1841402
Description
Flashcards by Morgan Morgan, updated more than 1 year ago
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Created by Morgan Morgan
over 9 years ago
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| Question | Answer |
| Gout is a condition in which? It is an inflammatory arthritis. | Monosodium urate accumulates and crystals may be deposited at various sites including joints. |
| It is intensely painful. The typical site is? But it can also occur in the ? It most commonly affects .......... And an attack will usually begin at? There is .......................history | 1st MTPJ Ankles, knees, elbows, wrists and fingers. Males. Night Familial |
| There is a sudden onset of ........., ................., ............................, and ................movement in the foot or ankle. | pain, swelling, erythema, limited movement |
| What is the name given to chalky white deposits of monosodium urate? | Tophi |
| Where can they occur? 5 Most commonly found in? | Synovium (joints and bursa) Subchondral bone Tendons Articular cartilage Subcutaneous tissue superficial to deep facia Midfoot, Fingers, toes, ulnar side of forearms, bursae, achilles tendon. Spinal canal and vocal cords. Heberden's nodes. |
| Tophi can? 3 Intra-articular tophi are associated with? They usually take about ....years to form after the initial attack. | compress blood vessels and nerves may ulcerate can be surgically removed The formation of bone erosion and joint damage in gout. 10 years |
| Risk factors 8 plus | Alcohol Dietary - intake of purines from redmeat and seafood. Use of drugs that can raise plasma urate levels Family history Obesity Hypertension Diabetes Vascular disease |
| Four stages of gout? | Asymptomatic hyperuricaemia Acute gouty arthritis Intercritical gout Chronic tophaceous gout |
| Classic gout/acute 'gouty arthritis' affects the 1st MTPJ, ankle and distal IPJ It starts as a ....... ............. and builds usually in .... hours ant there is extreme pain The joint is? Weightbearing is? It is associated with mild? It may last a few days or weeks. It subsides leaving a normal joint. It is usually followed by further attacks. | Dull ache, 24 hours The joint is swollen, tender, hot, red and dry. Impossible Fever |
| Chronic tophaceous gout Urate crystals collect in? They enlarge to form? Tophi are often found in ? Chalky white contents are visible through the ...... and often ............. Which type of involvement normally co-exists? | *Articular cartilage *Palpable, visible nodules *Pinna of ear *Skin, ulcerate *Renal involvement often co-exists |
| Diagnosis - 7 | Ideally the synovial fluid would be tested for crystals, but this is often not practical. Blood tests - testing the serum uric acid level which is higher in men than women. Urine analysis X-ray Bone scan Diagnostic ultrasound Double contour sign |
| Differential diagnosis | Septic arthritis OTHER CRYSTAL DEPOSITION DISORDERS such as: Pseudogout; calcium pyrophosphate deposition disease (CPPD) Hydroxyapatite crystal deposition disease. Osteoarthritis Psoriatic arthritis Reactive arthritis Rheumatoid arthritis Seronegative spondyloarthropathy Haemochromatosis |
| Management (Conservative) - 6 | Weight loss Low purine diet Alcohol reduction Avoid diuretic therapy Local ice therapy Increase fluid intake |
| Pharmacological - 4 | NSAIDS for acute attack (48hours after the resolution) Colchicine (reduces inflammatory response to deposited urate crystals) Corticosteroids (oral or IM) Allopurinol Febuxostat as second-line therapy if allopurinol is not tolerated or is contraindicated. |
| Podiatric management 8 | Limit first MTP movement • long shaft pad • casted and OTS FO • Aspiration of tophus • Injection therapy • Physical therapy • Protection for soft tissues on medial/dorsal aspect • Tophi can cause ulceration – management as appropriate Footwear advice re. soft shoe uppers but firm /rigid thick soles/rocker bar |
| The Acute Hot Joint - what are you looking for and what do you do? | Medical emergency: priority is exclusion of sepsis • Commonly affects weight bearing joints • Foot: 1st MTP joint and 1st IPJ • Examination: – Tender/ restricted / hot / red • Refer to medical team ASAP • IV antibiotics for septic arthritis |
| Causes of acute hot joint | Sepsis: rare but important • Crystal arthritis: – Gout – Pseudo-gout (CPPD) • Reactive arthritis: - Chlamydial genital infection - Gut infections e.g. salmonella • Post intra-articular steroid injection |
| Septic arthritis is a serious infection of the ? Characterised by? 6 | Septic arthritis (aka infectious arthritis) is a serious infection of the joints characterised by fever, chills, pain, inflammation and swelling in one or more joints, and loss of function in those joints. |
| It is considered a medical emergency because of the damage it causes to ? And its potential for creating? | Septic arthritis is considered a medical emergency because of the damage it causes to bone as well as cartilage, and its potential for creating septic shock; a potentially fatal condition. • It is important to distinguish between RA flare affecting a joint and septic arthritis. |
| Risk factors include age and having which conditions? • It most commonly affects .............................joints, The 1st ..... and 1st..... joints are most commonly affected. Septic arthritis must be diagnosed quickly and treated with IV antibiotics. | Older than 80. Diabetes or RA and recent joint surgery. Weight bearing. IPJ and MTPJ |
| Sero-negative arthropathies. Sero-negative is absence of? | Absence of rheumatoid factor |
| Seronegative arthritis' include? | Ankylosing spondylitis Psoriatic arthritis Reactive arthritis (Reiter's syndrome) |
| Classification | Inflammatory spinal pain or Synovitis plus one or more of the following: Positive family history Inflammatory bowel disease Urethritis, cervicitis or acute diarrhoea (1 month before arthritis) Buttock pain alternating between right and left Enthesopathy Sacroiliitis |
| Ankylosing spondylitis Sites commonly involved in enthesitis? | Inflammation of the entheses and joints in the spine. Achilles tendon insertion • Insertion of the plantar fascia on the calcaneus • Insertion of the plantar fascia the metatarsal heads • Base of the fifth metatarsal head • Tibial tuberosity, • Superior and inferior poles of the patella • Iliac crest |
| Occurs predominantly in young? Around 90% of European caucasians with AS possess which gene? AS tends to occur in? The most likely trigger is? | Males HLA-B27 Families Infection |
| Symptoms | *Pain is due to sacroiliitis frequently experienced in the buttock or back of the thigh may result in erroneous diagnosis of sciatica *low-back pain that is worse at night, in the morning, or after inactivity • stiffness and limited motion in the low back • hip pain and stiffness • limited expansion of the chest • limited range of motion, especially involving spine and hips • joint pain and joint swelling in the shoulders, knees, and ankles • heel pain • chronic stooping to relieve symptoms • fatigue, fever, low grade, weight loss, loss of appetite • eye inflammation |
| Treatment - 9 | *Minimise postural deformity • Physiotherapy • Podiatry – achilles enthesitis, PF • Heat therapy/ postural awareness • Exercise - strengthening and stretching • Sleeping on firm mattress/periods of prone lying • Reduce pain - analgesics • DMARDs for peripheral arthritis rather than spine – e.g MTX, SLZ • Biologics, bisphosphonates |
| The foot in AS - sites involved? Implications for podiatrists? Management with? | Calcaneus and mid tarsal joint Lower back pain means that the patient is unable to bend and reach their feet. Heel pain - plantar and posterior Peripheral joint pain -limited manual dexterity. Corticosteroid injections for pain. and Foot orthoses. |
| Psoriatic arthritis The exact cause is unknown, although the trigger could be an ? Psoriasis usually precedes the arthritis. It commonly affects small joints of .................. and ................ It involves DIPJ AND PIPJ which give the toes a ? There are nail changes. | Arthritis associated with psoriasis. Infection. Hands and feet. Sausage like appearance |
| Diagnosis Swelling of ? Studies show that the arthritis occurs for the first time within a matter of months of the onset of the skin complaint in the majority of cases. | The absence of rheumatoid factor in the serum a single digit - dactylitis - can be toe or finger Enthesitis |
| PSA in the foot characterised by? Forefoot deformities? | – Enthesitis – Plantar fascia/AT – Skin/nail involvement Dactylitis – Hallux valgus – Lesser toes deformities – Telescoping digits |
| Management - drugs | NSAIDs • IA corticosteroids • DMARDs • Biologics • Physio • Podiatry- FO, treatment of PF, TA enthesitis, targeted injections |
| Reiter's syndrome usually follows? It's a triad of? Commonest cause of? | Triad of: arthritis, conjunctivitis, urethritis • Usually follows bacterial dysentry or sexual exposure • Commonest cause of inflammatory arthritis in young men • Leads to inflammatory arthritis affecting knees, ankles, or MTPs |
| Reiter’s clinical features 6 | *skin and nail lesions are characteristic • macules, vesicles or pustules – palms and soles • painless ulcerations of mouth and tongue, shallow penile ulcers • hyperkeratotic rash – sheds – leaves normal, unmarked skin • nails may have sub-ungual hyperkeratosis • calcaneal spurs may develop • D/D 1st MTPJ = gout or infection |
| Reactive arthritis is an .......................arthritis It usually follows a .....or......infection, so it is not caused by an active infection. A limited form of Reiter's syndrome Can also be caused by chlamydia | Aseptic GI or GU |
| The joints become inflamed because the immune system, when reacting to the infection somehow causes an inflammatory reaction in the? | Joint lining |
| Clinical features | *People with HLA-B27 gene have a greater chance of developing reactive arthritis. *Joint pain and swelling may be seen first in the knees and ankle may be 1st sign. – On X-ray fluffy calcaneal and TA spurs – Conjunctivitis – Scaly skin rashes over the hands or feet (keratoderma blennorrhagicum) – Other features are diarrhoea, mouth ulcers and inflammation of the genital tract. |
| Enteropathic arthritis is arthritis which may accompany ? | Irritable bowel syndrome |
| Summary of sero-negs | Group of conditions with overlapping clinical features • Absence of rheumatoid factor in serum • Genetic association with HLA B27 • Common presenting features in the feet of enthesitis, tendonitis, dactylitis • Various levels of deformity and disability present but all will impact on quality of life and ability to undertake ADL |
| Hypermobility may result from? | The shape of joints – Weak / stretched ligaments (differences in biochemical reactions, altered collagen fibres) – Reduced muscle tone – Decreased proprioception – Rare inherited conditions - osteogenesis imperfecta, Marfan syndrome and EhlersDanlos syndrome. |
| Hypermobility in the lower limb | the lower limb • If hypermobility related to collagen, hernias, varicose veins more common • Flat foot, arch pain, • Recurrent ankle sprains • Muscle tenderness, tendonitis • Dislocations • Early OA changes |
| Scleroderma is a connective tissue disease. It mainly affects........... It may be triggered by? | Women Chemicals |
| Scleroderma results in ? It is an ...............condition. | in hard, thickened areas of skin and sometimes problems with internal organs and blood vessel. Scleroderma is an autoimmune condition, which means the body attacks its own tissues. In the case of scleroderma, the connective tissue underneath the skin and surrounding internal organs and vessels is affected. This causes scarring and thickening of the tissue in these areas. |
| What phenomenon is seen in 90-95% of patients? There is diffuse...................of hands and feet (non-pitting oedema) Ulceration is common. | Raynaud's Puffiness |
| 3 main groups | • Limited (CREST) • Diffuse • Morphea |
| Limited (CREST) | Limited (CREST) – Long history of Raynauds – Face, arms and legs |
| Diffuse | – Diagnosis with Raynauds or just prior to SSc diagnosis – Internal involvement |
| Morphea | Morphea – Patches – Usually seen in children |
| Systemic lupus | Systemic lupus is a chronic and presently-incurable illness of the immune system, a condition in which the body's defence mechanism begins to attack itself through an excess of antibodies in the blood stream causing inflammation and damage in the joints, muscles and other organs. |
| Symptoms | Raynaud’s phenomenon (80% patients), numbness, tingling, colour changes • Vasculitis, ulceration, necrosis, gangrene • Skin rashes, uticaria |
| Vasculitis | Vasculitis means inflammation of the blood vessels. It can affect any of the body’s blood vessels, causing a variety of symptoms and potential complications. Inflammation causes swelling of the blood vessel walls, reducing or even blocking the flow of blood to tissues and organs. The amount of damage vasculitis causes depends on which part of the body is affected. The larger the affected blood vessels, the more damage there may be. And the more important the affected body tissue, the more serious the damage will be. The walls of affected blood vessels can swell and bulge (this is called an aneurysm) and may even burst, causing bleeding inside your body. Apart from the damage to the blood vessel itself, this can lead to damage in the tissues or organs that are supplied by the blood vessel. - |
| Occurs as feature of? | SLE AND RA |
| Osteoarthritis | Osteoarthritis is a condition that affects your joints. The surfaces within your joints become damaged so the joint doesn’t move as smoothly as it should (see Figures 1 and 2). The condition is sometimes called arthrosis or osteoarthrosis. Older terms are degenerative joint disease or wear and tear. When a joint develops osteoarthritis, some of the cartilage covering the ends of the bones gradually roughens and becomes thin, and the bone underneath thickens. All the tissues within the joint become more active than normal – as if your body is trying to repair the damage: The bone at the edge of your joint grows outwards, forming bony spurs called osteophytes. The synovium (the inner layer of the joint capsule which produces synovial fluid) may thicken and make extra fluid. This causes your joint to swell. The capsule and ligaments (tough bands that hold the joint together) slowly thicken and contract as if they were trying to make your joint more stable. |
| Symptoms | *Pain – The pain tends to be worse when you move your joint or at the end of the day. If you have severe osteoarthritis, you may feel pain more often. *Stiffness – Your joints may feel stiff after rest, but this usually wears off as you get moving. A grating or grinding sensation (crepitus) – Your joint may creak or crunch as you move. *Swelling – The swelling may be hard (caused by osteophytes) or soft (caused by synovial thickening and extra fluid), and the muscles around your joint may look thin or wasted. *Not being able to use your joint normally – Your joint may not move as freely or as far as normal. |
| Management | Education, physiotherapy, occupational therapy. Analgesics, NSAIDs Capsaicin, Steroid injections, |
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