Arthritis and soft tissue rheumatism Flashcards Preview

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Flashcards in Arthritis and soft tissue rheumatism Deck (46):
1

What is generalised OA?

OA in three or more sites

2

When is OA pain worse?

During activity, relieved by rest
usually morning stiffness lasting 30 mins

3

What will you hear in an OA joint?

Crepitus

4

Why is an OA joint enlarged?

Osteophytes

5

OA joint distribution?

foot, knee, hip, cervical spine, lumbar spine, hand

6

Which joints does OA affect in hand?

DIP, PIP, and 1st CMC joints

7

Heberdens nodes

DIP

8

Douchards nodes

PIP

9

What might the thumb look like in OA?

Squared off

10

What kind of cyst might you find in the knee in OA?

Bakers cyst

11

Where might you feel OA hip pain?

may feel in groin
may radiate to knee
may feel in lower back

12

Intra-articular pharmacological management of OA?

Steroids
Hyaluronic acid

13

Surgical management of OA

Arthroscopic washout
Loose body
Soft tissue trimming
Joint replacement

14

Which condition are urate crystals found in?

Gout

15

Which type of crystals are found in gout?

Urate

16

Birefringent in gout?

Negative

17

How does the body respond to gout?

Acute inflammatory response with phagocytosis of crystals

18

Psoriasis and hyperuricemia?

Psoriasis can cause hyperuricemia

19

Which foods are high in purine?

Red meat
Seafood
Corn syrup

20

Causes of reduced urate excretion

Chronic renal impairment
Volume depletion eg heart failure
Hypothyroidism
Diuretics
Cytotoxics eg cyclosporin

21

Which cytotoxics can cause reduced urate excretion?

Ciclosporin

22

Ciclosporin and renal function

Ciclosporin causes a reduced renal blood flow and glomerular filtration rate

23

Causes of increased urate production

Inherited enzyme defects
Myeloproliferative/Lymphoproliferative disorders
Psoriasis
Haemolytic disorders
Alcohol (beer, spirits)
High dietary purine intake (red meat, seafood, corn syrup

24

How would you treat hydroxyapatite?

NSAID
Intra-articular steroid injection
Physiotherapy
Partial or total arthroplasty

25

Prophylactic treatment for gout and when you should start it

Allopurinol
Febuxstat
-Start 2-4 weeks after acute attack
-Provide cover with NSAIDS etc

26

Treatment for acute attacks of gout?

NSAIDs
Allopurinol
Colchicine
Steroids

27

Calcium pyrophosphate deposition disease

Commoner in elderly
Chondrocalcinosis increases with age
Related to osteoarthritis
Affects fibrocartilage - knees, wrists, ankles
Acute attacks related to shedding of calcium pyrophosphate crystals (pseudogout)
Calcium pyrophosphate crystals-envelope shaped, mildly positively birefringent

28

Inflammatory markers in CPPD

Raised inflammatory markers in CPPD

29

Hydroxyapatite

“Milwaukee shoulder”
Hydroxyapatite crystal deposition in or around the joint.
Release of collagenases, serine proteinases and IL-1
Acute and rapid deterioration.
Females, 50-60 years

30

Which mediators are released in hydroxyapatite?

Collagenases
Serine proteases
IL-1

31

CPDD crystal deposition disease associations

Hyperparathyroidism
Familial hypocalciuric hypercalcemia
Hemochromatosis
Hemosiderosis
Hypophosphatasia
Hypomagnesia
Hypothyroidism
Gout
Neuropathic joints
Aging
Amyloidosis
Trauma

32

Treatment for CPDD

NSAIDS
Steroids
Colchicine
Rehydration

33

Causes of pseudogout

Lack of fluid (dehydration).
An attack of any severe illness.
Overactivity of the parathyroid glands (hyperparathyroidism).
Long-term use of steroid medicine.
Underactive thyroid gland (hypothyroidism).
Any cause of arthritis.
Haemochromatosis
Wilson's disease
Acromegaly
Kidney dialysis.
Surgery or injury.
Low magnesium level in the blood (hypomagnesaemia).

34

Hydroxyapatite

Hydroxyapatite (HA) crystal deposition disease (HADD) is a well-recognized systemic disease of unknown etiology that is caused by para-articular and/or intra-articular deposition of HA crystals. The disease is clinically manifested by localized pain, swelling, and tenderness about the affected joint along with variable limitation of joint motion, although not all patients are symptomatic. Plain radiographs may show calcifications of varying size and shape in the para-articular tendons, bursae, and capsule. The disease may be mono- or polyarticular in distribution. The shoulder is most commonly involved with calcification in the supraspinatus tendon. When intra-articular, HA crystals can cause joint destruction. Any joint can be involved; the shoulder is most commonly affected, resulting in "Milwaukee shoulder." Treatment of HADD usually requires use of analgesics, local heat, needling with or without aspiration of the calcific deposits, steroid injections, and, at times, even surgery for relief of pain.

35

Soft tissue rheumatism vs fibromyalgia

Pain should be confined to a specific site e.g. shoulder, wrist etc.

More generalised soft tissue pain – consider fibromyalgia

36

Some patients with reactive arthritis may suffer from a triad of symptoms (Reiters), what is the triad?

Urethritis
Uveitis
Arthritis

37

Where does enteropathic arthritis affect?

Spine and peripheral joints

38

Nail changes often seen in psoriatic arthritis

Pitting and oncholyitis (lifting of the nail from the nail bed)

39

Common sites for enthesitis

Common sites for enthesitis are:
at the top of the shin bone
behind the heel (Achilles tendon)
under the heel
where the ribs join to the breast bone
If your ribs are affected, you may experience chest pain, and you may find it difficult to expand your chest when breathing deeply.

40

Dactylitis

Sausage digit

41

Common first sign of scleroderma/systemic sclerosis

Swelling of the fingers

42

Common enthsopathies in reactive seronegative autoimmune arthritis

-Plantar fasciitis
-Achilles insertional tendonitis

43

Bamboo spine in which condition?

Ankylosing spondylitis

44

Which kind of arthritis may someone with ankylosing spondylitis develop?

Knee or hip

45

Conditions associated with ankylosing spondylitis

Associated conditions include aortitis, pulmonary fibrosis and amyloidosis.

46

Treatment for ankylosing spondylitis

Treatment consists of physiotherapy, exercise, simple analgesia and DMARDs for more aggressive disease. Surgery is mainly reserved for hip and knee arthritis and kyphoplasty to straighten out the spine is controversial and carries considerable risk.