Arthritis Flashcards
(146 cards)
1
Q
which arthritis is seropositive
A
rheumatoid arthritis
2
Q
what conditions (other than rheumatoid arthritis) are seropositive
A
lupus
sjorgens
scleroderma
vasculitis
3
Q
what are the seronegative types of arthritis (4)
A
ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis
4
Q
are women or males more likely to get rheumatoid arthritis (and by how much)
A
women are 3 times more likely
5
Q
which age group does rheumatoid arthritis affect
A
any age
6
Q
what are the risk factors for rheumatoid arthritis (2)
A
genetics (HLA-DR4 gene)
smoking (increases likelihood of RA antibodies)
7
Q
what are the triggers of rheumatoid arthritis
A
stress
infection
trauma
8
Q
after a trigger, what happens in early rheumatoid arthritis (2)
A
autoantibodies (produced by B cells) react to trigger and affect synovium
cause hypertrophy of synovium (synovitis)
9
Q
what type of hypersensitivity reaction is rheumatoid arthritis
A
type IV
10
Q
what happens in early rheumatoid arthritis that continues in well established rheumatoid arthritis
A
synovitis
11
Q
which type of cell (osteoclast or osteoblast) is activated in rheumatoid arthritis
A
osteoclast
12
Q
what is the function of an osteoclast in rheumatoid arthritis
A
it ‘chews’ up bone = causes erosions
13
Q
what time period distinguishes established rheumatoid arthritis from early rheumatoid arthritis
A
2 years since symptom onset
14
Q
which joints are typically affected in rheumatoid arthritis (7+1 not)
A
wrist knee ankle hip TMJ first 2 vertebrae PIP
NOT DIP joints
15
Q
is the distribution of affected joints in rheumatoid arthritis symmetrical or asymmetrical
A
symmetrical
16
Q
how does rheumatoid arthritis present (7)
A
joint pain joint swelling early morning stiffness (>30 mins) improvement of symptoms with exercise rheumatoid nodules dry eyes corneal ulcers
17
Q
what is early morning stiffness a red flag for
A
rheumatoid arthritis
18
Q
what relieves the symptoms of rheumatoid arthritis
A
exercise
19
Q
what investigations would you do for rheumatoid arthritis (3)
A
autoantibodies
xray
MRI
20
Q
which autoantibodies are present in rheumatoid arthritis (2)
A
rheumatoid factor (aka rheumatoid IgM) anti-CCP antibodies (aka ACPA)
21
Q
what is bad about looking for rheumatoid factor in rheumatoid arthritis
A
it is not specific to rheumatoid and not everyone with rheumatoid will have it
22
Q
is rheumatoid factor or anti-CCP antibodies preferred for diagnosis of rheumatoid arthritis
A
anti-CCP antibodies
23
Q
is it possible to have neither anti-CCP antibodies and rheumatoid factor, but still have rheumatoid arthritis
A
yes
24
Q
what does more anti-CCP antibodies in rheumatoid arthritis mean
A
worse condition
25
what would you see on xray of early rheumatoid arthritis
not much
| swelling
26
what would you see on xray of late rheumatoid arthritis
```
erosions
osteopenia (less density) around joints
```
27
when would you do an MRI for rheumatoid arthritis
after xray if xray wasnt diagnostic
28
what is the assessment score for rheumatoid arthritis
DAS28 assessment score
29
what does a DAS28 score of <2.6 mean
no rheumatoid arthritis
30
what does a DAS28 score of >5.1 mean
active rheumatoid arthritis
31
how does DAS28 assessment score work
squeeze joints (28, doesnt include feet) and count how many are tender/swollen
32
what is the symptomatic treatment for rheumatoid arthritis
```
aspirin
paracetamol
NSAIDs (eg ibuprofen)
steroid (eg prednisolone)
opioids (eg codeine, morphine)
```
33
what is the long term treatment of rheumatoid arthritis
DMARDs
| biologics
34
what is the first line DMARD for rheumatoid arthritis
methotrexate
35
what is the second line DMARD for rheumatoid arthritis after methotrexate
sulfasalazine
36
what is the third line DMARD for rheumatoid arthritis after methotrexate + sulfasalazine
hydroxycholorquine
37
what would you add on to methotrexate + sulfasalazine + hydroxychloroquine if the combination therapy wasnt working
biologics
38
which DMARD is used in replace of methotrexate if the side effects of methotrexate occur
leflunomide
39
what is the therapeutic window for long term treatment of rheumatoid arthritis
3 months from symptom onset (not a long time!)
40
what is the purpose of long term treatment for rheumatoid arthritis
prevention of deformities/disease progression
41
when on DMARDs for long term treatment of rheumatoid arthritis, what needs to be monitored and why
bloods
| for infection, immunosuppression, liver function (side effects of DMARDs)
42
what are the 2 indications for stopping methotrexate use in rheumatoid arthritis
pregnancy
| side effects
43
how long before conception must methotrexate be stopped in rheumatoid arthritis
3 months
44
what DMARD is used in replacement of methotrexate in pregnancy for someone with rheumatoid arthritis
sulfasalazine or hydroxychloroquine
45
what DMARD is used in replacement of methotrexate when side effects occur, in someone with rheumatoid arthritis
leflunomide
46
what are the side effects of methotrexate (7)
```
pneumonitis (SOB and cough)
infection/immunosuppression
mouth ulcers
hepatitis
leucopenia
pulmonary fibrosis
nausea, diarrhoea
```
47
what is the dosage of methotrexate for someone with rheumatoid arthritis
15mg once per week
48
what supplement needs to be taken alongside methotrexate
5mg folic acid
49
how does methotrexate work
lowers antibodies in blood
50
what is a general side effect of all DMARDs
infection/immunosuppression
51
how does sulfasalazine work
the antibodies attack the sulfasalazine instead of the joint synovium
52
what are the side effects of sulfasalazine (5)
```
infection/immunosuppression
nausea
rash
mouth ulcers
neutropenia
```
53
what is the mechanism of hydroxychloroquine (what type of drug is it)
antimalarial drug
54
what are the side effects of hydroxychloroquine (6)
```
irreversible retinopathy
infection/immunosuppression
GI disturbance
headache
rash
blood disorders
```
55
apart from the 4 DMARDs that are in the 'standard' rheumatoid treatment pathway, what are the other DMARDs that could be used in rheumatoid arthritis (3)
gold IM
penicillamine PO
azathioprine
56
after the ineffective use of 3 DMARDs, which biologic is used for rheumatoid arthritis
anti-TNF
57
what does an anti-TNF end in
-umab
58
when are biologics indicated for use in rheumatoid arthritis
DAS28 >5.1 = active disease
AND
when 2 DMARDs have been ineffective
59
what are the side effects of anti-TNF agents
infection/immunosuppression/reactivation of TB
skin cancer risk
exacerbation of heart failure or pulmonary fibrosis
60
what drug is used to treat a flare up of rheumatoid arthritis
steroids
61
what environmental factors are recommended in the treatment of rheumatoid arthritis
stop SMOKING!
| stop drinking
62
what treatment may be required if complications arise in rheumatoid arthritis
surgery - joint fusion, joint replacement
63
what are the complications of rheumatoid arthritis in the hands (6)
```
swan necking
boutonnieres
z shaped thumb
trigger finger
extensor synovitis
bilateral carpal tunnel syndrome
```
64
what is the common complaint of people with complications of untreated rheumatoid arthritis in the feet
like theyre 'walking on pebbles'
65
what is trigger finger, and how does it occur in rheumatoid arthritis
the inflammation of finger tendons = get caught on 'pulleys' when bending = painful
66
what is extensor synovitis and how does it occur in rheumatoid arthritis
the inflammation of the tendon sheath + tendons inside it = tendon degeneration and rupture, so needs replaced
67
how does carpal tunnel syndrome occur in rheumatoid arthritis
synovial tissue inflammation = compression of median nerve
68
what is bilateral carpal tunnel syndrome suggestive of
rheumatoid arthritis
69
how does carpal tunnel syndrome present
weakness in thenar (thumb) muscles
| numbness in digits 1-3 and lateral half of digit 4
70
when do flare ups of rheumatoid arthritis usually occur
after birth
71
rheumatoid arthritis is a risk factor for which body system
cardiovascular
72
what is osteoarthritis
the gradual thinning of cartilage in joints
73
what is the most common type of arthritis
osteoarthritis
74
which age group is osteoarthritis most common in
elderly
75
are men or women more likely to get osteoarthritis
women
76
what are the risk factors for osteoarthritis (7)
```
elderly
women>men
genetics
occupation - heavy lifting
sports
previous injury in joint
obesity
```
77
what part of cartilage is lost in osteoarthritis
the matrix
78
what cell attempts to replace the cartilage matrix in osteoarthritis
chondrocytes
79
what happens to the synovial fluid in osteoarthritis
it dissects into bone = cyst formation
80
is there increased or decreased bone turnover in osteoarthritis
increased
81
which joints are typically affected in osteoarthritis (5+1)
```
base of thumb (trapezium)
fingers (DIP and PIP)
knees
first MTP
carpometacarpal
```
joints with previous injury/gout/infection
82
are the joints affected in osteoarthritis symmetrical or asymmetrical
asymmetrical
83
when is pain worst in osteoarthritis
after exercise, at end of day
84
what relieves pain in osteoarthritis
rest
85
is the onset of osteoarthritis gradual or sudden
gradual
86
is morning stiffness present in osteoarthritis, if so for how long?`
ye s
| <30 mins
87
how would osteoarthritis present on examination
crepitations/creaking
88
what knee abnormality is associated with osteoarthritis
bakers cyst
89
how does a bakers cyst occur in osteoarthritis
excess fluid in knee from matrix being replaced in osteoarthritis
90
what bony enlargement occurs at the DIP joints in osteoarthritis
heberdens nodes
91
what bony enlargement occurs at the PIP joints in osteoarthritis
bouchards nodes
92
what bony enlargement occurs at the base of the thumb
squaring of thumb base
93
how is osteoarthritis diagnosed
xray
| bloods - to exclude rheumatoid arthritis
94
what are you looking for on an xray of someone with osteoarthritis
```
LOSS;
loss of joint space
osteophytes (rough bit on otherwise smooth bone)
subchondral cysts
sclerosis (white on xray)
```
95
can osteoarthritis be cured
no
96
what is the first line treatment for painful osteoarthritis
weight loss
paracetamol
physiotherapy
97
what is the treatment of an osteoarthritis flare up
steroids
98
what is the treatment of osteoarthritis that is still painful with paracetamol, weight loss etc
surgery - arthrodesis, excision/resection arthroplasty, joint replacement
99
what is an excision/resection arthroplasty
where is it used in osteoarthritis
removal of a diseased joints
used in small joints
100
what is arthrodesis
where is it used in osteoarthritis
fusion of bones in a joint in a position of function
used in small joints
101
when is joint replacement used in severe osteoarthritis
in large joints (eg shoulder, hip) when paracetamol etc is ineffective
102
contraindications of total hip replacement in osteoarthritis
age <65
cardio/resp problems
obesity (wont make much difference)
unless you explain risks and pain is so bad that they still want it
103
complications of total hip replacement in osteoarthritis (6)
aseptic loosening - presents as thigh pain, loosening of bone to replacement, common
hip dislocation
breakage
nerve damage
infection
cant do intense exercise (though usually irrelevant)
104
when is a hemiarthroplasty used in osteoarthritis
in elderly with little movement requirements (eg care home, bed ridden)
105
what is it called when someone has a combination of rheumatoid arthritis and osteoarthritis
mixed picture arthritis
106
which gene is associated with seronegative spondyloarthropathies
HLA B27
107
where does ankylosing spondylitis present
spine
108
when does ankylosing spondylitis present
late adolescence, early adulthood
| needs to be <45 for diagnosis
109
what are the 4 type of seronegative spondyloarthropathies
ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis
110
what gene is associated with ankylosing spondylitis
HLA B27
111
where does ankylosing spondylitis present
back and buttock pain
112
when is the pain associated with ankylosing spondylitis relieved
after exercise
113
what posture is associated with ankylosing spondylitis
'question mark spine'
114
what causes 'question mark spine' in ankylosing spondylitis
LLL = Loss of Lumbar Lordosis
from fusing of lumbar vertebrae
115
which examination test can confirm ankylosing spondylitis
schobers test
116
what condition are the xray features; 'bamboo' spine, 'shiny' corners and sacroillitis associated with
ankylosing spondylitis
117
when would you use an xray for diagnosis of ankylosing spondylitis
if symptom onset >6 months
118
when would you use a MRI for diagnosis of ankylosing spondylitis
if symptom onset <6 months (wont see anything on xray)
119
what is the treatment of ankylosing spondylitis
```
physio
occupational therapy
NSAIDs (eg ibuprofen)
DMARDs
anti-TNF if severe
```
120
can you cure ankylosing spondylitis
no, symptomatic treatment
121
what complication is associated with ankylosing spondylitis
spinal fracture
122
which dermatological condition is psoriatic arthritis associated with
psoriasis
123
which gene is psoriatic arthritis associated with
HLA B27
124
how do the hands present in psoriatic arthritis
```
arthritis mutilans (shortened digits)
dactylitis (sausage fingers) caused by inflammation
```
125
what xray appearance in the hands is associated with psoriatic arthritis
'pencil in cup' deformity
126
how are the tendons affected in psoriatic arthritis
enthesitis - inflammation of tendons where they attach to the bone
127
what nail sign is associated with psoriatic arthritis
onycholysis - lifting of nail from nail bed
128
the treatment of what other condition is the same as the treatment of psoriatic arthritis
rheumatoid arthritis
129
what is the treatment of psoriatic arthritis
DMARD1 (methotrexate) + DMARD2 (sulfasalazine) + DMARD3 (hydroxychloroquine) + biologics (anti-TNF -umab)
130
what is reactive arthritis
when an infection triggers arthritis in a genetically susceptible individual
131
what gene is associated with reactive arthritis
HLA B27
132
which joint does reactive arthritis usually occur in
knee
133
when does reactive arthritis present (in relation to the infection)
1-4 weeks after infection
134
how does reactive arthritis present (triad)
reiters triad;
'cant see, cant pee, cant bend the knee'
uveitis/conjunctivitis, urethritis, arthritis
135
what is reiters triad
what condition is it associated with
'cant see, cant pee, cant bend the knee'
uveitis/conjunctivitis, urethritis, arthritis
reactive arthritis
136
what is the first line investigation for reactive arthritis
joint aspiration - to exclude septic arthritis
137
what condition do you need to exclude if you suspect reactive arthritis
septic arthritis
138
how is reactive arthritis cured
it is self limiting, if still there after 6 months = DMARDs
139
what is the symptomatic treatment for reactive arthritis
steroids
| antibiotics for infection
140
what GI condition can arthritis be associated with
inflammatory bowel disease (IBD) - crohns, ulcerative colitis
141
what is it called when someone has IBD and arthritis
enteropathic arthritis
142
when is enteropathic pain worst
during IBD flare ups
143
what is the first line investigation for enteropathic arthritis
joint aspiration - to exclude septic arthritis
144
how is enteropathic arthritis treated (3)
fix IBD
DMARDs
anti-TNF (-umab)
145
what is the symptomatic treatment for enteropathic arthritis
paracetamol
NOT NSAIDs - make IBD worse
steroids
146
how can rheumatoid arthritis affect the kidneys
amyloidosis (deposition of amyloid in kidneys)
