rheumatology and orthopaedics

Question 1

what does seronegative spondyloarthropathies mean

Answer 1

group of rheumatologic disorders that don’t have rheumatoid factor

Question 2

define reactive arthritis

Answer 2

sterile inflammation in joints following infection (environmental trigger), especially urogenital and gastrointestinal infections

Question 3

example of urogenital infection

Answer 3

Chlamydia trachomatis

Question 4

examples of gastrointestinal infections

Answer 4

Salmonella, Shigella, Campylobacter infections

Question 5

3 extra-articular manifestations of reactive arthritis

Answer 5

enthesopathy (disordered attachment of tendon to bone), skin inflammation, eye inflammation

Question 6

what 2 infections may reactive arthritis be the first manifestation of

Answer 6

HIV, hep C

Question 7

who are usually affected by reactive arthritis

Answer 7

young adults with genetic predisposition and environmental trigger

Question 8

what is the gene associated with genetic predisposition of reactive arthritis

Answer 8

HLA-B27

Question 9

duration after infection that reactive arthritis symptoms occur

Answer 9

1-4 weeks

Question 10

3 categories of musculoskeletal symptoms of reactive arthritis

Answer 10

arthritis, enthesitis, spondylitis

Question 11

3 features of arthritic symptoms of reactive arthritis

Answer 11

asymmetrical, oligoarthritis (<5 joints affected), lower limb joints typically affected

Question 12

3 features of enthesitis symptoms of reactive arthritis

Answer 12

heel pain (Achilles tendonitis), swollen fingers (dactylitis - inflammation of soft tissue), painful feet (metatarsalgia due to plantar fasciitis)

Question 13

2 features of spondylitis symptoms of reactive arthritis

Answer 13

sacroiliitis (inflammation of sacro-iliac joints), spondylitis (inflammation of spine)

Question 14

describe ocular eye inflammation condition which is an extra-articular feature of reactive arthritis

Answer 14

sterile conjunctivitis

Question 15

describe genito-urinary condition which is an extra-articular feature of reactive arthritis

Answer 15

sterile urethritis

Question 16

describe 2 skin conditions which are extra-articular features of reactive arthritis

Answer 16

circinate balantis, psoriasis-like rash on hands and feet

Question 17

rheumatoid vs reactive arthritis: sex prevalence

Answer 17

rheumatoid: F>M vs reactive: M>F

Question 18

rheumatoid vs reactive arthritis: age affected

Answer 18

rheumatoid: all ages (30-50) vs reactive: 20-40

Question 19

rheumatoid vs reactive arthritis: features of arthritis

Answer 19

rheumatoid: symmetrical, polyarticular, small and large joints vs reactive: asymmetrical, oligoarticular, large joints

Question 20

rheumatoid vs reactive arthritis: enthescopathy

Answer 20

rheumatoid: no vs reactive: yes

Question 21

rheumatoid vs reactive arthritis: spondylitis

Answer 21

rheumatoid: no except atlanto-axial joint in cervical spine vs reactive: yes

Question 22

rheumatoid vs reactive arthritis: urethritis

Answer 22

rheumatoid: no vs reactive: yes

Question 23

rheumatoid vs reactive arthritis: skin involvement features

Answer 23

rheumatoid: subcutaneous nodules vs reactive: K.blennorhagicum, circinate balantis

Question 24

rheumatoid vs reactive arthritis: rheumatoid factor present

Answer 24

rheumatoid: yes vs reactive: yes

Question 25

rheumatoid vs reactive arthritis: HLA gene associated

Answer 25

rheumatoid: HLA-DR4 vs reactive: HLA-B27

Question 26

what is the single best investigation of a single inflamed joint

Answer 26

remove synovial fluid and do a gram staining culture to exclude septic arthritis

Question 27

distinguishing features of septic arthritis

Answer 27

infection, high CRP, look sick, usually only one joint affected

Question 28

examples of infections causing septic arthritis

Answer 28

S. aureus

Question 29

infection causing oligoarticular arthritis

Answer 29

gonorrhoea (enters bloodstream and seeds into multiple joints)

Question 30

besides synovial fluid examination, what 2 other investigations can be conducted to determine type of arthritis

Answer 30

microbiological (cultures of blood, throat, urine, stool, utethra and cervix; serology e.g. HIV, hep C), immunological (rheumatoid factor)

Question 31

why would you not always diagnose reactive arthritis based on HLA-B27 presence

Answer 31

genetic risk factor, but doesn't confirm diagnosis

Question 32

septic vs reactive arthritis: results of synovial fluid culture

Answer 32

septic: positive vs reactive: sterile

Question 33

septic vs reactive arthritis: is antibiotic therapy appropriate

Answer 33

septic: yes vs reactive: no

Question 34

septic vs reactive arthritis: is joint lavage (washing) appropriate

Answer 34

septic: yes for large joints vs reactive: no

Question 35

what patients have increased risk of septic arthritis

Answer 35

if immunocompromised or immunosuppressed

Question 36

normal treatment of reactive arthritis

Answer 36

in majority of patients, complete resolution occurs within 2-6 months with no role for antibiotics

Question 37

when would further treatment be given for reactive arthritis

Answer 37

if very symptomatic, severe or one joint with infection excluded

Question 38

2 further treatments for articular reactive arthritis

Answer 38

NSAIDs, intra-articular corticosteroid therapy

Question 39

further treatment for extra-articular reactive arthritis

Answer 39

typically self-limiting so symptomatic therapy e.g. topical steroids

Question 40

what 2 treatments can be given if refractory reactive arthritis

Answer 40

oral glucocorticoids, steroid-sparing agents e.g. sulphasalazine