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MC > Arthritis > Flashcards

Arthritis Flashcards

1
Q

In a UK National Morbidity Survey, rheumatic
disease composed just over_______ of all morbidity
presenting to the family doctor

A

7%

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2
Q

The commonest cause of arthritis was________

which affects 5–10% of the population

A

osteoarthritis (OA),

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3
Q

The population incidence of rheumatoid arthritis

(RA) is _____

A

1–2%.

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4
Q

There should be no systemic manifestations with ______

A

OA.

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5
Q

The pain of inflammatory disease is ______ at rest
(e.g. on waking in the morning) and improved by
_____

A

worse

activity

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6
Q

Causes of _______ include crystal deposition
disease, sepsis, osteoarthritis, trauma and
spondyloarthritis

A

monoarthritis

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7
Q

______ is almost exclusive to males: in
women, it is usually seen only in those who are
postmenopausal or taking ________

A

Acute gout

thiazide diuretics

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8
Q

The probability diagnoses for the patient presenting
with arthritis are:

  • ______ (mono- or polyarthritis)
  • ______ (if acute and polyarthritis
A

osteoarthritis

viral arthritis

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9
Q

OA is very common in general practice. It may be
primary, which is usually ________, and can affect
many joints

A

symmetrical

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10
Q

secondary OA follows _______

A

injury and other wearand-

tear causes

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11
Q

Viral polyarthritis is more common than realised.
It presents usually within ______days of the infection,
and is usually mild

A

10

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12
Q

Serious disorders not to be missed

It is important to be forever watchful for_________. It presents typically as a migratory
polyarthritis involving large joints sequentially, one
becoming hot, red, swollen and very painful as the
other subsides. It rarely lasts more than 5 days in any
one joint

A

rheumatic fever (RF)

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13
Q

Serious disorders not to be missed

_______may present
in a single joint or as flitting polyarthritis, often
accompanied by a rash

A

Gonococcal infection

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14
Q

______can cause arthritis and sacroiliitis and can be confused with the spondyloarthropathies

A

Brucellosis

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15
Q

________ is becoming a great mimicker. It
can present as a chronic oligoarticular asymmetrical
arthritis. 3 It can also present as a rash very similar to
psoriasis

A

HIV infection

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16
Q

With the large influx of migrants from South-
East Asia the possibility of ______ presenting as
arthritis should be kept in mind.

A

tuberculosis

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17
Q 
In respect to malignant disease, arthralgia is
associated with 
1
2
3
A

acute leukaemia, lymphoma and

neuroblastoma in children

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18
Q

bronchial carcinoma may cause __________ especially of the wrist and ankle (not a true arthritis but simulates it).

A

hypertrophic

osteoarthropathy,

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19
Q

Monoarticular metastatic disease may

involve the knee ______

A

(usually from lung or breast).

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20
Q

What are the red flags for polyarthritis

A
  • Fever
  • Weight loss
  • Profuse rash
  • Lymphadenopathy
  • Cardiac murmur
  • Severe pain and disability
  • Malaise and fatigue
  • Vasculitic signs
  • Two or more systems involved
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21
Q

There are several pitfalls, most of which are rare.

A common pitfall is gout. This applies particularly to
older women taking diuretics, whose osteoarthritic
joints, especially of the hand, can be affected. The
condition is often referred to as ______ and
does not usually present as acute arthritis.

A

nodular gout

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22
Q

Pitfalls

it can mimic the connective tissue
disorders in its early presentation—typically a
woman in the third or fourth decade

A

Fibromyalgia syndrome

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23
Q

Another ‘trap’ is __________ in a patient with a

bleeding disorder

A

haemarthrosis

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24
Q

Infective causes that may be overlooked are
______, especially in travellers returning from a
tropical or subtropical area, and _______ which
is now surfacing in many countries, especially where
ticks are found

A

dengue fever

Lyme disease,

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25
Q

Sarcoidosis causes two forms: an acute benign
form, usually in the ________, and a chronic
form with long-standing sarcoidosis that involves
_________ disease.

A

ankles and knees

joints (large or small) adjacent to underlying bone

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26
Q

Haemochromatosis can present with a degenerative

arthropathy that characteristically affects the ________

A

second

or third metacarpophalangeal joints

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27
Q

Drug-induced arthritis usually affects the hands

and is generally_____

A

symmetrical

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28
Q 
Those that
include a lupus syndrome include the 
1
2
3
A

anti-epileptics,
chlorpromazine and some
cardiac drugs

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29
Q

_________may be associated with
septic arthritis, hepatitis B and C, HIV-associated
arthropathy, SBE with arthritis and serum sickness
reactions.

A

Intravenous drug abuse

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30
Q

_________ can uncommonly cause
acropathy (clubbing and swelling of the fingers) and
may present as pseudogout

A

Hyperthyroidism

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31
Q

_________ can present with an arthropathy or cause proximal muscle pain, stiffness and weakness.

A

hypothyroidism

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32
Q

________ may cause an arthropathy that can be painless or mild to moderately painful.

A

Diabetes mellitus

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33
Q

The spondyloarthropathies may be a causative
factor. They often present with an acute monoarthritis,
particularly in teenagers some time before causing
_____ and ______

A

sacroiliitis and spondylitis

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34
Q

So-called _______ of the lower limb are
common in children, and the physical examination
and investigations are norm

A

‘growing pains’

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35
Q

Clinical approach to dx:

A priority is to determine whether or not the arthritis
is caused by:

A

a primary rheumatic disorder or whether

it is part of an underlying systemic disorder

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36
Q

A family history is important because a positive

family history is associated with conditions such as

A

RA (rarely), ankylosing spondylitis, connective tissue
disorders (rarely), psoriasis, gout, pseudogout and
haemophilia

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37
Q

A very hot, red, swollen joint suggests either

______

A

infection or crystal arthritis.

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38
Q 
Joint swelling:
• acute (1–4 hours) with intense pain = \_\_\_\_\_
• subacute (1–2 days) and soft = \_\_\_\_\_\_
• chronic and bony = \_\_\_\_\_
• chronic and soft/boggy = \_\_\_\_\_\_
A

blood infection or crystals (e.g. gout)

fluid (synovial effusion)
osteoarthritis
synovial proliferation

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39
Q

A coarse crepitus suggests ______

A

OA

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40
Q

Inspection should note

the presence of lumps or bumps such as ________on the osteoarthritic DIP joints of the hands,

A

Heberden

nodes

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41
Q

_________on the osteoarthritic PIP joints of
the hands, and rheumatoid nodules, which are the
only pathognomonic finding of RA and gouty tophi

A

Bouchard nodes

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42
Q

Important to do serological testing for the AUS epidemics:

A

polyarthritis, Lyme disease, rubella, Brucella, hepatitis
B, gonococcus, mycoplasma, HIV tests, parvovirus
and Barmah Forest virus.

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43
Q

______ or at least a fourfold rise on paired

sera confirms recent infection

A

Seroconversion

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44
Q

________ has limited value in the
diagnosis of polyarthritis but is very useful for specific
joints such as the shoulder and the knee

A

Arthrography

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45
Q

____ for joints such as the shoulder and the

hip can be very useful

A

Ultrasound

examination

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46
Q

______ should not be used for arthritis
screening. It has a high sensitivity for ankylosing
spondylitis, but low specificity, and should rarely be
ordered

A

HLA-B 27

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47
Q

Immno tests to rule out CTD

A

rheumatoid factor and anti-CCP
• antinuclear antibodies
• dsDNA antibodies

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48
Q

____ is very common in children.

A

viral arthritis

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49
Q

FBE in pts with viral arthritis

A

lymphopaenia, lymphocytosis or atypical lymphocytes.

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50
Q

It is worth noting that underlying____ can be present as joint pain if the tumour is adjacent to the joint

A

bone tumours

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51
Q

Acute-onset monoarticular arthritis

associated with fever is _____until proven otherwise

A

septic

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52
Q

defined as
a chronic arthritis persisting for a minimum of 6
weeks (some criteria suggest 3 months) in one or
more joints in a child younger than 16 years of age

A

JIA, also known as juvenile chronic arthritis and

juvenile rheumatoid arthritis (US)

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53
Q

The commonest types of JIA are _________ arthritis, affecting four or fewer
joints (about 50%), and ________
affecting five or more joints (about 40%).

A

oligoarticularc (pauciarticular)

polyarticular arthritis,

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54
Q

Systemic onset arthritis, previously known as _______

accounts for about 10% of cases.

A

Still syndrome,

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55
Q

SSx of JIA

A

The children can present with a high
remittent fever and coppery red rash, plus other
features, including lymphadenopathy, splenomegaly
and pericarditis

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56
Q

T or F

In JIA

Arthritis is not an initial feature but develops ultimately, usually involving the small joints of the hands, wrists, knees, ankles and metatarsophalangeal joints

A

T

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57
Q

Other subtypes of JIA

A
  • Oligo (pauci) articular
  • Seropositive polyarticular (juvenile RA)
  • Seronegative polyarticular
  • Systemic onset arthritis (Still disease)
  • Enthesitis related arthritis
  • Psoriatic juvenile arthritis
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58
Q

Other musculoskeletal conditions that become more prevalent with increasing age are

A
  • polymyalgia rheumatica
  • Paget disease of bone
  • avascular necrosis
  • gout
  • pseudogout (pyrophosphate arthropathy)
  • malignancy (e.g. bronchial carcinoma)
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59
Q

This crystal deposition arthropathy (chondrocalcinosis) is
noted by its occurrence in people over 60 years. It usually
affects the knee joint but can involve other joints

A

Pseudogout

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60
Q

Although it usually begins between the ages of
30 and 40 it can occur in elderly patients, when it
occasionally begins suddenly and dramatically

A

RA

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61
Q

In RA,it tends to respond to small doses of______and has a good prognosis.

A

prednisolone

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62
Q

RF is an inflammatory disorder that typically occurs

in children and young adults following a ____

A

group

A Streptococcus pyogenes infection

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63
Q

T or F

RF is uncommon
in developing countries and among Indigenous
Australians

A

F

common

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64
Q

Dx of RF

Based on clinical criteria:

_____ or _______

in the presence of supporting evidence of preceding
Group A streptococcal infection.

A

2 or more major criteria

or

1 major + 2 or more minor criteria

65
Q

Major criteria for RF

A 
Carditis
• Polyarthritis
• Chorea (involuntary abnormal movements)
• Subcutaneous nodules
• Erythema marginatum
66
Q

Minor criteria for RF

A
  • Fever ( ≥ 38 ° C)
  • Previous RF or rheumatic heart disease
  • Arthralgia
  • Raised ESR >30 mm/hr or CRP >30 mg/L
  • ECG—prolonged PR interval
67
Q

Other dxtics for RF

  • streptococcal _____
  • ________ (repeat in 10–14 days)
  • C-reactive protein
  • plus ECG and echocardiogram (if ↑ PR) and CXR
A

ASOT

streptococcal anti-DNase B

68
Q

Tx of RF in children

What abx to give?

A

Benzathine penicillin 900 mg IM (450 mg in child
<20 kg) statim or phenoxymethylpenicillin
500 mg (o) bd, 10 days

69
Q

Tx of RF in children

What apin reliever to give?

A

• Paracetamol 15 mg/kg (o) 4 hourly (max. 60 mg/

kg/day); aspirin or naproxen for arthritis

70
Q

T or F

Septic arthritis

evolves over hours or days and can rapidly destroy
a joint structure

A

T

71
Q

Organisms associated with Septic arthritis

A

The commonest

organisms are S.aureus and N. gonorrhoea.

72
Q

__________ is the most common type of arthritis, occurring in about 10% of the adult population and in 50% of those aged over 60

A

OA

73
Q

___________is usually symmetrical and can affect
many joints. Unlike other inflammatory disease the
pain is worse on initiating movement and loading the
joint, and eased by rest.

A

Primary OA

74
Q

OA is usually associated with

_________, especially after activity, in contrast to RA

A

stiffness

75
Q

In primary OA all the synovial joints may be involved,
but the main ones are:

1
2
3

A

• first carpometacarpal (CMC) joint of thumb
• first metatarsophalangeal (MTP) joint of
great toe
• distal interphalangeal (DIP) joints of hands

76
Q

_______ can complicate OA, especially
in the fingers of people taking diuretics (e.g. nodular
gout).

A

Crystal arthropathy

77
Q

OA does not exhibit the typical inflammatory pattern.
The clinical diagnosis is based on:

• gradual onset of pain after\_\_\_\_
• the pattern of joint involvement
• the lack of \_\_\_\_\_\_\_\_\_
• the transient nature of the \_\_\_\_\_\_
• takes <30 minutes to settle after rest while
inflammatory arthritis takes at least
30 minutes
A

activity (worse
towards the end of the day)

soft tissue swelling

joint stiffness or
gelling

78
Q

Xray findings of OA

• Joint space narrowing with\_\_\_\_\_
• Formation of osteophytes on the joint margins or
in ligamentous attachments
• \_\_\_\_\_\_in the subchondral bone
• Altered shape of bone ends
A

sclerosis of subchondral bone

Cystic areas

79
Q

Pain meds for OA

Simple analgesics (regularly for pain). Use
_________ (avoid codeine or
dextroproproxyphene preparations, and aspirin if
recent history of dyspepsia or peptic ulceration).

A

paracetamol/acetaminophen

80
Q

As a rule
________ are not recommended
but occasionally can be very effective for an
inflammatory episode of distressing pain and
disability on a background of tolerant pain (

A

IA corticosteroids

81
Q

Viscosupplementation. ________,
especially for OA of knee. Supported by level I
evidence

A

Intra-articular hylans

82
Q

__________, a natural
amine sugar, derived from chitin in shellfish
shell, has had anecdotal claims of efficacy for the
treatment of OA

A

Glucosamine

83
Q

C ontraindicated drugs. For OA these include the

________

A

immunosuppressive and disease-modifying drugs
such as oral corticosteroids, gold, anti-malarials
and cytotoxic agents

84
Q

_____ which is an autoimmune disease of unknown
aetiology, is the commonest chronic inflammatory
polyarthritis and affects about 1–2% of the
population

A

RA,

85
Q

Genetic factors may represent a risk of ______ of

developing RA.

A

15–70%

86
Q

RA generally presents with the _______ onset of
pain and stiffness of the small joints of the hands
and feet

A

insidious

87
Q

Joints involved in RA

• Hands: \_\_\_, \_\_\_\_\_\_\_, \_\_\_\_\_joints (30%)
• Wrist and elbows
• Feet: MTP joints, tarsal joints (not IP joints),
ankle
• Knees (common) and hip (delayed—up to 50%)
• Shoulder (\_\_\_\_\_\_\_) joints
• Temporomandibular joints
• Cervical spine (not \_\_\_\_\_\_\_)
A

MCP and PIP joints, DIP

glenohumeral

lumbar spine

88
Q

Clinical features of RA

• Insidious onset but can begin acutely ____
• Any age 10–75 years: peak _____years but
bimodal 25–50 (peak age) and 65–75
• Female to male ratio = _____

A

(explosive RA)

30–50

3:1

89
Q

Later stages of RA associated with

A

deformity, subluxation, instability

or ankylosing

90
Q

Later stages of RA associated with

A

deformity, subluxation, instability

or ankylosing

91
Q

Deformities associated with RA

A

swan necking, boutonnière and z

deformities, ulnar deviation

92
Q

Dxtics for RA

• ______ usually raised according to activity of
disease
• Anaemia (_____ and _______ may
be present

A

ESR/CRP

normochromic and normocytic)

93
Q 
\_\_\_\_\_\_\_
— positive in about 70–80% (less frequent in
early disease)
— 15–25% of RA patients will remain
negative
A

Rheumatoid factor

94
Q

______: more specific for RA (96% specificity)

A

Anti-cyclic citrullinated peptide (anti-CCP)

antibodies

95
Q

Xray findings associated with RA

— erosion of joint margin:\_\_\_\_\_\_\_
appearance
— loss of joint space (may be destruction
— \_\_\_\_\_\_\_
— cysts
— advanced: \_\_\_\_\_\_\_\_\_
A

‘mouse-bitten’

juxta-articular osteoporosis

subluxation or ankylosing

96
Q

Revised criteria for the diagnosis of
rheumatoid arthritis

  1. Symptom duration of______weeks
  2. Early morning stiffness of ______
  3. Arthritis in _______
  4. Bilateral compression tenderness of the ________
  5. Symmetry of the areas affected
  6. ______ positivity
  7. _______ positivity
  8. Bony erosions evident on radiographs of the hands or
    feet, although these are uncommon in early disease
A

> 6

> 1 hour

three or more regions

metatarsophalangeal joints

Rheumatoid factor

Anti-cyclic citrullinated peptide antibody

97
Q

Since many studies show disease progression in
the first 2 years, relative aggressive treatment
with ______ from the outset is advisable, rather
than to start stepwise with analgesics and
NSAIDs only

A

disease-modifying antirheumatic drugs

DMARDs

98
Q

RA Tx

________ in doses to deliver 4 g of omega-3 long-chain
polyunsaturated fatty acids daily (typically 0.2 g/kg)
has been shown to reduce symptoms and the need for
NSAIDS through its anti-inflammatory activity

A

Fish oil

99
Q

Oral use should be considered in patients with severe
disease as a temporary adjunct to DMARD therapy
and where other treatments have failed or are
contraindicated

A

Glucocorticoids

100
Q

The dose of prednisolone for RA is _______.

Avoid doses higher than 15 mg daily if possible

A

5–10 mg (o) daily.

101
Q

These agents target synovial inflammation and
prevent joint damage. The choice depends on several
factors, but is best left to the specialist coordinating
care.

A

Disease-modifying antirheumatic drugs

DMARDs

102
Q

In most patients with recently diagnosed RA,
_______is the cornerstone of management and
should be commenced as early as possible

A

methotrexate

103
Q

_______ are the newer
agents which should be considered if remission
is not achieved with appropriate methotrexate
monotherapy, ‘triple therapy’ or other combinations

A

Biological DMARDs (bDMARDs)

104
Q

Standard initial drug therapy

_________ (or occasionally another DMARD) is standard. Less than 20% will reach disease remission and, if not achieved, increase the dose or consider combination therapy

A

Monotherapy with methotrexate

105
Q

Consider standard triple therapy for RA:

A

methotrexate + sulfasalazine + hydroxychloroquine.

106
Q

Arthritis is the commonest clinical feature of
________(over 90%). It is a symmetrical polyarthritis
involving mainly small and medium joints, especially
the proximal interphalangeal and carpal joints of the
hand

A

SLE

107
Q

________can present as a polyarthritis
affecting the fingers of the hand in 25% of patients,
especially in the early stages. Soft tissue swelling
produces a ‘sausage finger’ pattern

A

Scleroderma

108
Q

Arthralgia and arthritis occur in about 50% of
patients with _________ and may
be the presenting feature before the major feature
of muscle weakness and wasting of the proximal
muscles of the shoulder and pelvic girdles appear

A

polymyositis/dermatomyositis

109
Q

Arthritis, which can be acute, chronic or asymptomatic,

is caused by a variety of _______

A

crystal deposits in joints

110
Q

The three main types of crystal arthritis are

1
2
3

A
  1. monosodium urate (gout),
  2. calcium pyrophosphate dihydrate (CPPD)
  3. calcium phosphate (usually hydroxyapatite).
111
Q

______ is an abnormality of uric acid metabolism
resulting in hyperuricaemia and urate crystal
deposition.

A

Gout

112
Q

Urate crystals deposit in:

  • joints—_________
  • soft tissue—______
  • urinary tract—________
A

acute gouty arthritis
tophi and tenosynovitis
urate stones

113
Q

Four typical stages of gout are recognised:

• Stage 1 —\_\_\_\_\_\_\_
• Stage 2 —\_\_\_\_\_\_\_
• Stage 3 —\_\_\_\_\_\_\_ (intervals between
attacks)
• Stage 4 —\_\_\_\_\_\_\_
A

asymptomatic hyperuricaemia

acute gouty arthritis

intercritical gout

chronic tophaceous gout and chronic
gouty arthritis

114
Q

What crystal is deposited?

Acute gout
Tophaceous gout
Asymptomatic
Chronic gouty arthritis

A

Monosodium

urate

115
Q

What crystal is deposited?

Acute pseudogout
Destructive arthropathy (like RA)
Asymptomatic (most common
A

Calcium
pyrophosphate
dihydrate
(CPPD)

116
Q

What crystal is deposited?

Acute calcific periarthritis
Destructive arthropathy
Acute arthritis

A

Basic calcium phosphate

117
Q

Where are crystals deposited?

Basic calcium phosphate

Calcium pyrophosphate dihydrate (CPPD)

Monosodium urate

A

Shoulder (supraspinatus)

Knee, wrist

Metatarsophalangeal joint of big toe

118
Q

Develops in postmenopausal women with kidney
impairment taking diuretic therapy who develop
pain and tophaceous deposits around osteoarthritic
interphalangeal (especially DIP) joints of fingers

A

Nodular gout

119
Q

Dx of nodular gout

_________ → typical uric acid
crystals using compensated polarised
microscopy; this should be tried first (if possible)
as it is the only real diagnostic feature

A

Synovial fluid aspirate

120
Q

Dx of nodular gout

• _______ (up to 30% can be
within normal limits with a true acute attack) 19
• __________ punched out erosions at joint margins

A

Elevated serum uric acid

X-ray:

121
Q

The acute attack of nodular gout

_______ in full dosage, are first-line and effective.
_______ Avoid if kidney impairment, with macrolide antibiotics, long-term use

_______intra-articular following aspiration and culture (gout and sepsis can occur together); a digital anaesthetic block is advisable

A

NSAIDs,

Colchicine:

122
Q

The acute attack of nodular gout

  • Avoid _______
  • Monitor______
A

aspirin and urate pool lowering drugs (probenecid, allopurinol, sulphinpyrazone)

kidney function and electrolytes

123
Q

Prevention of gout

________(a xanthine oxidase inhibitor) is the drug
of choice: dose 100–300 mg daily.

A

Allopurinol

124
Q

Indications of Allopurinol

1
2
3
4

A
  • frequent acute attacks
  • tophi or chronic gouty arthritis
  • kidney stones or uric acid nephropathy
  • hyperuricaemia
125
Q

ADR of Allopurinol

1
2

A
  • rash (2%)

* severe allergic reaction (rare)85775

126
Q

treatment of intercritical and chronic gout

Allupurinol

• Commence_____ after last acute attack.
• Start with 50 mg daily for the first week and
increase by 50 mg weekly to maximum ____

A

6–8 weeks

300 mg.

127
Q

treatment of intercritical and chronic gout

Allupurinol

• Check uric acid level ______ aim for level
<0.38 mmol/L.

• Add ______ 0.5 mg bd for 6 months (to avoid
precipitation of gout) or______ 25 mg bd
or other NSAIDs

A

after 4 weeks:

colchicine

indomethacin

128
Q

Good for hyperexcretion of uric acid by blocking renal
tubular reabsorption.

Dose: 500 mg/day (up to 2 g)

Note: Aspirin antagonises effect

A

Probenicid

129
Q

The finding of calcification of articular cartilage
on X-ray examination is usually termed
________

A

chondrocalcinosis

130
Q

The crystals in synovial fluid are readily identified

by ______

A

phase-contrast microscopy

131
Q

X-rays are helpful in

showing _____

A

calcification of the articular cartilage

132
Q

Pseudogout

Management is based on aspiration and
installation of a __________ by
injection into the joint (if joint infection excluded)
plus analgesia

A

depot glucocorticosteroid

133
Q

Tx of Pseudogout

Treatment includes:

  1. ________ 50 mg (o) tds (if tolerated) until symptoms abate and/or
  2. ______ 0.5 mg (o) tds until attack subsides
    and
    3.______ 500–1000 mg (o) four times
    daily, if necessa
A

indomethacin

colchicine

paracetamol

134
Q

The _______ are a group of
related inflammatory arthropathies with
common characteristics affecting the spondyles
(vertebrae) of the spine

A

spondyloarthropathies

135
Q

It is appropriate to
regard them as synonymous with the seronegative
spondyloarthropathies in contradistinction to ____, which is seropositive and affects the cervical spine
only

A

RA

136
Q

THE SPONDYLOARTHROPATHIES

Apart from back pain this group tends to
present with ______ in younger patients

A

oligoarthropathy

137
Q

THE SPONDYLOARTHROPATHIES

The arthritis is characteristically peripheral,
1
2
3

A

asymmetrical, affects the lower limbs and can exhibit

dactylitis

138
Q

THE SPONDYLOARTHROPATHIES

• ______with or without spondylitis
• ________, especially plantar fasciitis, Achilles
tendonitis, costochondritis
• Arthritis, especially larger ______

A

Sacroiliitis

Enthesopathy

lower limb joints

139
Q

THE SPONDYLOARTHROPATHIES

  • Absent _____
  • Association with _____
  • Familial predisposition
A

rheumatoid factor

HLA-B 27 antigen

140
Q

THE SPONDYLOARTHROPATHIES:

Associated DO

A 
iritis/anterior uveitis,
 mucocutaneous lesions, 
psoriasiform skin and 
nail lesions, chronic GIT and GU
inflammation)
141
Q

What are the SPONDYLOARTHROPATHIES:

A 
1 Ankylosing spondylitis
2 Reactive arthritis
3 Inflammatory bowel disease (enteropathic
arthritis)
4 Psoriatic arthritis
5 Juvenile onset ankylosing spondylitis
6 Unclassified spondyloarthritis
142
Q

This usually presents with an insidious onset of
inflammatory back and buttock pain (sacroiliac
joints and spine) and stiffness in young adults (age
<40 years), and 20% present with peripheral joint
involvement before the onset of back painAnkylosing spondylitis

A

Ankylosing spondylitis

143
Q

What does Ankylosing spondylitis affect?

A

It usually affects the girdle joints (hips and shoulders), knees or ankles

144
Q

Ankylosing spondylitis

• Low back pain persisting for ______months
• Associated morning stiffness >30 minutes
Improvement with ________
• Limitation of lumbar spine motion in______

A

> 3

exercise and not relieved by rest

sagittal and
frontal planes

145
Q

_________ is a form of arthropathy in which
non-septic arthritis and often sacroiliitis develop
after an acute urogenital infection

A

Reactive arthritis

146
Q

Infectious associated with Reactive arthritis

A

(usually Chlamydia trachomatis ) or an enteric infection (e.g. Salmonella, Shigella ).

147
Q

NSU + conjunctivitis ± iritis + arthritis

A

reactive arthritis

148
Q

Joints affected in reactive arthritis

A

the larger peripheral
joints, especially the ankle (talocrural) and knees,
but the fingers and toes can be affected in a patchy
polyarthritic fashion

149
Q

Inflammatory bowel disease (ulcerative colitis, Crohn
disease and Whipple disease) may rarely be associated
with peripheral arthritis and sacroiliitis

A

Enteropathic spondyloarthropathy

150
Q

Like reactive arthritis, this can develop a condition
indistinguishable from ankylosing spondylitis. It is
therefore important to look beyond the skin condition
of psoriasis

A

Psoriatic arthritis

151
Q

How many percent of patients with Psoriasis will develop arthritis?

A

5%

152
Q

Psoriatic arthritis

1 mainly _______ joints
2 identical RA pattern but RA factor negative
3 identical ankylosing spondylosis pattern with
___ and ____
4 monoarthritis, especially knees
5 severe deformity or ____

A

DIP

sacroiliitis and spondylitis

‘mutilans’ arthritis

153
Q

Morning stiffness and pain, improving with

exercis

A

RA

154
Q

Flitting polyarthritis and fever =

A

rheumatic fever;

?endocarditis; ?SLE.

155
Q

If rheumatoid arthritis involves the neck, beware of

______ and _____

A

atlantoaxial subluxation and spinal cord compression

156
Q

If a patient returns from overseas with arthralgia,
think of _______ but
if the pain is intense consider _______

A

drug reactions, hepatitis, Lyme disease,

dengue fever.

157
Q

Consider the possibility of _______in people
with a fever, rash and arthritis who have been
exposed to tick bites in rural area

A

Lyme disease

158
Q

If a patient presents with Raynaud phenomenon
and arthritis, especially of the hands, consider
foremost ________

A

RA, SLE and systemic sclerosis

MC (90 decks)

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