Clinical - Arthritis

Question 1

Diagram of a typical synovial joint

Answer 1

Question 2

What are the bones of a synovial joint lined by?

Answer 2

A layer of hyaline cartilage that functions to absorb shock and reduce friction during movement.

Question 3

What is synovitis?

Answer 3

Inflammation of the synovial membrane

Question 4

What is inflammatory arthritis?

Answer 4

A chronic autoimmune disease in which your immune system misidentifies your own body tissues as harmful germs or pathogens and attacks them. The result is inflammation of the affected tissues in and around joints.

Question 5

What happens during inflammatory arthritis / synovitis?

Answer 5

Synovial membrane becomes inflamed and pumps out inflammatory chemicals which creates collection of fluid in joint

Question 6

What is osteoarthritis?

Answer 6

• Most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of your bones wears down over time.
• Most commonly affects joints in your hands, knees, hips and spine.
• Most commonr reason for knee and hip replacements

Question 7

What happens when bits of cartilage start to flake off in OA? How does this affect synovial membrane?

Answer 7

• Cartilage flakes into synovial lining, causing inflammation within lining of joint –> synovitis
• As synovium becomes inflamed, the bone reacts to low level of inflammation by trying to heal itself –> becomes thicker and bulkier
• Joint physically grows thicker
• Get cysts forming in the subchondral bone –> pain

Question 8

What is subchondral bone?

Answer 8

The layer of bone just below the cartilage in a joint

Question 9

Hands of OA

Answer 9

Tends to affect middle and distal joints of fingers –> appear swollen

Question 10

X-ray of knee with arthritis

Answer 10

• Bone appears white –> due to sclerosis
• Chunkiness and irregularity around edge –> Osteophytes are exostoses (bony projections) that form along joint margin usually due to inflammation

Question 11

How does OA affect inflammatory markers?

Answer 11

Inflammatory markers and antibodies are normal - no specific blood tests can help diagnose

Question 12

Key features of inflammatory arthritis?

Answer 12

• Morning stiffness more than 30 minutes
• Raised inflammatory markers (CRP) –> usually
• Definite joint swelling
• Positive blood tests for certain antibodies –> usually
• Inflammatory back pain
• Not just in old people!

Take notes of key differences between inflammatory arthritis and OA

Question 13

What type of arthritis is rheumatoid arthritis?

Answer 13

Inflammatory arthritis - autoimmune

Question 14

Key features of rheumatoid arthritis

Answer 14

• F:M 3:1
• Most common age 40-50s
• Joint swelling, heat, pain, morning stiffness
• Small joints of hands and feet
• Other organs can be affected too
• 80% positive Rheumatoid Factor blood test
• CCP blood test

Question 15

What blood tests can be used to diagnose Rheumatoid arthritis?

Answer 15

• CRP - measures inflammation
• Rheumatoid Factor blood test - Rheumatoid factors are proteins that the immune system produces when it attacks health tissue
• CCP - Anti-CCPs are antibodies also produced by the immune system. People who test positive for anti-CCP are very likely to develop rheumatoid arthritis.

Question 16

What are Rheumatoid nodules?

Answer 16

Firm, noticeable lumps that form underneath the skin of some rheumatoid arthritis patients.

Question 17

Is OA treatable? Is Rheumatoid treatable?

Answer 17

No

Yes

Question 18

How can RA be treated?

Answer 18

Lots of new drugs - focus on immune suppression

Question 19

What is Psoriatic arthritis?

Answer 19

A type of arthritis that affects some people with the skin condition psoriasis - autoimmune

Question 20

Symptoms of psoriatic arthritis?

Answer 20

• Chronic plaque psoriasis –> This causes patches of red, raised skin, with white and silvery flakes
• Pain, swelling and stiffness because of inflammation inside a joint –> inflammatory arthritis
  
  • Look at symptoms for inflammatory arthritis
• Swollen fingers or toes –> dactylitis
• Fatigue
• Small round dents in finger and toe nails –> pitting. Nails can also change colour, become thicker and the nail may lift away from your finger.

Question 21

What does psoriatic and rheumatoid arthritis put you at risk of?

Answer 21

Increased CV risk

Question 22

What is axial spondyloarthritis?

Answer 22

An umbrella term for types of inflammatory arthritis that primarily affect the spine and the sacroiliac (SI) joints that connect the lower spine to the pelvis

Question 23

Key facts about axial spondyloarthritis

Answer 23

• Inflammatory back pain
  
  • Pain in 2nd half of night (takes a while to start)
  • Morning stiffness
• Young people
• Average length of time to diagnose is 8 years
• Pain and stiffness can be treated
• Can cause red inflamed eyes (iritis)
• Can affect tendon insertion sites (Achilles)

Question 24

Difference between x-ray

Answer 24

• Spinal fusion (lost spaces between vertebrae)

Question 25

What is gout?

Answer 25

A type of arthritis caused by **too much uric acid** and it goes into your joints --\> really really painful * uric acid can form crystals in and around joints * these crystals can also build up under the skin and form small white or yellow lumps known as tophi

Question 26

Gout symptoms?

Answer 26

* Sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe * An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire * Can eventually cause **rat-bite erosions** (seen in x-rays)

Question 27

Gout treatment?

Answer 27

Easy to treat - give good analgesics

Question 28

What is pseudo-gout?

Answer 28

A form of arthritis that results from deposits of **calcium pyrophosphate crystals**. It commonly affects wrists and knees.