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MSK Continued > Inflammatory arthropathies (Cortex) > Flashcards

Inflammatory arthropathies (Cortex) Flashcards

1
Q

two main categories of arthritis are:

A

Non-inflammatory arthritis (commonly osteoarthritis)

Inflammatory arthritis

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2
Q

inflammatory arthritis can be further subdivided into:

A

Seropositive arthritis (includes Rheumatoid arthritis and connective tissue diseases)
Seronegative inflammatory arthropathy (many different types)
Infectious
Crystal induced

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3
Q

Scleroderma, Sjorgen’s and vasculitis are what type of arthritis?

A

Seropositive arthritis

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4
Q

ankylosing spondylitis, psoriatic and inflammatory disease arthritis are what type of arthritis?

A

Seronegative

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5
Q

What are autoantibodies?

A

antibodies generated by the immune system against the body’s own proteins
characteristic of many rheumatological conditions

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6
Q

Anti-CCP (citrullinated protein) antibody is associated with?

A

Rheumatoid arthritis

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7
Q

Anti-double stranded DNA antibody (dsDNA), Anti-Sm, Anti-Ro is associated with?

A

Systemic lupus erythematosus

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8
Q

Anti La and Anti Ro is associated with?

A

Sjorgens syndrome

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9
Q

Anti-cardiolipin antibody and lupus anti-coagulant is associated with?

A

Anti-phospholipid syndrome

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10
Q

Anti-Jo-1 antibody is associated with?

A

Myositis

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11
Q

Anti-neutrophil cytoplasmic antibody (ANCA) is associated with?

A

small vessel vasculitis

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12
Q

Anti-centromere antibody and Anti-Scl-70 antibody is associated with?

A

systemic sclerosis

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13
Q

OA is primarily a degenerative disorder

A

T

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14
Q

Over time the normal structure of every joint is subject to wear and deterioration

A

T

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15
Q

Which arthritis is assoc with imbalance exists between wear and repair of cartilage within joints?

A

OA

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16
Q

OA is assoc with genetic inheritance

A

F

no formal genetic mutation has been identified

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17
Q

Environmental factors, hobbies and type of work may have an influence and joints with abnormal alignment (developmental or pathological) are at higher risk of OA

A

T

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18
Q

What are common X ray findings in OA?

A

L – loss of joint space

O – osteophytes

S – sclerosis

S – subchondral cysts

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19
Q

It can be the case that some patients with substantial X‐ray changes of OA have minimal symptoms

A

T

The converse is also true ‐ some patients who are substantially symptomatic can have only mild disease on imaging

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20
Q

Management of OA?

A

Pain control - analgesia and opiates

Physiotherapy, weight loss and excersise

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21
Q

Unilateral distribution affecting a mixture of large and small joints. Red plaques on extensor surfaces?

A

Psoriatic arthritis

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22
Q

Arthropathy bilateral, first in small joints then progresses to large joints

A

RA

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23
Q

Genetic factors account for 50% of the risk for developing RA

A

T

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24
Q

The disease process of RA targets which part of the joint?

A

synovium which lines synovial joints and some tendons

25
Q

What are common triggers for RA?

A

smoking, infection or trauma have been implicated

26
Q

What is a complication of untreated RA?

A

Tendon ruptures and soft tissue damage can occur leading to joint instability and subluxation.

27
Q

What is pannus?

A

layer of vascular fibrous tissue extends over the surface of the joint space in adavnced RA

28
Q

Female, Fx of RA, Arthropathy in 3 small joints for 7 weeks, high positive for RF OR Anti CCP, abnormal CRP or ESR

A

RA

29
Q

Which joints are NOT affected in RA?

A

Distal interphalangeal

30
Q

Which extra-articular manifestation occur in 1/4 of RA patients?

A

Rheumatoid nodules

31
Q

Ocular involvement is common in individuals with RA

A

T

32
Q

Around 15-20% of patients with RA are seronegative

A

T

33
Q

X rays at the onset of RA will usually show which signs?

A

Will often show no jt abnormality

34
Q

TIn RA the goal is to commence DMARD therapy within how many months of symptom onset?

A

3

35
Q

IfRA does not respond to standard DMARD therapy then the patient may be eligible for?

A

Biologic therapy

36
Q

RA treatment for fhort term symptom relief?

A

simple analgesia, NSAIDs and Intramuscular/intra-articular and oral steroids.

37
Q

What is first line DMARD therapy?

A

methotrexate

38
Q

Why do DMARDs need regular blood monitering?

A

immunosuppressive so may increase the risk of infection and can cause bone marrow suppression

39
Q

How is disease activity monitored in RA?

A

DAS 28 score

40
Q

In RA, when is biologic therapy indicated?

A

High disease activity
DAS 28 score >5.1
unresponsive to DMARDs

41
Q

In RA surgery can be used for resistant disease, to control pain from a particular joint or to improve or maintain function

A

T

42
Q

Seronegative inflammatory arthropathy is often associated with disease in which part of the body?

A

Spine (spondyloarthropathy)
Sacroilitis
uveitis
dactylitis (digits)

43
Q

Patients with seronegative inflammatory arthropathy are often positive for which antigen? Bloods?

A

Human leukocyte antigen (HLA) B27

Elevated ESR and CRP

44
Q

What is Human leukocyte antigen (HLA) B27?

A

Peptides on the major histocompatibility complex that present as antigens to T cells, strongly assoc with ankylosing spondylitis

45
Q

Ankylosing spondylitis can lead to?

A

eventual fusion of the intervertebral joints and SI joints
“questionmark” spine

46
Q

Ankylosing spondylitis presents with spinal morning stiffness is marked and improves/worsens with exercise?

A

Improves

47
Q

Lumbar spine flexion can be measured using?

A

Schobers test
measuring 5cm below the posterior superior iliac crests and 10cm above, whilst the patient is upright, then asking them to bend forwards and remeasuring the distance. In normal situations it should extend beyond 20cm.

48
Q

In ankylosing spondylitis it is common for xrays to be normal at the time of presentation.

A

T

49
Q

In ankylosing spondylitis X ray may show?

A
  • sclerosis and fusion of the sacroiliac joints

- syndesmophytes bony spurs from vertebral bodies (can lead to fusion)

50
Q

Treatment for ankylosing spondylitis?

A

NSAIDs and anti-TNF inhibitors for more aggressive disease. DMARDs do not have any impact on spinal disease

51
Q

Psoriatic arthritis occurs in up to 30% of people affected by skin psoriasis

A

T

52
Q

Nail changes are common in psoriatic arthritis

A

T

pitting and onycholysis (lifting of the nail from its nailbed

53
Q

Treatment for psoriatic arthritis?

A

similar to RA, with DMARDs, usually methotrexate. Anti-TNF therapy is available for those who do not respond to standard treatment.

54
Q

10‐20% of IBD sufferers will experience spine or joint problems

A

T

55
Q

What is enteropathic arthritis?

A

inflammatory arthritis in patients with inflammatory bowel disease (Crohn’s disease and Ulcerative Colitis)

56
Q

What is reactive arthritis?

A

arthritis in response to an infection in another part of the body, 1‐3 weeks following the infection

57
Q

What is Reiter’s syndrome?

A

reactive arthritis with triad of symptoms of urethritis, uveitis or conjunctivits and arthritis

58
Q

Most cases of reactive arthritis are self limiting

A

T

some chronic/frequent relapses

59
Q

Treatment reactive arthritis?

A

underlying infectious cause and symptomatic relief, including IA or IM steroid injections. Occasionally DMARDs are required in chronic cases.

MSK Continued (10 decks)

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