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MSK Patrick Stenhouse > Inflammatory Arthropathies > Flashcards

Inflammatory Arthropathies Flashcards

1
Q

Inflammatory arthropathies can be classified into which four main groups?

A
  1. Seropositive
  2. Seronegative
  3. Infectious
  4. Crystal deposition
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2
Q

What is the most prevalent seropostive inflammatory arthropathy?

A

Rheumatoid arthritis

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3
Q

What is rheumatoid arthritis?

A

An autoimmune inflammtory symmetric polyarthropathy

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4
Q

Which gender is more commonly affected by RA?

A

Females

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5
Q

An immune response is initiate against what in RA?

A

The synovium

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6
Q

Which environmental triggers have been associated with RA?

A
  • Smoking
  • Infection
  • Trauma
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7
Q

What may happen to tendons and soft tissue as RA progresses?

A
  • Tendon rupture
  • Soft tissue damage

These can lead to joint instability and subluxation

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8
Q

What are the most common clinical presentations of RA?

A
  1. Symmetrical synovitis
  2. Pain
  3. Morning stiffness (>30 mins)
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9
Q

Which joints are commonly affected in RA and which joints are not?

A
  • MCPs and PIPs are affected
  • DIP joints are NOT affected
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10
Q

Over time, larger joints can become affected in RA. Which is an important joint that may become affected?

A

Joints in the cervical spine (C1 and C2)

Longstanding disease may cause atlanto-axial subluxation

This can cause spinal cord compression

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11
Q

Rheumatoid nodules occur in around 25% of patients with RA. Where do they commonly occur?

A

Extensor surfaces or sites of frequent mechanical irritation

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12
Q

Which other body systems are impacted often by RA?

A
  1. Lungs
  2. Heart
  3. Eyes
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13
Q

Lung involvement in RA involves what?

A
  1. Pleural effusions
  2. Interstitial fibrosis
  3. Pulmonary nodules
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14
Q

Ocular involvement is common in patients with RA, but what does it include?

A
  • Keratoconjunctivitis sicca
  • Episcleritis
  • Uveitis
  • Nodular scleritis (may lead to scleromalacia)
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15
Q

What is keratoconjunctivitis sicca?

A

Also called dry eyes syndrome, it is the condition of having dry eyes

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16
Q

What is episcleritis?

A

A benign, self-limiting inflammatory disease affecting the episclera - a thin layer of tissue that lies between the conjunctiva and the connective tissue layer that forms the sclera.

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17
Q

What is uveitis?

A

Inflammation of the uvea - the pigmented area of the eye

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18
Q

What is scleritis?

A

Inflammation of the sclera.

There are three types and the condition has associations with RA and granulmatosis with polyangiitis (Wegener’s).

It can involve very serious and damaging inflammation

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19
Q

Which autoantibodies are tested for in RA and which is the most useful?

A
  1. Rheumatoid factor
  2. Anti-CCP - much more specific
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20
Q

Besides autoantibodies, what else can be tested in the blood?

A
  • Inflammatory markers - CRP, ESR, PV
  • FBC
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21
Q

What are the early features of RA which may be picked up on an imaging modality?

A
  • Peri-articular osteopenia (bone thinning)
  • Soft tissue swelling
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22
Q

Which imaging modality is useful for detecting synovial inflammation if there is clinical uncertainty?

A

Ultrasound

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23
Q

Which treatments are used for short term symptom relief in RA?

A
  • Analgesia
  • NSAIDs
  • IM/IA steroids
24
Q

What are the drawbacks to DMARDs in general, which are the reason regular blood tests are required?

A
  • The increase risk of infection
  • They can cause bone marrow suppression

Hence, regular blood tests are required

25
Q

What are the most commonly used biologics in RA?

A

Anti-TNF therapies

26
Q

The use of biologics increases the risk of infection - especially for which disease?

A

Tuberculosis

27
Q

The DAS28 score is a composite score of 4 domains - what are these?

A
  1. Tender joint count
  2. Swollen joint count
  3. CRP/ESR
  4. Visual analogue score (patient’s own assessment of their disease activity
28
Q

What are the cut off values for the DAS28 score?

A
  1. < 2.6 = remission
  2. 2.6-3.2 = low disease activity
  3. 3.2-5.1 = moderate disease activity
  4. >5.1 = high disease activity
29
Q

Besides pharmacological therapy, what are the other options for rheumatoid arthritis?

A
  • Physiotherapists
  • Occupational therapists
  • Podiatrists
  • Othotists
  • Surgery - only for resistant disease
30
Q

Seronegative inflammatory arthropathy is a term encompassing which diseases?

A
  1. Ankylosing spondylitis
  2. Psoriatic arthritis
  3. Enteropathic arthritis
  4. Reactive arthritis
31
Q

How are seronegative inflammatory arthopathies often characterised?

A
  • Inflammation and/or arthritic disease of the spine (spondyloarthropathy)
  • Asymmetric oligoarthritis
  • Other features
32
Q

What are common features of seronegative inflammatory arthropathies?

A
  • Sacroiliitis
  • Uveitis
  • Dactylitis
  • Enthesopathies
33
Q

Which enthesopathies are most common with seronegative inflammatory arthropathies?

A
  1. Achilles insertional tendonitis
  2. Plantar fasciitis
34
Q

Patients with seronegative inflammatory arthropathy are often postive for which form of which gene?

A

HLA-B27

35
Q

What is ankylosing spondylitis?

A

Chronic inflammatory disease of the spine and sacro-iliac joints

36
Q

Left untreated, ankylosing spondylitis may lead to what?

A

Fusion of the intervertebral joints and SI joints

37
Q

Which gender and age of people are more susceptible to ankylosing spondylitis?

A

Males

Aged 20-40

38
Q

What do patients with ankylosing spondylitis often complain of?

A
  • Spinal pain
  • Stiffness (improves with exercise)
  • Knee or hip pain (due to associated arthritis)
39
Q

Over time, with ankylosing spondylitis, there is loss of spinal movement and a development of a ____________ ______ spine with loss of __________ ___________ and increased ___________ _____________

A

Question mark

lumbar lordosis

thoracic kyphosis

40
Q

Lumbar spine flexion can be measured via which test?

A

Schober’s test

41
Q

Conditions most associated with ankylosing spondylitis include what?

A
  • Anterior uveitis
  • Aortitis
  • Pulmonary fibrosis
  • Amyloidosis
42
Q

In a patient with ankylosing spondylitis, what features may be present on X-ray?

A
  • Sclerosis
  • Fusion of sacroiliac joints
  • Syndesmophytes which can bridge the intervertebral disc giving a “bamboo spine appearance”
43
Q

What features may be detected in early ankylosing spondylitis on MRI?

A
  • Bone marrow oedema
  • Enthesitis of the sponal ligaments
44
Q

90% of ankylosign spondylitis sufferers are __________ positive

A

HLA-B27

45
Q

What are the treatment options for ankylosing spindylitis?

A
  • Physiotherapy
  • Exercise (more movement, counteracts syndesmophyte formation)
  • NSAIDs
  • Anti-TNF therapy for severe disease

DMARDs do not impact spinal involvement, but may have a use if there is peripheral joint involvement

46
Q

What percentage of people with just skin psoriasis also develop psoriatic arthritis?

A

30%

47
Q

What is psoriatic arthritis?

A

An asymmetrical oligoarthritis which may also affect the hands in a similar pattern to RA.

It occurs alongside psoriasis

48
Q

What are other common features of psoriatic arthritis?

A
  • Spondylitis
  • Dactylitis
  • Enthesitis
  • Nail pitting
  • Onycholisis
49
Q

Which joints can be affected in psoriatic arthritis which are spared in RA?

A

DIP

50
Q

What is a very severe form of inflammatory arthritis which can be associated with both psoriatic or rheumatoid arthritis?

A

Arthritis mutilans

Characterszed by resorption of bones and the consequent collapse of soft tissue. When this affects the hands, it can cause a phenomenon sometimes referred to as ‘telescoping fingers.’

51
Q

What is the treatment for psoriatic arthritis?

A
  • DMARDs - usually methotrexate
  • Anti-TNF therapy in resistant cases
  • Joint replacement in larger joints
  • DIP joint fusion
52
Q

What is enteropathic arthritis?

A

An inflammatory arthritis involving peripheral joints and sometimes the spine. It occurs in patients with inflammatory bowel disease.

It tends to be a large joint asymmetrical oligoarthritis

53
Q

What is the treatment for enteropathic arthritis?

A

It usually involves coordination with the GI consultant to find a medication to manage the IBD as well as the arthritis

54
Q

What is reactive arthritis?

A

Arthritis which occurs subsequent to an infection that commonyl affects large joints

55
Q

Which infections commonly lead to reactive arthritis?

A
  1. Genitourinary infections (Chlamydia, Neisseria)
  2. GI infections (Campylobacter, salmonella)
56
Q

What is Reiter’s syndrome?

A

This syndrome occurs when patients with reactive arthritis present with a triad of symptoms:

  1. Urethritis
  2. Uveitis/conjuctivitis
  3. Arthritis

Most cases are self-limiting

57
Q

What is the treatmnent for reactive arthritis?

A
  1. Treat underlying cause (infection)
  2. Symptomatic relief e.g. IA/IM steroids
  3. DMARDs in chronic cases

MSK Patrick Stenhouse (60 decks)

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