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Flashcards in The GALS Screen Deck (29)
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1

Define the following terms:
a. Arthritis
b. Arthralgia
c. Subluxation
d. Synovitis
e. Dislocation

a. Arthritis
Refers to definite inflammation of a joint
b. Arthralgia
Refers to pain within a joint without demonstrable inflammation by physical examination
c. Subluxation
Partial dislocation of a joint
d. Synovitis
Inflammation of the synovium
e. Dislocation
Articulating surfaces are displaced and are no longer in contac

2

What does GALS stand for?

Gait
Arms
Legs
Spine

3

What is gout caused by?

It is caused by deposition of monosodium urate (MSU) crystals as a result of hyperuricaemia

4

What are the key clinical features of gout?

Tophi – subcutaneous depositions of aggregated monosodium urate crystals
Gouty arthritis

5

Which joint is commonly affected by gouty arthritis?

1st Metatarsophalangeal joint – this is called podagra

6

List some signs of irreversible joint damage.

Joint deformity
Crepitus
Loss of joint range or abnormal movement

7

List some signs of a mechanical defect in the joint.

Painful restriction of movement in the absence of features of inflammation
Instability

8

How many joints have to be involved for arthritis to be classifiedas ‘oligoarthritis’?

2-4

9

Describe the pattern of arthritis in the following diseases including the joints that are commonly affected and spared:
a. Rheumatoid arthritis
b. Reactive arthritis
c. Gout

a. Rheumatoid arthritis
Symmetrical polyarthritis involving large and small joints
Joints spared: DIP, lumbar spine, thoracic spine
Joints involved: most others
b. Reactive arthritis
Lower limb asymmetrical oligoarthritis and axial involvement
c. Gout
Exclusive inflammation of the 1st metatarsophalangeal joint
Joints commonly spared: axial

10

What is the main extra-articular feature of gout?

Tophi – subcutaneous deposits of uric acid

11

What are the two types of synovial lining cell?

Typa A – macrophage-like
Type B – fibroblast-like (secrete hyaluronic acid)

12

What is a synovial effusion?

Abnormal increase in synovial fluid volume

13

State two causes of spinal effusion and describe the synovial fluid composition in each of them.

Abnormal mechanical stimulation – can stimulate the fibroblasts to produce more hyaluronic acid – normal composition
Inflammation – inflammatory exudate – abnormal composition with inflammatory mediators and reduced hyaluronic acid

14

What features of the synovial fluid are examined to determine the cause of the synovial effusion?

How turbid it is
The presence and quantity of inflammatory cells (neutrophils in particular)
Non-inflammatory – slightly turbid – osteoarthritis or mechanical defects
Inflammatory – turbid – reactive arthritis or gout
Infection – very turbid – bacterial infection

15

When is synovial fluid examination performed?

When joint infection is suspected
Useful for confirming diagnosis of crystal arthritis

16

What are some contraindications for arthrocentesis?

Conditions that increase bleeding e.g. coagulopathy or anti-coagulant drugs
Overlying skin infection

17

List some possible complications of arthrocentesis

Risk of introducing infection
Bleeding into the joint
Damage to structures of the joint

18

What technique is used to detect crystals in the synovial fluid?

Polarising light microscopy

19

How is gout distinguished from pseudogout in synovial fluid examination?

Gout
 Urate crystals
 Needle shaped
 Negative birefringence (polarising light microscopy)
Pseudogout
 Calcium pyrophosphate dehydrate (CPPD) crystals
 Brick shaped
 Positive birefringence

20

What is a common feature of most connective tissue diseases?

Raynaud’s phenomenon (intermittent vasospasm of the digits on exposure to the cold)

21

What is Sjogren’s syndrome and what are its symptoms?

Autoimmune exocrinopathy
Symptoms:
Dry eyes (xerophthalmia)
Dry mouth (xerostomia)
Parotid gland enlargement
Extra-glandular features: non-erosive arthritis + Raynaud’s

22

Which antibodies are associated with Sjogren’s syndrome?

ANA
Anti-Ro
Anti-La
Rheumatoid factor

23

What is inflammatory muscle disease and what are the two types?

Proximal muscle weakness due to autoimmune-mediated inflammation either with a rash (dermatomyositis) or without a rash (polymyositis)

24

Describe the skin changes that take place in dermatomyositis.

Lilac rash on eyelid, malar region and naso-labial folds
Red or purple lesions on knuckles (Gottron’s papules)
Subcutaneous calcinosis
Mechanic’s hands (fissuring and cracking of the skin over the finger pads)

25

Which antibodies are associated with inflammatory muscle disease?

ANA
Anti-tRNA transferase antibodies
NOTE: also associated with elevated creatine phosphokinase, abnormal EMG and abnormal muscle biopsy

26

What other diseases is inflammatory muscle disease associated with?

Pulmonary fibrosis and Malignancy

27

What is systemic sclerosis?

Thickened skin with Raynaud’s phenomenon Features include:
 Dermal fibrosis
 Cutaneous calcinosis
 Telangiectasia

28

What are the two types of systemic sclerosis and what are the differences between them?

Diffused systemic sclerosis
 Fibrotic skin proximal to elbows or knees
 Anti-Scl-70 antibodies
 Pulmonary fibrosis and renal involvement
 SHORT history of Raynaud’s
Limited systemic sclerosis
 Fibrotic skin on hands, forearms, feet, neck and face
 Anti-centromere antibodies
 Pulmonary hypertension
 LONG history of Raynaud’s

29

What is overlap syndrome?

When feature of more than one connective tissue disease are presen