q
What is RA known as when it occurs in under 16s?
A
Juvenile idiopathic arthritis
7
Q
RA is an autoimmune disease. True or false?
A
True
8
Q
HLA-DR4 mediates which condition?
A
Rheumatoid arthritis
9
Q
What are some potential triggers for RA?
A
Smoking, stress, infections
10
Q
The presence of antibodies in RA has what effect on the prognosis?
A
Generally implies a worse prognosis
11
Q
What is the main structure affected by RA?
A
The synovium
12
Q
Which two areas does synovium line?
A
Inside of synovial joint capsules and tendon sheaths
13
Q
Which disease only affects joints which have synovium?
A
Rheumatoid arthritis
14
Q
Where in the spine can RA affect? Why?
A
C1 and C2, only spinal joints with synovium
15
Q
What causes the joint destruction in RA?
A
Inflammatory cytokines
16
Q
RA can cause joint fusion. True or false?
A
True
17
Q
Which biologic agent works by depleting B cells?
A
Retuximab
18
Q
In RA, T cells cause macrophage activation to release what 3 things?
A
TNF alpha, IL-1 and IL-6
19
Q
Rheumatoid factor is released by what type of cell?
A
B cells
20
Q
Infliximab and adalimumab work by inhibiting what?
A
TNF alpha
21
Q
Tocilizumab works by inhibiting what?
A
IL-6 receptor
22
Q
On x-rays for RA, it often looks like bits of bone have been eaten off (erosion)- what causes this to happen?
A
Osteoclast activity
23
Q
What do osteoblasts do?
A
Lay down bone
24
Q
What do osteoclasts do?
A
Resorb bone (remove cells by gradual breakdown)
25
Which condition spares the DIP joints?
Rheumatoid arthritis
26
Early RA is defined as when since symptoms began?
Less than 2 years
27
What is the therapeutic window of opportunity for better outcomes in RA?
The first 3 months since symptom onset
28
What causes morning stiffness for more than 30 mins?
Rheumatoid arthritis
29
Rheumatoid arthritis is usually asymmetrical. True or false?
False- it is usually symmetrical, though it can present in one joint before the other
30
Will you see radiographic changes in early RA?
No
31
What are the two main inflammatory markers?
CRP and PV
32
Apart from autoantibodies and inflammatory markers, what else could be seen in routine blood tests of an RA patient?
Anaemia and raised platelets
33
What types of imaging can be used for RA? Which is the gold standard?
X-rays
Ultrasound
MRI (gold standard)
34
Compressing the MCP and MTP joints will be painful in what condition?
Rheumatoid arthritis
35
What two auto-antibodies are associated with RA?
```
Rheumatoid factor (IgM)
Anti-CCP
```
36
Anti-CCP antibody is associated with which condition?
Rheumatoid arthritis
37
If a patient does not have the specific antibody, could they still have RA if the clinical signs were there?
Yes
38
What is tenosynovitis?
Tendon sheath inflammation
39
What is damage to the flexor tendons of the hand known as?
Trigger finger
40
Carpal tunnel is the compression of which nerve? Which fingers does this supply?
Median nerve- supplies the middle 3 fingers
41
What is palindromic rheumatism?
Rheumatoid arthritis which comes and goes
42
Can RA have systemic symptoms?
Yes
43
When should x-rays be done for RA?
Whenever a patient presents- it is standard to do an x-ray of the hands and feet, even if there are no symptoms there
44
Early rheumatoid will show what on an x-ray?
Nothing
45
What scoring system is used to assess RA?
DAS28
46
What parts of the body are missed out of the DAS28 system?
Feet and ankles
47
What DAS28 score is indicative of severe, active disease?
> 5.1
48
What DAS28 score is indicative of remission?
< 2.6
49
A DAS28 score of 3.2-5.1 indicates what?
Moderate disease
50
A DAS28 score of 2.6-3.2 indicates what?
Low disease activity
51
What group of drugs are the main treatment for RA?
DMARDs
52
What can be used as adjunctive therapy for RA?
NSAIDs and steroids
53
Can steroids be used as sole therapy?
No
54
Oral steroids can be stopped suddenly. True or false?
False- patients must be taken off oral steroids by gradually reducing the dose
55
What is the first line DMARD?
Methotrexate
56
What is a good second line DMARD (especially in pregnancy)?
Sulphasalazine
57
What should always be started together with a DMARD? Why is this?
Steroids- because DMARDs take a few months to start to work, the steroid controls the inflammation in the meantime
58
Why are patients on DMARDs monitored?
Bone marrow suppression- low WCC
59
Why should patients on methotrexate be told to look out for a dry cough or dyspnoea?
It can cause pneumonitis
60
What advice would you give to young women starting methotrexate?
Use contraception- you cannot get pregnant on this drug
61
When can you give a biologic drug in RA?
If there has been a failure to respond to at least two DMARDs, and a DAS28 score of > 5.1
62
Should methotrexate be co-prescribed with a biologic?
Yes
63
What are 2 major risk factors of biologics?
- Immunosuppression
| - Risk of reactivation of TB (patients should be screened)
64
What is the most common form of arthritis?
Osteoarthritis
65
Which arthritis is progressive and degenerative?
Osteoarthritis
66
What are 3 features of osteoarthritis?
- Gradual thinning of cartilage
- Loss of joint space
- Formation of bony spurs
67
When does osteoarthritis typically set in?
Around aged 40
68
Cartilage consists mainly of which type of collagen fibres?
Type II
69
What type of pain is found in osteoarthritis?
Mechanical pain
70
When is OA pain better and worse?
Worse on activity and by the end of the day
| Better with rest
71
What type of arthritis causes crepitus?
Osteoarthritis
72
What type of arthritis causes morning stiffness for < 30 mins?
Osteoarthritis
73
'One of the most common ares to be affected is the. neck' describes what condition?
Osteoarthritis
74
What are Heberden's nodes?
Bony enlargements in OA seen at the DIPs
75
What are Bouchard's nodes?
Bony enlargements in OA seen at the PIPs
76
What will the affected areas of OA feel like?
Hard and lumpy
77
What is a Baker's cyst?
An effusion in the knee spreads into the popliteal fossa and bulges out
78
What can a Baker's cyst be misdiagnosed as?
DVT
79
What can lumbar spine OA cause if it impinges on the spinal cord?
Spinal stenosis
80
Osteoarthritis is more common in which gender?
Females
81
What are 5 risk factors for OA?
- Occupation
- Hobbies
- Previous Injury
- Obesity
- Co-morbidities
82
How do inflammatory markers come back *usually* in OA?
Normal
83
What are 4 typical x-ray changes of OA?
- Loss of joint space
- Subchondral sclerosis
- Bony cysts
- Osteophytes
84
What are the primary affected joints of the hands in OA?
DIPs and CMCs
85
What are some options of pharmacological treatment for OA?
NSAIDs and analgesia
86
What are some non-pharmalogical treatments for OA?
Physiotherapy, weight loss, education, footwear
87
Will drugs reverse or cure the symptoms of OA?
No
88
What crystal arthropathy is associated with monosodium rate crystals?
Gout
89
What crystal arthropathy is associated with calcium pyrophosphate dihidrate (CPPD) crystals?
Pseudogout
90
How long do attacks of gout usually last?
2 weeks
91
Is gout an inflammatory arthritis?
Yes
92
Which sex is gout most common in?
Men
93
Which arthropathy is most common in men?
Gout
94
What are risk factors for gout?
Red meat, shellfish, alcohol
95
What conditions can cause increased cell turnover (which increases purines)?
Psoriasis, infections, extreme diets
96
What defines hyperuricaemia?
Serum uric acid > 7mg/dL
97
What does hyperuricaemia mean in terms of having gout?
Does not mean you will definitely have gout- though it does increase the risk
98
What are some 'overproduction' causes of gout?
Genetic, high cell turnover, overconsumption of purine rich foods
99
What are some 'under-excretion' causes of gout?
Renal insufficiency, starvation, thyroid problems, drugs and alcohol
100
When is the best time to measure serum urate?
2 weeks following an acute attack
101
What are 3 different differentials of gout?
- Septic arthritis
- Trauma
- Seronegative arthritis e.g. psoriatic
102
Can gout become chronic after repeated acute attacks?
Yes
103
What medication is often associated with chronic polyarticular gout?
Diuretics
104
What will blood tests for gout show?
Raised inflammatory markers and WCC
105
What will x rays for gout show in chronic vs acute attacks?
Acute- normal
| Chronic- erosions, osteophytes, joint destruction
106
What is the gold standard test for gout?
Joint aspirate
107
Needle shaped crystals with negative birefringence relates to what?
Gout
108
How do you manage an acute attack of gout?
NSAIDs, colchicine, steroids
109
What are 3 lifestyle recommendations for gout?
- Lose weight
- Restrict risk factors
- Fluids
110
What is used for gout prophylaxis and when should it be started?
Allopurinol- 2-4 weeks after an acute attack
| start low, go slow
111
What is the target serum rate in gout?
< 0.3 mmol/l
112
What can also be known as CPPD?
Pseudogout
113
Pseudogout is more common in who?
Older population
114
What is the only way to tell the difference between gout and pseudogout?
Joint aspirate
115
Rhomboid shaped crystals with a weakly positive birefringence relates to what disease?
Pseudogout
116
Is it possible to have both gout and pseudo gout?
Yes
117
Should allopurinol be given for pseudo gout?
No
118
What is caused by hydroxyapatite crystals?
Milwaukee shoulder
119
What has a similar presentation to Milwaukee shoulder?
Septic arthritis
120
Milwaukee shoulder causes an acute rapid deterioration, most common in females around ? years?
50-60
121
Hydroxyapatite crystals will be detected under microscopy. True or false?
False- but an alizarin stain shows red clumps
122
Does paracetamol cause any renal impairment?
No
123
Is paracetamol safe in pregnancy?
Yes
124
What are 2 examples of atypical analgesics?
Amitriptyline and gabapentin
125
Should NSAIDs be used long term?
No
126
Naproxen is what type of drug?
NSAID
127
Do NSAIDs cause renal impairment?
Yes
128
When is it important to not give NSAIDs?
In patients with asthma
129
Celecoxib is what type of drug?
COX2 inhibitor (a type of NSAID)
130
What is the benefit of COX2 inhibitors?
No risk of peptic ulceration
131
What is the disadvantage of COX2 inhibitors? For this reason, who should they be given to?
They greatly increase CV risk- should only be given to patients with no other risk factors for this
132
When should DMARDs be started?
Within 3 months of symptoms starting
133
What are two reasons for blood tests on patients on methotrexate?
- Low WCC
| - Liver damage
134
What supplement must be given to patients on methotrexate?
Folic acid
135
What are 4 rheumatological uses for methotrexate?
- Rheumatoid
- Psoriatic
- Connective tissue diseases
- Vasculitis
136
Does the teratogenic effect of methotrexate apply to males?
Yes
137
If a patient with RA was to develop a cough and SOB soon after diagnosis, what is this likely to be?
Pneumonitis
138
If a patient with RA was to develop a cough and SOB a long time after diagnosis, what is this likely to be?
RA associated pulmonary fibrosis
139
What other DMARD is often used in combination with methotrexate?
Sulphasalazine
140
What DMARD can cause reduced sperm count? Is it reversible?
Sulphasalazine- yes
141
What DMARD can cause Stevens Johnsons Syndrome?
Sulphasalazine
142
What is a teratogenic DMARD that is not methotrexate?
Leflunomide
143
What DMARD should you move patients toil methotrexate is causing too many side effects?
Leflunomide
144
Does hydroychloroquine have any effect in joint damage?
No
145
What DMARD can cause irreversible retinopathy?
Hydroxychloroquine
146
How are biologics given?
Subcutaneous injection
147
What 3 diseases are anti-TNF agents used for?
- RA
- Psoriatic
- Ankylosing spondylitis
148
Biologics have been said to increase risk of cancer. What kind specifically?
Melanoma
149
What type of drug used for RA exacerbates heart failure?
ANti-TNF biologics
150
What medications should be given alongside steroids?
Calcium and vitamin D
151
What drug should be used in gout patients who cannot tolerate allopurinol?
Febuxostat
152
Allopurinol and febuxostat are what type of drugs?
Xanthine oxidase inhibitors
153
What does xanthine oxidase do?
Changes purines into uric acid
154
When should febuxostat be used with caution?
Ischaemic heart disease
155
What other rheumatological condition can occur as a side effect of allopurinol?
Vasculitis
156
What can allopurinol and methotrexate combined cause?
Irreversible bone marrow suppression
157
What are another group of drugs which can be used for gout but are uncommon?
Uricosurics
158
You must come off methotrexate for how long before trying to conceive?
3 months
159
What are drug options for patients during pregnancy?
Sulphasalazine or biologics
160
RA gets worse in pregnancy. True or false?
False- it usually gets better, but there is often a flare up after birth
161
Are sponyloarthropathies inflammatory?
Yes
162
What makes individuals genetically predisposed to spondyloarthropathies?
Being HLA-B27 positive
163
Being from where makes you more likely to be HLA-B27 positive?
Northern countries
164
Being HLA-B27 + means you will definitely have one of the conditions it is associated with. True or false?
False
165
What are the 4 conditions that come under the spondyloarthropathies?
- Reactive arthritis
- Ankylosing spondylitis
- Psoriatic arthritis
- Enteropathic arthritis
166
When is inflammatory pain better/worse?
Worse with rest and better with activity
167
Do you get morning stiffness with inflammatory pain?
Yes
168
What area of the body is involved in sponydloarthropathies which is not involved in other kinds?
The spine and sacroiliac joints
169
What is enthesitis?
Inflammation at insertions of tendons into bones
170
What is dactylitis?
'Sausage digits'- inflammation of an entire digit
171
Is peripheral arthritis common in ankolysing spondylitis?
No
172
When does AS usually occur? Which sex is it more common in?
Usually late teens or early adulthood, more common in males
173
What can happen to the vertebrae in AS, causing patients to have limited movement?
Fusion
174
What can happen to chest expansion in AS?
Reduced
175
What blood tests are important for AS?
Inflammatory markers
| HLA-B27
176
What condition is Bamboo spine associated with?
Ankolysing spondylitis
177
Can an x-ray be normal in AS?
Yes, in early disease
178
What is the best test for AS?
MRI
179
How can you tell AS apart from osteoarthritis?
AS in inflammatory, OA is not
180
What will happen to bone density in AS?
Decreased
181
What will happen to bone density in OA?
Normal, maybe increased
182
Can you have psoriatic arthritis without psoriasis?
Yes (around 10%)
183
What are the findings with regards to rheumatoid nodules and factor in psoriatic arthritis?
Negative
184
What nail features can be seen in psoriatic arthritis?
Pitting and onycholysis
185
What happens in arthritis mutilans?
Lots of joint destruction very quickly
186
What disease may show erosions, osteolysis and enthesis on x-ray?
Psoriatic arthritis
187
Which biologic is particularly useful for psoriatic arthritis?
Secukinumab (anti- IL-17)
188
What cell mediates psoriatic arthritis?
T cells
189
What are some non-medical treatments for psoriatic arthritis?
Physiotherapy, occupational therapy, orthotics/chiropodists
190
What causes reactive arthritis to occur?
An infection of some sort
191
Is reactive arthritis inflammatory?
Yes (inflammatory synovitis)
192
Can microorganisms be cultured from reactive arthritis?
No
193
How soon after an infection do symptoms of reactive arthritis occur?
1-4 weeks
194
What are the commonest types of infection to cause reactive arthritis?
Urogenital, enterogenic
195
What age group and sex is reactive arthritis most common in?
20s-40s, with equal sex distribution
196
Are individuals who suffer from reactive arthritis HLA-B27 positive?
Yes
197
Reiter's syndrome is a class of reactive arthritis made up of what 3 things?
- Urethritis
- Conjunctivitis/uveitis/iritis
- Arthritis
198
Is reactive arthritis symmetrical? How many joints tend to be affected?
No, usually 1 joint or can be up to 4
199
What should you do in reactive arthritis to rule out infection?
Joint fluid analysis
200
What are the main treatments involved in reactive arthritis?
NSAIDs and corticosteroids
201
When should you give DMARDs in reactive arthritis?
If resistant or chronic
202
Is it possible to develop chronic reactive arthritis?
Yes
203
What condition is enteropathic arthritis associated with?
IBD
204
What will be the relation between arthritis and IBD flare ups?
Arthritis will be worse during a flare up
205
What skin condition may be associated with enteropathic arthritis and IBD?
Pyoderma gangrenosum
206
What medication should you NOT give in enteropathic arthritis? Why?
NSAIDS- they can exacerbate IBD
