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Flashcards in Rheumatology Deck (16):
1

What are the different divisions of arthritis?

Osteoarthritis: degeneration of joint cartilage and associated bone abnormalities; joint fluid typically has no inflammatory cells present
- primary: idiopathic, associated with aging
- secondary: caused by previous injury to affected joint

Inflammatory arthritis: chronic inflammatory conditions of body associated with arthritis but typically with other systemic symptoms
- rheumatoid arthritis: autoimmune, chronic inflammation of synovium of different joints on both sides of the body
- psoriatic arthritis: autoimmune, associated with psoriasis, involves mutiple joints
- gout: monosodium urate mono-hydrate crystals
- pseudogout: calcium pyrophosphate

2

How is osteoarthritis diagnosed?

Diagnosed by X-ray:
- presence of osteophytes
- subarticular sclerosis
- bone cysts
- joint space narrowing

3

How is osteoarthritis treated?

NSAIDs
Paracetamol
Opioid analgesics

4

What are the characteristics of osteoarthritis?

Pain increases with movement
Asymmetric spread
Slow progression
Affects larger joints more often
Morning stiffness lasting 30min and gets worse as day goes on
Swellings at PIPJ (Bouchard's nodes) and DIPJ (Heberden's nodes)
Starts distally and moves proximally

5

How is rheumatoid arthritis diagnosed?

BLOODS:
- rheumatoid factor
- anti-CCP
- CRP/ESR

X-ray:
- soft tissue swelling
- periarticular osteopenia
- joint space narrowing
- erosions
- deformity

MRI: synovitis and early erosions

6

How is rheumatoid arthritis treated?

NSAIDs
Analgesics
TNF inhibitors
Steroids
COX-2 inhibitors
Immunosuppressants
DMARDs

7

What are the characteristics of rheumatoid arthritis?

Pain decreases with movement
Symmetric spread
Rapid progression
Affects smaller joints more often
Morning stiffness lasts 1hr+ and worse after periods of rest
Systemic symptoms
Ulnar deviation, swan-neck deformity (DIP flexion and PIP hyper-extension), Boutonniere's deformity (hyperextension of DIP and MCP, flexion of PIP), Z deformity of thumbs, piano key deformity of wrists

8

What are the differentials for acute monoarthritis?

Inflammatory:
- septic arthritis
- vasculitis
- gout
- pseudogout
- systemic rheumatic disease

Non-inflammatory:
- juxta-articular fracture
- trauma
- haemarthrosis
- osteonecrosis
- loose body
- osteochondritis dissecans
- overuse
- avascular necrosis

9

What are the differentials for chronic monoarthritis?

Inflammatory:
- chronic infectious arthritis
- Lyme disease
- gout
- pseudogout
- JIA
- RA
- systemic rheumatic disease

Non-inflammatory:
- OA
- avascular necrosis
- haemarthrosis
- Paget's disease
- stress fracture
- osteomyelitis
- osteosarcoma
- mets

10

What are the differentials for acute polyarthritis?

- acute rheumatic fever
- gonococcal arthritis
- polyarticular gout and pseudogout
- viral arthritis
- bacterial endocarditis
- RA
- JIA
- SLE
- reactive arthritis
- sarcoidosis

11

What are the differentials for chronic polyarthritis?

Inflammatory:
- RA
- SLE
- viral arthritisi
- psoriatic arthritis
- reactive arthritis
- Behcet's disease
- ankylosing spondylitis

Non-inflammatory:
- OA
- trauma
- haemochromatosis
- amyloidosis
- acromegaly

etc.

12

Contrast the definitions of osteopenia, osteoporosis, and osteomalacia.

Osteopenia = reduced bone mass (-1s.d. from norm)

Osteoporosis = reduced bone mass (-2.5s.d. from norm, on steroids limit is changed to -1.5s.d.), normal mineralisation

Osteomalacia = bone mass variable, reduced mineralisation

13

Give some risk factors of osteoporosis.

Genetics = ethnicity, FHx, low BMI

Medical = RA, Cushing's, chronic diseases,hypothyroidism

Drugs = corticosteroids, anti-convulsants, chemotherapy, alcohol, smoking

14

Describe the procedure of a DEXA scan.

Radiation: 5 days background radiation, trans-atlantic flight

Unilateral hip (usually right) and lumbar spine (T12-L5) - elevate legs to eliminate lumbar lordosis and maximise vertebral space

Usually offered for 50yrs-80yrs

Remove potential artifacts

T-score = s.d. from ideal bone mass
Z-score = age-matched t-score

15

What is the management for osteoporosis?

Bisphosphonates e.g. alendronic acid (weekly, PO), risedronate, zoledronic acid (yrly, IV)
- ADRs: osteonecrosis of the jaw, increased risk of atypical fractures, oesophageal reactions, anaemia

Strontium ranelate

Denosumab
- ADRs: hypocalcaemia, osteonecrosis of jaw, atypical fractures

16

What are the classical deformities present in RA?

Ulnar deviation/drift

FPL rupture = Mannerfelt syndrome

Boutonniere deformity = fixed flexion of PIPs

Swan-neck deformity = fixed hyperextension of PIPs

Goalkeeper's thumb

Caput-ulna syndrome

Vaughan-Jackson syndrome

Hammer-toe deformity

Rheumatoid nodules