Cortex rhemuatology - Inflammatory arthropathies 1 Flashcards
(32 cards)
The term “arthropathy” is used to describe a “disease of the joint” whereas “arthritis” describes inflammation of the joint. Both expressions are often used synonymously.
Appreciate this
What does the term arthralgia mean ?
Pain in a joint
What are the two main categories of arthiritis ?
Inflammatory and non-inflammatory (commonly OA)
Gives a few examples of seronegative inflammatory arthritis and seropositive
Seropositive - RA, connective tissue diseases
Seronegative - many causes
Describe the idea of auto-immunity and what are the conditions associated with auto-immunity often referred to as ?
- Auto-antibodies are antibodies generated by the immune system against the body’s own proteins.
- It perceives them as alien and then begins to form antibodies against them, as it would an external threat eg. a virus.
- These auto-antibodies then begin to attack various organs and tissues, causing inflammation and damage.
Describe what OA is and the generally accepted underlying mechanism of it
- Is primarily a degenerative disorder
- It is generally accepted that an imbalance exists between wear and repair of cartilage within joints.
What are the two ways in which OA can arise ?
- Can be primary - no known cause
- Or Secondary - number of different causes/risk factors
What are some of the causes of secondary OA?
- Congenital dislocation of the hip
- Perthes
- SUFE - slipped upper femoral epiphysis
- Previous intra‐articular fracture
- Extra‐articular fracture with malunion
- Osteochondral / hyaline cartilage injury
- Crystal arthropathy
- Inflammatory arthritis (can give rise to mixed pattern arthritis)
- Meniscal tears
- Genu Varum or Valgum
What is the acronym to remember the charactersitic signs of OA on X-ray ?
LOSS:
- L - loss of joint space
- O - Osteophytes
- S - Sclerosis
- S - Subchondral cysts
What is the diagnosis of OA based on ?
Diagnose osteoarthritis clinically without investigations if a person:
- is 45 or over and
- has activity-related joint pain and
- has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes.
X-ray affected joints, serum CRP and ESR will be normal (hence non-inflammatory)
What is the management of OA ?
1st line:
- Local analgesia - e.g. capsaicin, methylsalicylate cream, or topical NSAIDs
- Non-pharmacological therapy - Physiotherapy. Weight loss and exercise are also important.
What are the main symptoms of OA ?
Pain and stiffness in your joints (remember not morning pain or if morning pain doesnt last > 30 mins)
What are the most commonly affected joints by OA ?
- Knees
- Hips
- Neck and back
- Big toes
- Hands.
How can inflammatory arthropathies (arthritis) be further classified ?
Seropositive, seronegative, infectious and crystal deposition disorders.
What is the mainstay of treatment of inflammatory arthropathies ?
Is pharmacological:
- Simple analgesia
- Anti‐ inflammatory medications (steroids & NSAIDs)
- Steroid injections
- Disease Modifying Anti Rheumatic Drugs (DMARDs).
What are the general features of inflammatory arthropathies ?
- Joint pain with associated swelling
- Morning stiffness
- Improvement in symptoms with exercise
- Synovitis on examination
- Raised inflammatory markers (CRP and plasma viscosity)
- Extra-articular symptoms
Classify RA
It is the most prevelant seropositive inflammatory arthropathy
(note 15-20% of patients with RA are seronegative)
Is there a genetic link for RA?
Yes - genetic factors account for 50% of the risk of developing RA
Describe the pathogenesis of RA
- Immune response occurs against synovium (lines synovial joints and some tendons).
- Inflammatory pannus (abnormal tissue ‘‘cloth’’ between bones) forms and attacks articular cartilage leading to joint destruction.
- Can also cause destruction to the soft tissues which can lead to tendon ruptures, joint instability and subluxation
How is RA diagnosed ?
1st investigations to order:
- Rheumatoid factor (RF)
- Anti-cyclic citrullinated peptide (anti-CCP) antibody (far more specific and therefore preferred test)
- Radiographs (hands & feet) + CXR (looking for apical sclerosis & nodules)
What are the clinical features of RA?
Early clinical features include:
- Symmetrical synovitis (doughy swelling)
- Pain and morning stiffness.
- The hands and feet tend to be involved early - affecting the MCP, PIP and wrist joints affected but not the DIP joints
- Osteopenia (bone thining)
Late clinical features include:
- Deformities
- Larger joints such as the knees, shoulders and elbows affected
- One important area is the cervical spine. In longstanding disease were may be atlanto-axial subluxation which can result in cervical cord compression.
What condition could be causing the feature here and what is the feature known as ?
Hint (swelling seen)
RA - feature seen is synovitis
What are some of the extra-artciular manifestations of RA?
Rheumatoid nodules occur on extensor surfaces or sites of frequent mechanical irritation
What are the results of CRP and ESR in RA?
Usually rasied (think it is a inflammatory arthropathy)
