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Y3 MedEd > Arthritis > Flashcards

Arthritis Flashcards

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1
Q

Define osteoarthritis

A

Slowly progressive degeneration of articular cartilage

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2
Q

RF osteoarthritis (4)

A

Obesity
Occupation
Age
Female gender

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3
Q

What can cause secondary osteoarthritis

A

Inflammatory arthritis
Metabolic conditions
Trauma
Deformity

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4
Q

What deformity can cause secondary osteoarthritis

A

developmental dysplasia of the hip

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5
Q

What metabolic conditions can cause secondary osteoarthritis

A

haemochromatosis, Wilson’s disease

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6
Q

Presentation of osteoarthritis (4)

A

Pain worse at end of day
Asymmetrical joint stiffness, especially after inactivity
Joint crepitus
Restricted activity

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7
Q

Which joints are most commonly affected by OA (6)

A 
Weight bearing joints (hip, knee)
Heavy use (DIP, PIP, 1st CMC, wrist)
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8
Q

What is seen on the hands of OA patients and which one is which (2)

A

Heberdens node DIPJ

Bouchards node PIPJ

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9
Q

What is seen in the X ray of osteoarthritis (4)

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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10
Q

What is seen in the joint aspirate of osteoarthritis (4)

A

Straw coloured fluid

Increased viscosity

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11
Q

RA definition

A

Chronic (>6 weeks), systemic inflammatory disease characterised by symmetrical deforming polyarthritis (>4 joints)

and extra-articular manifestations

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12
Q

How many joints are affected rheumatic arthritis

A

> 4

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13
Q

RF RA (2)

A

HLA DR4 mutation

Smoking

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14
Q

What is the gender ratio of RA

A

1:2

Male to female

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15
Q

What is the standard AI gender ratio

A

1 : 2 (autoimmune)

Male : female

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16
Q

History of RA

A

Pain worse at start of day
Joint stiffness for >1h in morning
Restricted activity

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17
Q

Which joints are affected in RA (6)

A

Small joints of hands (PIP, MCP, wrist – NOT DIP)

Other joints: hip, knee, shoulders

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18
Q

What later deformities are seen in RA (5)

A

Wrist: radial deviation
MCP: ulnar deviation of fingers, Z-deformity of thumb
PIP/DIP: Boutoinniere deformity, Swann neck deformity

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19
Q

Extra-articular manifestations of RA (7)

A 
Rheumatoid nodules
Lymphadenopathy
Eyes: episcleritis
Lungs/hearts: pleuritis (fibrosis) /pericarditis
Amyloidosis
Haematological:
Anaemia of chronic disease
Felty syndrome
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20
Q

What does synovial inflammation lead to in RA

A

Tenosynovitis

Bursitis

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21
Q

What haematological complications of RA can you get (2)

A

Anaemia of chronic disease

Felty syndrome

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22
Q

What is the Felty syndrome triad

A

Splenomegaly
Neutropenia
Anaemia of chronic disease

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23
Q

Systemic symptoms of RA (3)

A

Fever
Wt loss
Fatigue

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24
Q

What is seen in the X-ray of RA

A

Uniform joint space narrowing
Juxta-articular osteopenia
Joint erosions at joint margins
Joint deformity & destruction

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25
What do you test for in the blood of RA (6)
``` Chronic inflammation: Anaemia of chronic disease ↑ ESR/CRP Low albumin Antibodies: Rheumatoid factor (IgM against IgG) Anti-CCP (most specific) ```
26
Which antibodies in RA
``` Rheumatoid factor (IgM against IgG) Anti-CCP (most specific) ```
27
What is primary amyloidosis associated with (3)
multiple myeloma, lymphoma, waldenstron’s macroglobulinaemia
28
What is secondary amyloidosis associated with (4)
with RA, IBD/UC, chronic infections (e.g TB)
29
What is the difference between primary and secondary amyloidosis
``` Primary amyloidosis (AL amyloidosis) Deposition of immunoglobin light chain ``` ``` Secondary amyloidosis (AA amyloid) Deposition of serum amyloid A (acute phase protein) ```
30
Presentation of amyloidosis (6)
``` Nephrotic syndrome Hepatosplenomegaly Carpal tunnel syndrome + peripheral neuropathy Periorbital purpura Restrictive cardiomyopathy (1o) Macroglossia (1o) ```
31
Which presentation of amyloidosis is solely in primary amyloidosis (2)
``` Restrictive cardiomyopathy (1o) Macroglossia (1o) ```
32
Diagnostic test of amyloidosis
Apple-green birefringence under polarised light with Congo Red stain
33
What are the Seronegative spondyloarthropathies (4)
PEAR Psoriatic arthritis Enteropathic arthritis Ankylosing spondylitis Reactive arthritis
34
Associations/presentation of the seronegative arthropathies (5)
HEADS ``` HLA B27 Enthesitis Asymmetrical oligoarthritis with Axial involvement and extra-articular involvement Dactylitis Seronegative ```
35
Gender distribution of seronegative spondyloarthropathies
Men more commonly
36
Age and sex of AS
Affects young men (<40yrs)
37
Extraarticular manifestations of AS (3)
Anterior uveitis Apical lung fibrosis Aortic regurgitation
38
Where does AS affect
Affects spine (enthesitis) and sacroiliac joints (arthritis):
39
What happens in AS (4)
Gradual onset pain and morning stiffness | Eventually bone fusion, and loss of spinal movement
40
What changes to posture do you se in ankylosing spondylitis
Question-mark posture: loss of lordosis, kyphosis, neck hyperextension
41
Bloods to take in AS and what is seen in it
ACD, ESR/CRP, albumin
42
Best Ix for AS
MRI most sensitive
43
What is seen in X-ray of mild (1) and late (2) AS
Mild: sacroilitis Late: syndesmophytes & bamboo spine
44
What is reactive arthritis
Sterile inflammation ~2 weeks after extra-articular infection
45
Which infections can cause reactive arthritis
``` GU infection (chlamydia, gonorrhoea) GI infection (shigella, campylobacter) ```
46
What triad is seen in reactive arthritis
Arthritis: Asymmetrical oligoarthritis of lower limbs + spondylitis Enthesitis: Dactylitis, Achilles tendonitis, plantar fascitis Reiter’s syndrome “Can’t see, can’t pee, can’t climb a tree” Conjunctivitis, urethritis, arthritis
47
What is Reiter's syndrome
Reiter’s syndrome “Can’t see, can’t pee, can’t climb a tree” Conjunctivitis, urethritis, arthritis
48
What enthesitis manifestations is seen in reactive arthritis (3)
Dactylitis, Achilles tendonitis, plantar fascitis
49
Which organisms are usually involved in septic arthritis and which is more likely in which patient (2)
Staph. Aureus >30yrs | Neisseria gonorrhoea <30yrs
50
Main 2 RF of septic arthritis
Joint damage | Infection risk
51
What forms of joint damage can lead to septic arthritis (3)
Rheumatoid arthritis; prosthetic joint; gout
52
Which people are prone to infections that can lead to septic arthritis (3)
Immunosuppression; diabetes; IVDU
53
Presentation of septic arthritis (4)
``` Acute monoarthritis, usually affecting the knee: Exquisite pain Redness and swelling Restricted ROM Fever ```
54
Which joint does septic arthritis usually affect
Knee
55
Which Ix for septic arthritis and what results
``` Bloods: ↑ WCC, ↑ CRP Joint aspirate (before ABx): Turbid, yellow Low viscosity ↑ WCC (neutrophils >90%) MC&S ```
56
What is the crystal in gout
Monosodium urate crystals
57
What is the crystal in pseudogout
Calcium pyrophosphate crystals
58
What is the typical gout patient
Obese, middle-aged men
59
What is the typical pseudo-gout patient
Elderly women
60
What are the two presentations of gout
Acute monoarthritis Classically 1st MTP (podagra) Precipitated by: trauma, infection Chronic tophaceous gout: Polyarticular arthritis Tophi deposits Urate kidney stones
61
What is the two presentations of pseudo-gout
Acute monoarthritis Classically large joints (knee) Precipitated by: trauma, illness Chronic CPPD Polyarticular arthritis
62
Which joint(s) does gout typically affect
Classically 1st MTP (podagra)
63
Which joint(s) does pseudogout typically affect
Classically large joints (knee)
64
RF for gout (3)
Hyperuricaemia ↑ intake: alcohol ↑ production: tumour lysis syndrome ↓ excretion: diuretics
65
RF for pseudo-gout (7)
Idiopathic HyperPTH, hypoPO4, hypoMg Metabolic: haemochromatosis, Wilson’s, acromegaly
66
Metabolic causes of pseudo gout
haemochromatosis, Wilson’s, acromegaly
67
Precipitants of gout (2)
Precipitated by: trauma, infection
68
Precipitants of pseudo-gout (2)
Precipitated by: trauma, illness
69
Bloods of gout (3)
↑ WCC ↑ CRP Uric acid after 4-6 weeks
70
Bloods of pseudogout (2)
↑ WCC | ↑ CRP
71
How long for uric acid to be raised in gout
4-6 weeks
72
What is seen in the joint aspirate of gout
Turbid, yellow fluid Low viscosity ↑ WCC (↑ neutrophilis)
73
What is seen in the joint aspirate of pseudo gout
Turbid, yellow fluid Low viscosity ↑ WCC (↑ neutrophilis)
74
What is the result under polarised light of gout
Polarised light: | Needle shaped, negatively birefringent
75
What is the result under polarised light of pseudogout
Polarised light: | Rhomboid shaped, positively birefringent
76
What is seen in the X-ray of gout
Rate-bite erosions
77
What is seen in the X-ray of pseudogout
White lines of chondrocalcinosis
78
What is osteomyelitis
Infection of bone
79
What is most common organism in osteomyelitis
Staph aureus
80
What are the three ways of acquiring osteomyelitis
Haematogenous spread Contiguous spread Direct inoculating
81
Which patients are most at risk of haematogenous spread of osteomyelitis
IVDU Immunosuppression Diabetes Sickle cell (Salmonella)
82
Presentation of osteomyelitis (3)
Inflammation (pain & swelling) Reduced mobility Fever
83
Which bones commonly get osteomyelitis in children
Long bones
84
What is TB osteomyelitis of the vertebrae known as
Potts disease
85
Which bloods do we take for suspected osteomyelitis (3)
↑ WCC ↑ ESR/CRP Blood cultures
86
Which Ix is the most sensitive for osteomyelitis
X-ray

Y3 MedEd (34 decks)

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