Arthropathies

Question 1

What type of infections commonly cause reactive arthritis? How long after the infection does the arthropathy occur?

Answer 1

GU (e.g. chlamydia/gonorrhoea) or GI (e.g. campylobacter/salmonella) - the arthropathy typically occurs 1-3 weeks after the infection

Question 2

The diagnosis of rheumatoid arthritis is based on what 3 things?

Answer 2

Clinical presentation, serological analysis (inflammatory markers, autoantibodies, routine bloods) and radiographic findings

Question 3

Name the 4 main symptoms of osteoarthritis?

Answer 3

Mechanical pain, crepitus, joint stiffness (usually < 30 minutes), bony swellings and deformities

Question 4

How is psoriatic arthritis treated?

Answer 4

Symptomatic relief with painkillers, DMARD/biologic, often physiotherapy

Question 5

Which joints of the hands are affected by rheumatoid arthritis?

Answer 5

PIPs and MCPs

Question 6

Pain which is worse on activity, worse by the end of the day and relieved by rest is most likely to be caused by which type of arthropathy?

Answer 6

Non-inflammatory, typically osteoarthritis

Question 7

Which antibody is specific for rheumatoid arthritis?

Answer 7

Anti-CCP

Question 8

‘Pencil in cup appearance’ on x-ray is typical of which type of arthritis?

Answer 8

Psoriatic arthritis

Question 9

Enteropathic arthritis is related to what condition? There may also be skin involvement, this is known as what?

Answer 9

IBD, skin involvement is known as pyoderma gangrenosum

Question 10

What lifestyle advice should be given to someone suffering from gout?

Answer 10

Restrict alcohol/shellfish/red meat, keep hydrated, weight loss

Question 11

Rheumatoid arthritis typically affects which joints?

Answer 11

Small joints of the hands and feet

Question 12

In which joint does septic arthritis most commonly occur?

Answer 12

The knee

Question 13

Which joints of the hands can be affected by osteoarthritis?

Answer 13

DIPs, PIPs and the first CMC

Question 14

What are some of the nail changes mostly associated with psoriatic arthritis?

Answer 14

Pitting and onycholysis

Question 15

Name some examples of extra-articular manifestations of rheumatoid arthritis?

Answer 15

Rheumatoid nodules, lung disease (interstitial fibrosis, pulmonary nodules), increased CV morbidity, eye disease (episcleritis, scleritis, uveitis)

Question 16

What is the gold standard investigation for septic arthritis?

Answer 16

Joint aspirate for culture and gram stain (this should be taken before treatment is commenced)

Question 17

How is ankylosing spondylitis treated?

Answer 17

Physiotherapy and NSAIDs for pain relief (anti-TNF biologics may be used in more severe disease)

Question 18

What type of arthritis could typically be described as ‘asymmetrical oligoarthritis’?

Answer 18

Seronegative inflammatory arthropathies

Question 19

What is the most common site to be affected by gout? What is this known as?

Answer 19

The first MTP- known as Podagra

Question 20

When is the best time to measure serum urate?

Answer 20

2 weeks after an acute attack of gout

Question 21

How is reactive arthritis treated?

Answer 21

Most cases are self-limiting- treat the underlying infectious cause and give symptomatic relief (DMARDs may be required in chronic cases)

Question 22

How is septic arthritis treated?

Answer 22

IV antibiotics and joint aspiration

Question 23

Ankylosing spondylitis is an inflammatory disease typically affecting where?

Answer 23

The spine and sacroiliac joints

Question 24

How is osteoarthritis managed?

Answer 24

Pain control (simple analgesics, mild opioids, IA steroids), physiotherapy and lifestyle factors e.g. weight loss and exercise. Surgery can be used as a last resort.

Question 25

What makes pseudogout different to gout?

Answer 25

It is caused by calcium pyrophosphate crystal deposition

Question 26

Pain from osteoarthritis of the hip can be felt where? Hip pain is often actually caused by osteoarthritis of where?

Answer 26

Pain from the hip is typically felt in the groin or radiating to the knee; pain in the hip is often actually coming from the lower back

Question 27

What is the most common organism causing septic arthritis? In a younger, sexually active individual, what other cause should always be considered?

Answer 27

Staph Aureus is most common overall, Neisseria Gonorrhoeae should always be considered

Question 28

What are some risk factors for the development of gout?

Answer 28

Renal failure, diuretic use, high alcohol/red meat/seafood intake

Question 29

What are some features of ankylosing spondylitis which may be seen on examination?

Answer 29

'Question mark spine' due to loss of lumbar lordosis and increased thoracic kyphosis, and a decreased Schober's test

Question 30

What investigations are used in suspected reactive arthritis, which would not be necessary in the investigation of other seronegative inflammatory arthropathies?

Answer 30

Urine, blood and stool cultures, joint fluid analysis

Question 31

What are the 4 typical x-ray findings of osteoarthritis?

Answer 31

Loss of joint space, osteophytes, sclerosis, subchondral cysts

Question 32

Rheumatoid arthritis is an autoimmune disease which is mediated by which HLA type?

Answer 32

HLA-DR4

Question 33

The seronegative inflammatory arthropathies are related to which HLA type?

Answer 33

HLA-B27

Question 34

How is osteoarthritis usually diagnosed?

Answer 34

History, examination and typical x-ray findings

Question 35

Gout usually presents with a hot, tender, red, swollen joint. What is the most important differential of this and what is the gold standard investigation to differentiate the two?

Answer 35

Septic arthritis, requires joint aspirate for cultures, gram stain and polarised microscopy

Question 36

How is rheumatoid arthritis treated?

Answer 36

Symptomatic relief with painkillers, DMARD/biologic, often physiotherapy

Question 37

How is pseudogout treated?

Answer 37

NSAIDs, steroids and sometimes colchicine (there is no medication to prevent recurrence)

Question 38

How would uric acid crystals be described when seen under polarised microscopy?

Answer 38

Needle shaped crystals which display negative birefringence

Question 39

What are the 4 main features of seronegative inflammatory arthropathies?

Answer 39

Sacroiliitis, dactylitis, uveitis, enthesitis

Question 40

What triad of symptoms makes up Reiter's syndrome?

Answer 40

Uveitis/conjunctivitis, reactive arthritis and urethritis

Question 41

What are the 4 seronegative inflammatory arthropathies?

Answer 41

Ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis, reactive arthritis

Question 42

What are 3 key features of septic arthritis?

Answer 42

High fever, non-weight bearing, raised inflammatory markers

Question 43

Bony enlargements can be seen on the hands of people with osteoarthritis. What are these known as and where are each of them found?

Answer 43

Heberden's nodes (DIPs) and Bouchard's nodes (PIPs)

Question 44

'Peri articular erosions' is an x-ray finding in which disease?

Answer 44

Rheumatoid arthritis (usually later stage)

Question 45

If there has been 2 or more attacks of gout in 6 months, a person usually qualifies for urate lowering therapy. What two drugs can be used for this?

Answer 45

Allopurinol or febuxostat

Question 46

How is enteropathic arthritis treated?

Answer 46

Usually with immunosuppressants which control both conditions at once

Question 47

Which type of arthritis could be described as an 'autoimmune symmetric polyarthropathy'?

Answer 47

Rheumatoid arthritis

Question 48

Which condition will show rhomboid/envelope shaped crystals with weakly positive birefringence on joint aspirate?

Answer 48

Pseudogout

Question 49

What are the treatments for acute gout?

Answer 49

NSAIDs (usually naproxen) or colchicine if NSAIDs are contraindicated (there may also be a role for IM/IA steroids)

Question 50

What is Felty's syndrome?

Answer 50

A triad of rheumatoid arthritis, splenomegaly and neutropenia

Question 51

How should an acute flare up of rheumatoid arthritis be treated?

Answer 51

Oral or IM steroids (methylprednisolone)