Rheumatology Concepts and Inflammatory arthropathies

Question 1

Define arthropathy

Answer 1

disease of the joint

Question 2

Define arthritis

Answer 2

inflammation of the joint

Question 3

Define arthralgia

Answer 3

Pain in a joint

Question 4

List Seropositive inflammatory arthritides

Answer 4

Rheumatoid
Lupus
Scleroderma
Vasculitis 
Sjogrens

Question 5

List Seronegative inflammatory arthritides

Answer 5

Ankylosing Spondylitis
Psoriatic Arthritis
Reactive Arthritis
Inflammatory Bowel Disease

Question 6

What are the other types of inflammatory arthritis?

Answer 6

Infectious

Crystal induced

Question 7

What is a seropositive condition?

Answer 7

Auto-antibodies found in serum

Question 8

What causes the failure of immune regulation in auto-immune disease?

Answer 8

Genetic Predisposition
Environmental Insults
-infection
-chemical exposure

Question 9

What is Anti-CCP antibody associated with?

Answer 9

Rheumatoid Arthritis

Question 10

What is Anti-nuclear antibody (ANA) antibody associated with?

Answer 10

SLE, Sjogrens, Systemic Sclerosis, Mixed connective tissue disease, autoimmune liver disease

Question 11

What is Anti-double stranded DNA antibody associated with?

Answer 11

SLE

Question 12

What is Anti-Sm antibody associated with?

Answer 12

SLE

Question 13

What is Anti-Ro antibody associated with?

Answer 13

SLE, Sjogrens

Question 14

What is Anti-La antibody associated with?

Answer 14

Sjogrens Syndrome

Question 15

What is Anti-centromere antibody associated with?

Answer 15

Systemic sclerosis (limited)

Question 16

What is Anti-Scl-70 antibody associated with?

Answer 16

Systemic sclerosis (diffuse)

Question 17

What is Anti-RNP antibody associated with?

Answer 17

SLE, Mixed connective tissue disease

Question 18

What is Anti-Jo-1 antibody associated with?

Answer 18

Myositis

Question 19

What is Anti-cardiolipin antibody and lupus anticoagulant associated with?

Answer 19

Anti-phospholipid syndrome

Question 20

What is Anti-neutrophil cytoplasmic antibody associated with?

Answer 20

Small vessel vasculitis (GPA, EGPA, MPA)

Question 21

List causes of secondary osteoarthritis?

Answer 21

Congenital Dislocation of the hip
Perthes
SUFE
Previous intra-articular fraction
Extra-articular fracture with malunion
Osteochondral/hyaline cartilage injury 
Crystal arthropathy 
Inflammatory arthritis 
Meniscal tears
Genu Varum
Genu Valgum

Question 22

What are typical radiographic findings of OA

Answer 22

L- oss of joint space
O- steophytes
S- clerosis
S- ubchondral cysts

Question 23

What is the management of OA

Answer 23

Pain control

• analgesia, mild opiates
• physiotherapy
• weight loss
• exercise

Replacement depending on joint affected

Question 24

What is the treatment of inflammatory arthropathies?

Answer 24

Simple analagesia

Anti-inflammatories

• steroids
• NSAIDs

Steroid injections

DMARDs

Question 25

Describe the distribution of rheumatoid arthritis?

Answer 25

``` Cervical vertebrae Shoulder Joints Elbow Joints Hip Wrist MCP PIP ``` NOT DIPs Knee Ankles Tarsal joints MTP

Question 26

Describe the distribution of psoriatic arthritis?

Answer 26

Not symmetrical ``` Elbow DIP Wrist Knee Ankle DIP ```

Question 27

Describe the distribution of inflammatory spondylitis?

Answer 27

``` Spine Shoulders SI Joint Hip Knee ```

Question 28

Describe the distribution of osteoarthritis?

Answer 28

``` Cervical spine Lumbar spine Hip Thumb DIP Knee toes ```

Question 29

What are the features suggestive of joint inflammation?

Answer 29

- Joint pain with associated swelling - Morning Stiffness - Improvement with exercise - Synovitis on examination - Raised inflammatory markers (CRP and PV) - Extra-articular symptoms

Question 30

Who is most likely to be affected by RA?

Answer 30

Women : men 3/2:1 35-50 yrs People with affected 1st degree relatives 3x

Question 31

Describe the pathogenesis of RA?

Answer 31

Immune response against synovium lining joints and some tendons Triggers -smoking, infection, trauma Formation of inflammatory panus, attacks and denudes articular cartilage leading to joint destruction Tendon ruptures and soft tissue damage can lead to subluxation

Question 32

How is RA diagnosed?

Answer 32

Based on clinical presentation, radiographic findings and serological analysis

Question 33

Describe extra-articular manifestations of RA?

Answer 33

Rheumatoid nodules (25%) on site of mechanical irritation Lung involvement - pleural effusions - interstitial fibrosis - pulmonary nodules Cardiovascilar morbidity and mortality Occular involvement is common - keratoconjunctivitis sick - episcleritis - uveitis - nodular scleritis - scleromalacia

Question 34

What might you see on early X-ray of RA?

Answer 34

No joint abnormalities | Peri-articular osteopenia

Question 35

Describe the treatment of RA?

Answer 35

Aim to start DMARD within 3 month of symptom onset Methotrexate usually first line Biologic agents - anti-TNF alpha - tocluzimab - rituximab - abatacept MUST HAVE DAS 28 + FOR BIOLOGICS

Question 36

Which surgeries can be performed in RA?

Answer 36

``` Synovectomy Joint replacement Joint excision Tendon transfer Arthrodesis Cervical Spine stabilisation ```

Question 37

What are individuals with seronegative arthropathies often positive for?

Answer 37

HLA-B27 CRP and ESR elevation

Question 38

Describe ankylosing spondylitis?

Answer 38

Chronic inflammatory disease of the spine and sacroiliac joints Lead to fusion of intervertebral joints and SI joints

Question 39

Who is more affected by ankylosing spondylitis?

Answer 39

Male : female 3:1 20-40 years

Question 40

How can lumbar spine flexion be tested

Answer 40

Schobers test

Question 41

Which conditions are associated with ankylosing spondylitis?

Answer 41

Uveitis Aortitis Pulmonary fibrosis Amyloidosis

Question 42

What is the treatment for ankylosing spondylitis?

Answer 42

Physiotherapy Exercise NSAIDs Anti-TNF DMARDs have no effect unless peripheral joint inflammation

Question 43

What surgery can be done in ankylosing spondylitis?

Answer 43

Kyphoplasty to straighten spine is controversial

Question 44

What commonly occurs on psoriatic arthritis?

Answer 44

Spondylitis, dactylitis, enthesitis Nail changes - pitting - oncholysis

Question 45

What is the destructive form of psoriatic arthritis?

Answer 45

Arthritis mutilans

Question 46

What is the treatment for psoriatic arthritis?

Answer 46

DMARDs | Anti-TNF

Question 47

Describe enteropathic arthritis?

Answer 47

Involves peripheral joints and sometimes spine in patients with IBD

Question 48

Describe reactive arthritis

Answer 48

Occurs in response to an infection in another part of the body - GU infection - GI infection Occurs 1-3 weeks following infections

Question 49

What triad of symptoms can be present in reactive arthritis?

Answer 49

Urethritis, Uveitis or conjunctivitis, arthritis Reiters syndrom