Arthritis

Question 1

How can OA be subdivided?

Answer 1

Primary: Generalised
Secondary: Haemochromatosis, occuptional, obesity

Question 2

What are the signs of OA?

Answer 2

Unilateral Large weight bearing joints:

• Pain & crepitus
• Worse at end of day
• Stiffness after prolonged rest (30mins)
• Joint instability
• Tenderness
• ↓ RoM
• Mild synovitis

Question 3

What are the signs of OA in the hands?

Answer 3

Heberdens (DIP)

Bouchards (PIP)

Question 4

What is the diagnostic criteria for OA?

Answer 4

>45yo
Activity related joint pain
AND
No am joint related stiffness or <30mins
IF FIT CRITERIA no need for radiology

Question 5

What are the signs of OA on X-ray:

Answer 5

LOSS:
L : Loss of joint space
O: Osteophytes
S: Subarticular sclerosis
S: Subchondral cysts
= joint destruction

Question 6

How is OA managed?

Answer 6

-Exercise (Strengthen muscle THEN aerobic fitness), Quads & grip strengthening exercises
-Weight loss & footwear
-Analgesia:
1) Paracetamol + TOP NSAIDs
2) Work up analgesic ladder
3) IA steroid injections
-Surgery:
Arthroscopic lavage
Total joint replacement

Question 7

Who can be considered for surgery w/OA?

Answer 7

ALL of following:
Joint Sx
Substantial impact on QoL
Refractory to non-surgical Tx

Question 8

What are the RFs for RA?

Answer 8

Smoking
Poor dental hygiene
Female
>50yo
HLA DR4/DR1 linked

Question 9

What is RA?

Answer 9

Chronic, systemic inflammatory joint disease characterised by autoantibody production

Question 10

What are the early Sx of RA?

Answer 10

Relapsing & remitting
Symmetrical
Worse in the am w/stiffness >60mins
Small joints: swollen, painful & tender
Tenosynovitis/bursitis
Fatigue & malaise
Weight loss

Question 11

Which joints are commonly affected in RA?

Answer 11

Wrists
MCP
PIP

Question 12

What are the late Sx of RA?

Answer 12

Ulnar deviation
Dorsal wrist subluxation
Boutonniere & swan necking
Z deformity of thumb
Hand extensor tendon rupture

Question 13

What are the extra-articular signs of RA?

Answer 13

RA nodules
LUNGS: Fibrosing alveoli’s, RA nodules, effusion, bronchiolitis
VASCULAR: Raynaud’s, vasculitis, lymphadenopathy
EYES: Epi/Scleritis, Scleromalacia, conjunctivitis

Question 14

How is RA investigated?

Answer 14

Referral if criteria met
Bloods: 
RF (ANYONE w/Synovitis) +ve in 70%
-ve → anti-CCP
ESR↑↑
CRP↑
Plasma viscosity↑
Xray of hands & feet: Monitor progression

Question 15

What is the criteria for RA referral to rheumatology?

Answer 15

Any of:
Small joints of hands & feet affected
>1 joint affected
Delay of >3m between onset + medical advice

Question 16

What are the signs on an X-ray of RA?

Answer 16

Soft tissue swelling
Deformities – ulnar dev, boutonnieres etc.
Osteopenia + Periarticular osteoporosis
↓Joint space (late), Bony Erosions, Subluxation or complete Carpal destruction (late)

Question 17

How is RA managed?

Answer 17

MDT management
1) DMARD: START ASAP = 
Methotrexate +1:
-Sulfasalazine
-Hydroxychloroquine
IF NO AFFECT: Rituximab
\+) Analgesia: NSAIDs
\+) Steroids: Prednisolone
Surgery

Question 18

How is RA monitored?

Answer 18

DAS28 score: Adequate = >1.2points

CRP: Normal

Question 19

What is assessed at annual review for RA?

Answer 19

RA activity & function
Co-morbidities: HTN, OP, Depression, IHD
Complications: Vasculitis, spinal disease, lungs, eyes

Question 20

What are the complications of RA medications?

Answer 20

Immunosuppression
Retinopathy: SE of hydroxychloroquine (irreversible)
CVD
Pneumonitis: SE of MTX
Rash, ↓Sperm count, ulcers: SE of Sulfasalazine

Question 21

What is seronegative arthritis?

Answer 21

Inflammatory arthritis without a positive RF

Question 22

What differentials should be considered alongside seronegative arthritis?

Answer 22

Sponyloarthropathies
Crystalline arthropathis
Inflammatory/CT disease
Systemic disease
Infectious arthritis
Neoplastic arthritis