Rheumatology conditions week 2

Question 1

What is rheumatoid arthritis?

Answer 1

an AI disease that causes pain, swelling and stiffness in joints.

Can lead to:

• severe joint damage
• loss of function
• disability

Question 2

Epidemiology of Rheumatoid arthritis:

Answer 2

W>M - 3:1
peak at age 40
incidence increases with age

Question 3

What can trigger rheumatoid arthritis?

Answer 3

an interaction between environmental and genetic factors

Question 4

what are the first clinical signs typically seen in patients with rheumatoid arthritis?

Answer 4

insidous onset of pain and stiffness in the small joints of the hands and/or feet

Question 5

Key SSx of rheumatoid arthritis:

Answer 5

• morning pain/stiffness
• ST and joint swelling
• tenderness on palpation
• systemic symptoms

Question 6

Name 4 joint deformities associated with RA:

Answer 6

Butonniere
Swan neck
Z deformity
Ulnar deviation

Question 7

what are some other clinical features of RA outside of joints:

Answer 7

Blood -anaemia
Skin: rheumatoid nodules
Eye: scleritis
Lung: nodules
Cardiac: Peri/myocarditis
Atherosclerosis
Renal
Neuropathy

Question 8

What 3 symptoms indicate a strong suspicion of RA according to the RACGP?

Answer 8

1. persistent joint pain and swelling in >3 joint areas
2. symmetrical involvementof MCP or MTP joints
3. morning stiffness >30 mins

Question 9

common investigations of RA:

Answer 9

ESR/CRP
Rh factor
Anti CCP
X-ray

Question 10

Management of RA:

Answer 10

education
NSAIDs
DMARDs
exercise

Question 11

What is ankylosing spondylitis?

Answer 11

a seronegative spondyloarthropathy causing restriction and fusion at the SIJ and Tx spine

Question 12

What populations are associated with AS?

Answer 12

age under 30
M>W
HLA-B27
1st degree relative ^ risk

Question 13

what rheumatological conditions are associated with HLA B27?

Answer 13

mnemonic: PAIR
Psoriasis
Ankylosing spondylitis
IBS
Reactive arthritis

Question 14

Pathogenesis of AS:

Answer 14

HLA-B27 and timmune response –> influx of inflammatory cytokines and tissue destruction

Question 15

SSx of Ankylosing spondylitis?

Answer 15

Low back pain -SIJ/buttock
Lx flexion restriction
Enthesitis
peripheral arthitis
bowel inflam

Question 16

AS diagnostic tests

Answer 16

X-ray
MRI
ESR/CRP

Question 17

What is Psoriatic arthritis?

Answer 17

seronegative spondyloarthropathy

AI disease characterised by red scaly patches and arthritic joint changes

Question 18

Psoriatic arthritis epidemiology

Answer 18

M=W

ages 30-50 most common

Question 19

Psoriatic arthritis pathogenesis:

Answer 19

AI process:
- immune system attacks self-antigens in the joints
Thought to be related to an environmental trigger (trauma, infection)

Question 20

what are the 5 different classifications of Psa?

Answer 20

distal predominant
oglioarticular
polyarticular
spondylitis
arthritis mutilans

Question 21

SSx of Psa:

Answer 21

peripheral arthritis
axial arthritis
dactylitis
enthesitis
tendonitis

Question 22

pencil in cup deformity is associated with which condition?

Answer 22

psoriatic arthritis

Question 23

what is septic arthritis?

Answer 23

is the invasion of a joint by an infectious agent resulting in joint inflammation.

Question 24

what bacteria can cause septic arthritis?

Answer 24

Staph A

Neisseria gonorrhoeae

Question 25

risk factors for septic arthritis?

Answer 25

over 60
immunocompromised
artificial joint
joint trauma
osteomyelitis
RA

Question 26

clinical features of septic arthritis:

Answer 26

red hot and swollen joints (often in knee)
reduced joint ROM
systemic symptoms

Question 27

when should septic arthritis be suspected?

Answer 27

rapidly unwell
painful joint - movement
tenderness surrounding joint
hot, swollen red joint
fever >38 deg