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Year 3 - MedEd Lectures > Arthritis > Flashcards

Arthritis Flashcards

1
Q

What is Osteoarthritis?

A

Prgressive degeneration of articular cartilage.

Considered a disease of ‘Wear and Tear’

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2
Q

What are the causes of Osteoarthritis?

A

Primary - Risk Factors

Secondary - Pre-Existing Abnormalities (RA, Haemochromatosis, Trauma, Deformities)

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3
Q

How does Osteoarthritis typically present?

A

Pain worse at the end of the day

Joint Stiffness after inactivity

Joint Crepitus

Asymmetrical - Mainly on the weight-bearing (Hip, Knee) and Heavy Use (DIP, PIP, 1st CMC, Wrist) joints.

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4
Q

How should you investigate a suspected case of Osteoarthritis?

A

X-Ray, LOSS

Loss of joint space

Osteophytes

Subchondral Sclerosis

Subchondral Cysts

Joint Aspirate

Straw-coloured fluid with increased viscosity

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5
Q

Define Rheumatoid Arthritis.

A

Chronic (>6 Weeks), Systemic inflammatory disease causing:

Symmetrical deforming polyarthritis (>4 Joints)

and

Extra-Articular Manifestations

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6
Q

What are the main risk factors for Rheumatoid Arthritis?

A

HLA DR4

Smoking

Co-existence of other autoimmune diseases

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7
Q

How does Rheumatoid Arthritis typically present?

A

Pain worse at the start of the day

Morning Stiffness (>1 Hour)

Small joints of the hands

Hip, Knee, Shoulders

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8
Q

Which joint is typically spared in RA?

A

DIP

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9
Q

What are the key late signs that can often be seen in patients with RA?

A

Radial Deviation

Ulner Deviation of Fingerts

Z-Deformity

Boutoinniere Deformity

Swan Neck Deformity

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10
Q

What are the main Extra-Articular features you may observe in a patient with RA?

A

Rheumatoid Nodules

Lymphadenopathy

Episcleritis

Pleuritis

Pericarditis

Amyloidosis

Anaemia of CD

Felty Syndrome

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11
Q

How should you investigate a suspected case of RA?

A

Bloods - AoCD, ESR/CRP, Hypoalbuminaemia

X-Ray

RF

Anti-CCP

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12
Q

What might you see on an X-Ray of someone with RA?

A

Uniform joint space narrowing

Juxta-articular osteopenia

Joint erosions at joint margins

Joint deformity and destruction

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13
Q

What is Amyloidosis?

A

Condition characterised by the Extracellular Deposition of abnormal Amyloid proteins.

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14
Q

Which conditions is Amyloidosis typically associated with?

A

Primary - Multiple Myeloma, Lymphoma, Waldenstron’s Macroglobulinaemia

Secondary - RA, IBD, TB

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15
Q

How does Amyloidosis typically present?

A

Nephrotic Syndrome

Hepatosplenomegaly

Carpal Tunnel Syndrome

Periorbital Purpura

Restrictive Cardiomyopathy

Macroglossia

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16
Q

How is Amyloidosis diagnosed?

A

Apple-green birefringence under polarised light with Congo-Red stain

17
Q

What are the main Seronegative Spondyloarthropathies?

A

PEAR

Psoriatic Arthritis

Enteropathic Arthritis

Ankylosing Spondylitis

Reactive Arthritis

18
Q

Which features do all Seronegative Spondyloarthropathies present with?

A

HEADS

HLA B27

Enthesitis

Asymmetrical Oligoarthritis with Axial involvement

Dactylitis

Seronegative

19
Q

How does Ankylosing Spondylitis typically present?

A

Gradual onset pain & morning stiffness in the :

Spine (Enthesitis)

Sacroiliac Joints (Arthritis)

Eventually, Bone-fusion and loss of spinal movement.

20
Q

What are the key extra-articular features in Ankylosing Spondylitis?

A

Anterior Uveitis

Apical Lung Fibrosis

Aortic Regurgitation

21
Q

How should you investigate a suspected case of Ankylosing Spondylitis?

A

Bloods - ACD, ESR/CRP, Albumin

MRI

X-Ray - Sacrolitis, Bamboo Spine, Syndesmophytes

Schober’s Test

22
Q

What is Reactive Arthritis?

A

Sterile inflammation 2 weeks after extra-articular infection.

23
Q

What are the most common infections that lead to the development of Reactive Arthritis?

A

GU (Chlamydia, Gonorrhoea)

GI (Shigella, Campylobacter)

24
Q

How does Reactive Arthritis typically present?

A

Asymmetrical oligoarthritis of the lower limbs and spondylitis

Dactilytis, Achilles Tendonitis, Plantar Fascitis

Reiter’s Syndrome

25
Q

What is Reiter’s Syndrome?

A

Can’t see, can’t pee, can’t climb a tree

Conjunctivitis

Urethritis

Arthritis

26
Q

What is Septic Arthritis?

A

Emergency that may lead to joint destruction.

Joint inflammation due to direct bacterial inoculation of the joint.

Staph. a most common cause

27
Q

What are the main Risk Factors for Septic Arthritis?

A

Joint Damage (RA, Prosthetics, Gout)

Infection (Immunosuppression, Diabetes, IV Drug User)

28
Q

How does Septic Arthritis typically presenty?

A

Acute monoarthritis, usually affecting the knee.

Hot, Red, very painful joint.

Fever

29
Q

What might you see upon Joint Aspiration of a Septic Knee?

A

Turbid, yellow fluid

Low Viscosity

Neutrophils

30
Q

What are the main risk factors for gout?

A

Obesity

Male

Hyperuricaemia

Alcohol

31
Q

How does Gout present?

A

Acute Monoarthritis on the 1st MTP, precipitated by trauma dn infection.

32
Q

How does Pseudogout typically present?

A

Acute monoarthritis of the large joints (knee) in Elderly women

33
Q

What would you see upon investigation of a suspected case of Gout?

A

Uric Acid, Raised WCC/CRP

Turbid, yellow fluid with neutrophils and low viscosity

Needle-Shaped, negatively birefringent crystals of Monosodium Urate when seen under polarising light.

‘Rat Bite erosions’ under X-Ray

34
Q

What might you see upon investigation of a case of Pseudogout?

A

Similar to Gout.

Rhomboid-shaped, positively birefringent crystals of Calcium Pyrophosphate.

White Lines of Chondrocalcinosis on X-Ray

35
Q

What is Osteomyelitis?

A

Bone infection, usually by Staph aureus

36
Q

What might increase the risk of developing Osteomyelitis?

A

Haematogenous

IVDU

Immunosuppression

Diabetes

Sickle Cell (Salmonella)

Contiguous

Cellulitis

Localised Infection

Direct

Penetrating Injury

37
Q

How does Osteomyelitis typically present?

A

Inflammation

Fever

Long Bones - Children

Vertebrae - Adults (Think Pott’s)

38
Q

How should you investigate a suspected case of Osteomyelitis?

A

Bloods - WCC, CRP, ESR, Cultures

X-Ray

MRI

Year 3 - MedEd Lectures (29 decks)

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