Arthropathies

Question 1

What is OA?

Answer 1

degenerative disorder of joints

imbalance between wear and repair of cartilage

Question 2

What predisposes you to developing OA?

Answer 2

obesity
age
mechanical injury
high impact sport

Question 3

How does OA present?

Answer 3

joint pain

short lived morning stiffness

Question 4

What joints does OA effect?

Answer 4

DIP, PIP, hip, knee

Question 5

What is found on examination in OA?

Answer 5

effusion, tender joint, crepitations, bony enlargement
Baker’s cyst - behind knee
Heberden’s nodes - bony enlargement of DIP joints

Question 6

What is seen on xray in OA?

Answer 6

LOSS
loss of joint space 
osteophytes 
sclerosis 
subchondral cysts

Question 7

How is OA managed?

Answer 7

weight loss
physio
analgesia:
- paracetamol, topical NSAIDs (hands, knee)
- oral NSAIDs or COX2 inhibitors, opioids, capsaicin cream, IA steroids
- duloxetine
?joint replacement

Question 8

What is RA?

Answer 8

autoimmune inflammatory symmetrical polyarthropathy

Question 9

What predisposes you to developing RA?

Answer 9

female
smoker
genetics (HLA DR1/4)

Question 10

How does RA present?

Answer 10

joint pain and swelling
morning stiffness
deformity

extra articular manifestations:
lungs - pulmonary fibrosis
eyes - keratoconjunctivitis sittica, episcleritis, uveitis
anaemia

Question 11

What joints does RA effect?

Answer 11

small joints of hands and feet
cervical spine

DIP not affected

Question 12

What can cervical spine RA cause?

Answer 12

cord compression - atlantoaxial subluxation

Question 13

What is found on examination in RA?

Answer 13

synovitis
deformity
swelling
tenderness

Question 14

How is RA diagnosed?

Answer 14

raised CRP
xray - osteopenia, soft tissue swelling
USS - synovitis
autoantibodies - anti CCP, rheumatoid factor

Question 15

How is RA managed?

Answer 15

simple analgesia, NSAIDs, steroids used in combination
aim to start DMARDS within 3 months of symptoms
- methotrexate (first line)
- sulfasalazine
- hydroxychloroquine
- leflunomide

flares - steroids

if inadequate response to at least 2 DMARDs (including methotrexate)
- anti TNF (etanercept, infliximab)

Question 16

What are the side effects of methotrexate?

Answer 16

pneumonitis
liver cirrhosis/ LF derangement
myelosuppression

Question 17

What can happen with anti TNF use?

Answer 17

reactivation of TB

Question 18

What is ankylosing spondylitis?

Answer 18

chronic inflammatory disease of the spine and the sacro-iliac joints

Question 19

What can ank spon lead to?

Answer 19

fusion of the IV and SI joints

Question 20

What is associated with ank spon?

Answer 20

HLA B27

Question 21

How does ank spon present?

Answer 21

spinal pain
morning stiffness
worse at night, improves with exercise
loss of spinal movement over time

Question 22

What extra articular manifestations of ank spon are there?

Answer 22

anterior uveitis
pulmonary fibrosis
aortitis
amyloidosis

Question 23

What is a question mark spine in ank spon?

Answer 23

loss of lumbar lordosis

Question 24

How is ank spon diagnosed?

Answer 24

Schober's test <5cm (lumbar spine flexion) 
increased inflammatory markers 
HLA B27 positive 
xray 
MRI

Question 25

What is seen on xray and MRI in ank spon?

Answer 25

xray - sclerosis, fusion, sacroiliitis, bamboo spine MRI - early features (e.g. bone marrow oedema)

Question 26

How is ank spon managed?

Answer 26

physio exercise NSAIDs e.g. naproxen (prescribe PPI alongside) Anti-TNF - for aggressive disease

Question 27

What kind of arthritis do you get with psoriasis?

Answer 27

psoriatic | asymmetrical oligoarthritis

Question 28

What nail changes do you get in psoriatic arthritis?

Answer 28

pitting | onchylysis

Question 29

What do you see on xray in psoriatic arthritis?

Answer 29

pencil in cup | erosive changes

Question 30

What do you get in psoriatic arthritis that you don't in RA?

Answer 30

dactylitis (swelling of entire digit)

Question 31

How is psoriatic arthritis managed?

Answer 31

like RA

Question 32

What antibodies are positive in RA?

Answer 32

anti CCP

Question 33

What is enteropathic arthritis?

Answer 33

affects peripheral joints and spine in people with IBD

Question 34

How does enteropathic arthritis present?

Answer 34

symptoms of IBD, history of IBD | large joint arthritis

Question 35

What organisms can cause reactive arthritis?

Answer 35

salmonella, campylobacter | chlamydia, neisseria gon.

Question 36

What is Reiter's syndrome?

Answer 36

urethritis uveitis arthritis

Question 37

What causes gout?

Answer 37

deposition of urate crystals within a joint - usually due to increased serum uric acid levels

Question 38

What is uric acid?

Answer 38

final product of purine breakdown (DNA metabolism)

Question 39

What can trigger gout?

Answer 39

trauma surgery dehydration

Question 40

What causes hyperuricaemia?

Answer 40

renal underexcretion (precipitated by diuretics) high red meat, alcohol, seafood diet

Question 41

How does gout present?

Answer 41

intensely painful, hot, swollen joint unilateral 1st MTPj, ankle, knee gouty tophi

Question 42

What are gouty tophi?

Answer 42

painless white accumulations of uric acid in chronic gout

Question 43

How is gout diagnosed?

Answer 43

increased inflammatory markers joint aspirate - polarised microscopy - needle shaped crystals, negative birefringence

Question 44

How is gout managed?

Answer 44

acute: NSAIDS, colchicine (when NSAIDs are contraindicated) chronic: allopurinol (what until acute flare is over as can precipitate), lifestyle changes

Question 45

What is pseudogout?

Answer 45

calcium pyrophosphate crystals deposited in joint

Question 46

How is pseudogout diagnosed?

Answer 46

joint aspiration - polarised microscopy - weakly positive birefringence - rhomboid shaped crystals

Question 47

How is pseudogout treated?

Answer 47

NSAIDs, corticosteroids

Question 48

What are the side effects of hydroxychloroquine and what should you monitor?

Answer 48

monitor visual acuity can cause retinopathy and corneal deposits

Question 49

What helps to distinguish gout from pseudogout?

Answer 49

pseudogout - chondrocalcinosis