Arthropathies

Question 1

Name the seropostiive arthritidies

Answer 1

RA
SLE
Scleroderma
Vasculitis 
Sjogrens

Question 2

Name the seronegatives

Answer 2

Ank spon
Psoriatic
Reactive
Enteropathic

Question 3

Why makes something a seropositive condition?

Answer 3

Antibodies found in the serum

Question 4

What can be seen on x-ray of OA?

Answer 4

Loss of joint space
Osteophytes
Sclerosis
Subchondral cysts

Question 5

Why would you think something was inflammatory over OA?

Answer 5

Morning stiffness lasting hours
Hot
Younger age

Question 6

Which gender is more affected by rheumatoid arthritis?

Answer 6

Women

Question 7

Outline the pathogenesis of RA

Answer 7

Immune response initiated against synovium

Forms an inflammatory pannus around joints which attacks and denudes articular cartilage

Question 8

How does RA typically present?

Answer 8

Symmetrical joint pain and swelling in the small joints of the hands and feet
(doesn’t affect DIPs)

Question 9

What are the common extra-articular manifestations in RA?

Answer 9

Rheumatoid nodules on extensor surfaces
Lungs: pleural effusions, interstitial fibrosis, pulmonary nodules
Increased CV risk
Ocular involvement: episcleritis, uveitis, nodular scleritis, keratoconjuncitivitis sicca

Question 10

What investigations would you do for suspicion of RA?

Answer 10

Antibody screen
FBCs
X-rays

Question 11

Which is more specific for RA: anti-CCP or rheumatoid factor?

Answer 11

Anti-CCP

Question 12

What is first line treatment for RA?

Answer 12

Methotrexate (DMARDs)

Question 13

What do you do if 1 DMARD isnt helping?

Answer 13

Add another DMARD

Question 14

What do you need to prescribe alongside methotrexate?

Answer 14

Folic acid

Question 15

What can you give before the DMARD starts working?

Answer 15

IM Steroids

Question 16

When would biologics be considered?

Answer 16

After multiple DMARDs havent worked and disease activity still high (DAS >5.1)

Question 17

What is the typical presentation of ank spon?

Answer 17

Young male, back pain, SI joint pain, morning stiffness thats better with exercise

Question 18

What is a syndesmophyte?

Answer 18

Bony outgrowths with bridge the intervertebral discs causing pain

Question 19

What is it that gets attacked in the seroneg arthropathies?

Answer 19

Entheses

Question 20

What test can be done on examination for ank spon?

Answer 20

Schobers test

Question 21

What investigations should be done with suspicion of ank spon?

Answer 21

X-ray
MRI
Genetic studies

Question 22

What genetic mutation is associated with ank spon?

Answer 22

HLA-B27

Question 23

What is commonly seen on x-ray with ank spon at presentation?

Answer 23

Nothing

Question 24

What can be seen on MRI in ank spon?

Answer 24

Bone marrow oedema

Enthesitis of spinal ligaments

Question 25

What are the main treatment options for ank spon?

Answer 25

Physio NSAIDs Biologics

Question 26

Why dont you use DMARDs for ank spon?

Answer 26

Enthesis of spine is not very vascular so DMARDs can reach it properly

Question 27

When are biologics given in ank spon?

Answer 27

Trial of two NSAIDs plus physio for 4 weeks each

Question 28

When is surgery considered in ank spon?

Answer 28

Potentially for associated knee and hip but not on the spine!

Question 29

How does psoriatic arthritis present?

Answer 29

A symmetrical oligoarthritis in people with skin conditions | Associated with nail changes and dactylitis

Question 30

What is arthritis mutilans?

Answer 30

Particularly aggressive form of psoriatic arthritis

Question 31

How is psoriatic arthritis treated?

Answer 31

Similar to RA Methotrexate, moving onto DMARDs if particularly aggressive Joint replacement in large joints Joint fusion in smaller joints

Question 32

How does enteropathic arthritis occur?

Answer 32

Oligoarthritis in peripheral joints in people who suffer from IBD

Question 33

What is the main treatment of enteropathic arthritis?

Answer 33

Control the IBD

Question 34

Which infections are the typical for reactive arthritis?

Answer 34

Chlamydia, neisseria, salmonella, campylobacter

Question 35

How does reactive arthritis?

Answer 35

Inflammation of the large joints 1-3 weeks following infection

Question 36

Which joint is most commonly affected in reactive arthritis?

Answer 36

The knee

Question 37

What is Reiter's syndrome?

Answer 37

Urethritis Uveitis/conjunctivitis Arthritis

Question 38

Why does urethritis occur in seroneg arthropathies?

Answer 38

Enthesitis of the choroid muscle attaching onto the orbit

Question 39

How do you treat reactive arthritis?

Answer 39

Usually self-limiting Control the underlying infection DMARDs in chronic cases