reactive arthritis Flashcards
(22 cards)
what is it and what is i not
inflammatory response in joints AFTER STI or gut infection NOT infection in joints (septic arthritis)
parts affected apart from joints
enthesitis (inflammation of tendons eg achiles), and inflammation to skin and eye
genetic component of reactive A
HLA B27 (not HLA-D unlike rheumatoid A), which is class 1 allele ie CD8 cells involved instead
main musculoskeletal symptoms symptoms of reactive arthritis
ASYMMETRICAL OLIGOARTHRITIS (less than 5 joints affected) enthesitis (inflammation of tendons like in achilles, swollen fingers and feet) spondylitis (inflammation of spine)
extra-articular features of reactive A
inflammation to conjunctiva of EYE, pain when PEEING, and rashes on SKIN
rheu A vs reac A- males vs females, genes, features, diagnosis, joints
males more affected in reactive A HLA difference arthritis is different (assymetrical oligoarthritis) extra-articular features diferent no rheumatoid factor often affects larger joints
diagnosis of reactive arthritis
clinically look better than those with rheu A MUST exclude septic arthritis by culture of SYNOVIAL FLUID- if no microbes in it, points towards reactive A: use other cultures too use rheu factor to exclude rheu A
key diseases associated with reactive A
HIV/HEP C
septic vs reactive athritis
synovial fluid- NO MICROBES antibiotics only for septic septic needs joint lavage (washing of joints)
treatment of reac A
NSAIDS/corticosteroids into joint refractory (stubborn)- oral glucocorticoids eg methotrexate
define osteoarthritis and joint affected, and what usually spared
slow gradual wearing down of articular cartilage affected joints of hands (not usually MCP’s), spine and weight bearing joints in lower limbs (1st MTP, knee and hip)
names for swellings in hands
swelling at DIP is HEBERDENS NODES swelling at PIP is BOUCHARDS NODES
symptoms of osteoarhtritis
joint pain (better with rest and worse upon exertion unlike rheu A) crepitus (creaking of joints) more stiff, enlarged (nodes), less motion PIES LOVE the CHINESE
xray changes
joint space narrow (cartilage should be there)= bone on bone contact sclerosis (whitening) osteophyte (bony projections ie swelings ie node)
DIAGRAM xrays vs RA: include joints
both have joint space narrowing but no sclerosis (whitening) , no osteophytes, and in RA there is osteopenia (darkening) and BONY erosion MCPS spared in OA
synovial joint- what it contains
consists of synovial membrane, synovial fluid and articular cartilage
properties of fluid
rich in hyaluronon
properties of cartilage
cartilage rich in proteoglycan aggrecan(attracts water) and type 11 collagen no vessels/nerves ie no pain
cartilage changes in OA
reduce proteoglycan, collagen, and death of chondrocytes
bone changes in OA
bone where cartilage gone proliferates= sclerosis (stiffening of tissue due to replacement with connective tissue) and osteophytes
treatment of OA
physiotherapy, exercise, NSAIDS/paracetamol and joint replacement if necessary
difference in treatment vs RA
no DMOADS or glucocorticoids
