Arthritis Flashcards
(28 cards)
Osteoarthritis
Pathology
Loss of articulate cartilage over time
Causing extra bone (osteophytes) to form
Osteoarthritis
Clinical Features
Pain
Joints affected
Morning stiffness lasting less than 1 hours
Pain worse on movement
Joints affected: load bearing joints e.g. hands (distal interpharyngeal joints DIP), knees, hips
Osteoarthritis
What are Heberden’s node’s?
Heberden’s node’s are bony prominences (due to osteophyte production) on the distal interpharngeal joint (DIP)
Rheumatoid arthritis
Pathology
Rheumatoid arthritis is a symmetrical and chronic inflammation of joints
Rheumatoid arthritis
Clinical features
Joints affected
Tends to affect small joints e.g. the wrist and hands
But Knees, elbows, shoulders, ankles and small joints of the feet can be affected too
Morning stiffness tends to last over one hour
Stiffness is relieved by movement
Rheumatoid arthritis
Late clinical features in the hands
Thumb: Boutonniere deformity (where the thumb looks like it’s pressing down on the button)
Fingers: swan neck deformity and ulnar deviation of the metacarpophalangeal joints (MCP)
What are the types of chronic inflammatory arthritis?
It depends whether rheumatoid factor is measurable
Rheumatoid factor being present means seropositive (e.g. rheumatoid arthritis)
Rheumatoid factor not being present means seronegative (e.g. CRAP)
The types of seronegative arthritides include:
Colonic/ enteropathic (associated with Crohn’s)
Reactive
Ankylosing spondylitis
Psoriatic arthritis
Ankylosing spondylitis
Clinical features
Systemic features
Tends to affect young men (Onset age less than 40 years old)
Morning stiffness that improves with movement
Back pain at night
Tends to affect the spine and sacroiliac joints
Systemic manifestations: uveitis, psoriasis, IBD
Ankylosing spondylitis
Diagnosis
Schober’s test: marking appoint 10 cm above the dimples of Venus/ Iliac crest and 5 cm below. Get patient to touch toes. Bending should cause the space between the points to increase by more than 5 cm. If not, sign of ankylosing spondylitis
Fabers test: flexion, abduction and external rotation of sacroiliac joint
HLA– B 27 positive
Official ankylosis spondylitis diagnosis needs SIJ changes on X-ray (but there is a diagnosis of ankylosising spondylitis that does not have any radiographic joint changes and only clinical Features)
MRI if not clear on X-ray: inflammatory Romano lesions
Psoriatic arthritis
Five major types
Other clinical Features
Associated complications
Inflammatory arthritis associated with psoriasis
Five major types:
1. Poly arthritis – rheumatoid arthritis like (as it affects small joints et cetera)
- Axial – ankylosing spondylitis like (tends to affect spine and sacroiliac joints)
- Asymmetrical oligoarthritis- less than 5 large joints affected
- Distal interpharyngeal joints – Osteoarthritis like
- Arthritis mutilans - rapidly destructive
Other clinical Features: nail involvement, synovitis
Associated with co-morbidities: hypertension, metabolic disorders (obesity, T2DM), depression
Psoriatic arthritis
Diagnosis
X ray: pencil in cup appearance of joints
Septic arthritis
Clinical features
Red hot swollen joint
Painful
Restricted movement
Septic arthritis
Pathology
Pathogen enters joint space
Usually due to a cut in the skin
Common pathogen is: staph aureus, Neisseria
Septic arthritis
Diagnosis
Joint aspiration/synovial fluid: Gram stain and culture
Bloods: FBC, CRP, ESR, blood cultures
Imaging: consider x-ray, Ultrasound, MRI
Septic arthritis
Management
IV Antibiotics
First line: flucloxacillin
Second line: Vancomycin (if penicillin allergic)
Triax own (if Neisseria gonorrhoea or Neisseria meningitides)
Reactive Arthritis
Clinical Features
Onset 1-3 weeks after infection
Reiters triad: can’t see, can’t pee, can’t climb a tree
- Uveitis
- Urtheritis
- Arthritis
Enteropathic arthritis
Clinical Features
Tends to be crohns (instead of UC)
Any joint can be affected: axial is more associated with crohn’s
Systemic features: erythema nodosum, pyoderma gangrenosum
Management for spondylarthropathies
Medical
NSAIDs: first line for axial
Steroids: intracapsular-articulation and systemic if skin involved
DMARDs for peripheral arthritis:
Methotrexate ( also for psoriasis)
Sulfasalazine
Leflunamide
Biological:
Management for spondylarthropathies
Non medical
MDT
Physio therapy
Psych counselling
Gout
Clinical features
First metatarsal- phalangeal joint
Painful joint
Swollen joint
Joint effusion
Restricted movement of joint /Morning stiffness which improves with movement
Tophi: Especially found over extensor surfaces e.g. knees, elbows or Achilles’ tendon
Gout
Risk factors
Male older
Diuretics
Aspirin use
Cyclosporine use
Meat consumption
CKD
High cell turnover so making more Uric acid: chemotherapy
Dehydration
Trauma
Genetic: Filipino and SE Asian
Gout
Diagnosis
Joint aspirate/Synovial fluid analysis: Uric acid crystals are negatively bifringent needle shaped crystals
Bloods: Uric acid level, CRP
Imaging: ultrasound or x-ray
Gout
Medical Management
First line: NSAID e.g. ibuprofens or naproxen
Add PPI for gastric protection
Second line: colchicine
Third line: corticosteroids
Allopurinol used for prevention 2 to 3 weeks post episode
Gout
Lifestyle management
Restrict purines
Stop smoking
Hydrate and move around well
