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48 Cards in this Set
- Front
- Back
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acute monoarthritis: ddx?
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gout
septic arthritis |
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how many joints for it to be polyarthritis?
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>6 joints
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which arthritis is more common in males?
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gout
ankylosing spondylitis |
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joint changes seen in RA?
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Synovium swollen
Panus: soft tissue that goes through the bone and causes erosions |
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ulnar deviation: pathonmonic for what?
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RA
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Signs of RA?
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morning stiffness
3 or more joints symmetrical ulnar deviation* PIJ swollen DIJ generally spared rheumatoid nodule >6 weeks |
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rheumatoid factor
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NOT DIAGNOSTIC
+ve in 70% RA patients antibodies against self IgG Not specific: up in hep C and other chronic conditions |
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investigations for RA?
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Rheumatoid factors: +ve 70% pt
Anti-cyclic citrullinated peptide (anti-CCP) antibody: +ve 70-80%pt- good in RF -ve pt, useless if RF +ve Synovial fluid aspiration Xray |
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Systemic manifestations of RA?
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Eyes: scleritis, keratoconjunctivitis
Pleura: effusions Lung: fibrosis, nodules Lymph nodes: reactive lymphadenopathies Pericardium: effusions Spleen: splenomegaly Kidney/ gut: amyloidosis Bone marrow: anaemia, thromboyctopaenia Muscle: wasting Skin: thinning, ulceration Nervous system: peripheral neuropathy |
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olecranon subcutaneous nodule seen in which disease?
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RA
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Pathology: Gout
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crystals are deposited in joints and cause inflammation
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tophaceous gout
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recurrent attacks of gout lead to uric acid deposition in joints and other tissue
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chondrocalcinosis
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calcium deposition in the cartilage- pseudogout
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4 pathological features of OA
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1. subchondral bone: sclerosis and cysts
2. decreased joint space 3. osteophytosis and soft tissue growth at joint margin 4. thickening, distortion and fibrosis of capsule |
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OA: which nodules are distal, which proximal on fingers
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Heberden's nodules: distal (HIDeous)
Bouchard's: proximal (BIP) |
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Which side of the knee is more commonly affected in OA?
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medial side
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ANA test, worthwhile?
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diagnostic criteria in SLE
also up in scleroderma, RA, polymyositis Good -ve predictive value |
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DNA antibodies and SLE:
sensitivity? specificity? |
Specific! active SLE only
Low sensitivity for SLE Good +ve predictive value |
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large joint assymetrical oligoarthropathy is a characteristic of which spondyloarthropathy?
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All of them:
- ankylosing spondylitis - psoriatic arthritis - reactive arthritis - enteropathic arthritis |
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what is reiters syndrome?
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agressive form of reactive arthritis caused by chlamydia!
Features: - reactive arthritis - conjuncitivitis - urethritis Imp: heart conduction defect + nephritis Common in HIV positive patients |
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which HLA group is common to all spondyloarthropathies?
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HLA-B27
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what is enthesopathy?
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inflammation of attachments of bone
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who gets ankylosing spondylitis?
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young (20-30)
men (3:1) HLA-B27 in 90-95% |
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commonest presentation of ankylosing spondylitis
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back pain: spine and peripheral joints (SI and symphysis pubis)
PLUS morning stiffness |
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extraspinal features of ankylosing spondylitis
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peripheral arthritis
acute anteroir uveitis enthesitis aortitis upper lobe pulmonary fibrosis weight loss fatigue |
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what are syndesmophytes?
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new bone that grows on spine after inflammation (CD8+T lymphocytes and macrophages) destroy the existing cartilage and subchondral bone
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will the FBC be altered in ankylosing spondylitis?
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nope normal
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will you see xray changes in ankylosing spondylitis?
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only after 5-6 years
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How do you treat ankylosing spondylitis?
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1. excercise
2. education 3. NSAIDs 4. sulphasalazing, methotrexate of TNF-a inhibitors |
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hoes does psoriatic arthritis relate to psoriasis?
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occur together, NOT related in severity
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is psoriatic arthritis more common in men or women?
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equal
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what is the most common presentation of psoriatric arthritis in terms of joint involvment?
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oligoarthritis (<4)
can involve any, distinct from RA because of asymmetry and involvement of PID |
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what is datylitis, when it is seen in spondyloarthropathies
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inflammation of the entire digit due to flexor tenosynovitis
seen in psoriatic arthritis |
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lab results in psoriatic arthritis?
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anaemia of chronic disease
nm FBC raised CRP, ESR RF and anti CCP -ve |
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are there xray changes in psoriatic arthritis?
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not in early disease, but can see in chronic
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how do you diagnose psoriatic arthritis?
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clinical picture, not lab results
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mgt psoriatic arthritis?
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NSAIDs
intra-articular corticosteroid injections disease modifying anti-rheumatic drugs: - methotrexate - salazapyrin - TNF-a-inhibitors |
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Reactive arthritis: what % of patients with nongonococcal genital or enteric infections get it?
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1-5%
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when does a pt get reactive arthritis?
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10-15 days after genital or enteric infection
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in reactive arthritis, what is causing inflammation in joint
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NOT the organisms themselves
Bacterial antigen, probably a lipopolysaccharide. |
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clinical presentation in reactive arthritis?
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~3 joints affected
lasts for around 5 months |
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which reactive arthritis is most likely to recur?
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chlamydia
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does reactive arthritis resolve?
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yes. 85% are asymptotic at 1 yr.
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how do you treat reactive arthritis?
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NSAIDs
intra-articular steroids prednisone, sulphasalazing or methotrexate antibiotics- treat the causative infection |
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what diseases are associated with enteropathic arthritis?
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UC and crohns
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which disease is more commonly associated with enteropathic arthritis
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UC: 20%
crohns: 10% |
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is enteropathic arthritis erosive?
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nope, large joint, non erosive oligoarthritis
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treatment of enterpathic arthritis?
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NSAIDs
intraarticular corticosteroids prednisone sulphasalazine |
