Rheumatology Flashcards
What is Rheumatoid Arthritis?
Autoimmune disease which causes inflammation in the joints causing joint swelling, pain and stiffness
Which joints are affected first in RA?
Smaller joints in the hands, wrists and feet
Describe the pathophysiology of RA
The body attacks the synovium in the joints and causes inflammation so fluid and inflammatory cells build up around the joint. The fluid stretches the joint capsule so the joint becomes unstable and over time the joint space is worn away due to repeat inflammation
Give 5 symptoms of RA
joint pain, joint swelling, morning stiffness, tiredness, amnesia, depression, irritability, weight loss
Worse in the cold
Give 6 hand signs found in RA
Swelling of PIP and MCP joints
Boutonniere deformity (loss of thumb mobility and pincher grasp)
Swan-neck deformity
Ulnar deviation of the fingers at the MCP joint
Synovial cysts
Z-shaped thumb
MCP subluxation
Trenching of the dorsal extensor ligaments
Give 3 risk factors for developing RA
Smoking Excessive red meat Caffeine Low vitamin C Alcohol excess Family history
Which tests aid RA diagnosis?
FBC ESR or CRP Rheumatoid factor Anti-CCP X-ray of joints
What may be seen on joint x-ray in a patient with RA?
Soft tissue swelling Osteopenia Joint space narrowing Hand deformities Ulnar deviation Joint fusion
When monitoring and diagnosing RA, what criteria are used to assess the progression of the condition?
Joint involvement (1 point for 2-10 large joints, 2 points for 1-3 small joints, 3 points for 4-10 small joints, 5 points for >10 joints)
Serology (2 points for slight abnormality in RF and anti-CCP, 3 points for large abnormality)
Acute phase reactants (1 point for abnormal CRP/ESR)
Duration (1 point for >6 weeks)
If >6 points in total, diagnosis of RA can be made
Which classes of medications can be given to treat RA?
NSAIDs
DMARDs
Steroid injections
Analgesics
Give 5 respiratory complications of RA
Pulmonary fibrosis Pleural effusion Pulmonary nodules Bronchiolitis obliterans Methotrexate pneumonitis Pleurisy
Give 5 ocular complications of RA
Keratoconjunctivitis Sicca Episcleritis Scleritis Corneal ulceration Keratitis Steroid-induced cataracts Chloroquine retinopathy
What is osteoarthritis?
Surfaces of the joints become damaged so the joint does not move smoothly.
Describe the pathophysiology of osteoarthritis
The cartilage on the bone surface wears away with use and becomes rough. The underlying bone becomes thicker and grows outwards creating osteophytes. The synovium thickens and produces extra fluid which causes the joints to swell. The capsule and ligaments around the joint thicken and shorten to try and stabilise the joint but this causes joint stiffness.
Which joints does osteoarthritis normally affect?
Larger weight bearing joints
Hip, knee and spine
Give 4 symptoms of osteoarthritis
Pain at the end of the day Stiff joints Crepitus Joint swelling Loss of function in the joints
Symptoms worse in the damp weather
Give 4 risk factors for developing osteoarthritis
Old age Female Obesity Previous joint injury Congenital joint abnormalities Genetics Previous history of RA
What changes may be seen on a joint x-ray in a patient with osteoarthritis?
Loss of joint space
Sclerosis of the bone
Osteophytes
Bone cysts
How can OA be treated conservatively?
Exercise
Weight loss
Physiotherapy
How can OA be treated medically?
Steroid injections
NSAIDs
Capsaicin cream
How can OA be treated surgically?
Joint replacement
What are people with OA more at risk of developing?
Gout
Chondrocalcinosis (calcium pyrophosphate crystals form in the cartilage)
What is psoriatic arthritis?
Inflammation in and around the joints with associated psoriasis skin rashes
What are the symptoms of psoriatic arthritis?
Pain and stiffness in the joints Buttock pain (from spondylitis) Pitting discolouration Thickening of the nails Fatigue Psoriatic rash
How is psoriatic arthritis treated?
Physiotherapy Exercise Stop smoking NSAIDs DMARDs Steroid injections Vitamin A and D Joint replacement
What is reactive arthritis?
Condition which causes painful joint swelling after an event such as an infection of the bowel, genital tract or throat. It usually lasts for about 6 months
Give 5 symptoms of reactive arthritis
Pain and swelling in the joints which occurs suddenly Swollen toe or finger Conjunctivitis Scaly rash over hands and feet (keratoderma blennorrhagica) Diarrhoea Genital tract discharge Weight loss Fever
What is Reiter’s Syndrome?
Classic triad of urethritis, conjunctivitis and arthritis
What is the most common cause of reactive arthritis?
Chlamydia infection
What is ankylosing spondylitis?
A systemic, chronic autoimmune spondyloarthropathy which mainly affects the axial spine.
What is the epidemiology of ankylosing spondylitis?
Males at higher risk
Aged 30-40
Strong genetic link
Which blood tests can be done to diagnose ankylosing spondylitis?
HLA-B27 = positive
Rheumatoid factor = negative
ESR/CRP = high
What is the pathophysiology of ankylosing spondylitis?
HLA-B27 aggregates with peptides in the joints and starts a degenerative process due to the cytotoxic T-cell reaction against the HLA-B27. The soft tissue between the joints becomes inflamed and causes bony erosion, soft tissue ossification and joint stiffness.
Give 3 symptoms of ankylosing spondylitis?
Lumbosacral pain and stiffness Worse in the mornings Loss of horizontal gaze Shortness of breath Sciatica
What are some other features of ankylosing spondylitis? (The As)
Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis Peripheral arthritis
What is found on physical examination of a patient with ankylosing spondylitis?
Reduced chest wall expansion
Decreased forward flexion (can do Schober’s test)
Reduced lateral flexion
Kyphotic spine deformity
