Other arthritis's

Question 1

What is psoriatic arthritis?

Answer 1

inflammatory arhtritis that occurs mainly in people with arthritis, 10-15% dont have arthritis

Question 2

Is psoriatic arthritis rheumatoid factor positive or negative?

Answer 2

negative

Question 3

What are the different signs of psoriatic arthritis?

Answer 3

pitting and onchyloysis of nails
ankylosing spondylitis
dactylitis (sausage digit)
uveitis

Question 4

What is the common presentation of PA?

Answer 4

asymmetric oligoarthritis with dactylitis

Question 5

What is arthritis mutilans?

Answer 5

very aggressive form of psoriatic arthritis

Question 6

What is the investigations for PA?

Answer 6

Bloods - RF (-ve), raised inflammatory markers

Xrays - marginal erosions, osteolysis, enthesitis

Question 7

What is the non pharmacological treatment for PA?

Answer 7

physiotherapy

orthotics

Question 8

What is the pharmacological treatment for PA?

Answer 8

NSAIDs
Steroid injections
DMARDS
Anti TNF if very severe
Anti IL-17

Question 9

What is reactive arthritis?

Answer 9

inflammatory arthritis following a systemic illness

Question 10

What systemic illnesses can cause reactive arthritis?

Answer 10

Salmonella
Chlamidya
Shigella
Yersinea

Question 11

What is reactive arthritis characterised by?

Answer 11

inflammatory synovitis fomr which viable microorganisms cannot be cultured

Question 12

What is the peak population for reactive arthritis?

Answer 12

young adults 20-40

Question 13

What is the investigations for reactive arthritis?

Answer 13

Bloods - RF, increased inflammatory markers
HLA-B27 positive
Blood, urine and stool cultures
X ray of affected joint
joint fluid analysis

Question 14

What is Reiters Syndrome?

Answer 14

Type of reactive arthritis characterised by uveitis/conjunctivitis, urethritis and arthritis

Question 15

What are the common signs of reactive arthritis?

Answer 15

enthesitis
fever, malaise, fatigue
asymmetrical monoarthrtis or oligoarthritis
muscutaneous lesions - oral ulcers
visceral manifestations - mild renal disease, carditis
occular lesions - conjunctivitis and iritis

Question 16

What is the treatment for reactive arthritis?

Answer 16

90% resolve spontaneously - some become chronic
NSAIDs
antibiotics for underlying infection
DMARDs if chronic
Physio/Occupational Therapy

Question 17

How long after the initial disease/infection do symptoms start to show for RA?

Answer 17

1-4 weeks

Question 18

What is enteropathic arthritis associated with?

Answer 18

associated with IBD

Question 19

What is the presentation of EA?

Answer 19

arthritis in several joints - commonly sacroilitis
weight loss
fever
uveitis
skin involvement
GI watery stools
enthesitis
oral ulcers

Question 20

What are the investigations for EA?

Answer 20

upper and lower GI endoscopy showing IBD signs
joint aspirate
increased inflammatory markers
Xray/MRI showing sacroilitis
USS showing synovitis/tenosynovitis

Question 21

What is the treatment for EA?

Answer 21

analgesia - paracetamol, cocodamol
DONT GIVE NSAIDS
Treat IBD
Steroids 
DMARDs
Anti-TNF

Question 22

What is septic arthritis?

Answer 22

high bacterial load causes sepsis

Question 23

What is the pathophysiology of spetic arthritis?

Answer 23

proteolytic enzymes degrade hyaline cartilage and destroy the joint, may cause osteonecrosis of the hip

Question 24

What is the presentation of septic arthritis?

Answer 24

unable to weight bear
hip/groin pain
HIP FLEXED AND EXTERNALLY ROTATED
severe hip pain on passive movement
usually pyrexial

Question 25

What causes septic arthritis in neonates?

Answer 25

strep and gram -ve

Question 26

What causes septic arthritis in infants to adults?

Answer 26

staph aureus

Question 27

What causes septic arthritis in IV drug users?

Answer 27

pseudomonas | atypical organisms

Question 28

How is septic arthritis investigated?

Answer 28

``` blood tests - FBC, CRP blood cultures kochers criteria ultrasound +- aspiration Xrays ```

Question 29

How is septic arthritis treated?

Answer 29

URGENT open surgical washout antibiotics

Question 30

How can septic arthritis happen? (where can the organisms get in from?)

Answer 30

direct innoculation from trauma/surgery carried through blood can travel from adjacent bone e.g. osteomyelitis spreads from the metaphysis

Question 31

What is reactive synovitis?

Answer 31

inflammation of the synovium secondary to illness

Question 32

What is the presentation of reactive synovitis?

Answer 32

HIP FLEXED AND EXTERNALLY ROTATED groin/hip pain and limp pyrexial

Question 33

What distinguishes between reactive synovitis and septic arthritis?

Answer 33

Kochers criteria - fever - refusing to bear weight - serum WBC >12,000 - CRP >20

Question 34

How is reactive synovitis investigated?

Answer 34

Ultrasound | Kochers criteria

Question 35

How is reactive synovitis treated?

Answer 35

self limiting | analgesia and NSAIDs