Flashcards
Arthritides
Flashcards do conjunto (39)
- 1What is osteoarthritis?Imbalance between breakdown and repair of articular cartilage
Result from mechanical stress (repeated trauma, obesity etc.) - 2Symptoms of osteoarthritis are...Insidious, aching, poorly localised pain
Worse with activity, better with rest
Hips, knees, spine, small hand/foot joints
Reduced motion, limp, crepitus
Bony enlargement (Heberden's/Bouchard's nodes), bowing/knock-knees
Joint swelling - 3Joint fluid for osteoarthritis?Non-inflammatory (WBC below 1500)
Yellow, clear fluid - 4X-rays for osteoarthritis show...FLOSS
Flattened bone
Loss of/narrowed joint spaces
Osteophytes (more joint 'contacts')
Subchondral cysts
Subchondral sclerosis - 5Treating osteoarthritis.Analgesia (para, NSAIDs)
Topical NSAIDs, capsaicin
IA injections (steroids, hyaluronic acid)
Surgery for specific joint if all non-operative options exhausted, impact QoL
Restriction of painful activities
Exercise, weight loss (even if painful)
Heat packs, TENS, functional aids
Physio for muscle strengthening, prevent falls - 6Process of treating osteoarthritis?1: holistic assessment of patient (with pain assessment, co-morbidities)
2: core (self treatment i.e. info, weight loss, exercise)
3: non pharmacological (heat packs, OT aids)
4: pharmacological
5: surgical - 7What is rheumatoid arthritis?Autoimmune disease attacking joint
Destruction of bone and cartilage
Inflamed synovium
Joint instability, loss of function
Chronic pain, poor function - 8Symptoms of rheumatoid arthritis?Morning stiffness, improves with activity
Affects more than three joints
Swelling of hand joints (PIP, MCP, not DIP)
Ulnar deviation/Boutonniere's deformity
Symmetrical swelling
Extra-articular features (anaemia, subcutaneous nodules, vasculitis, intersitial lung disease, sarcopenia) Sjogren's)
Persistent (over 6 weeks) - 9Joint fluid analysis for rheumatoid arthritis?Turbid yellow
Less than 50000 WBC, still high - 10Investigations for rheumatoid arthritis?Rheumatoid factor positive in more than 85%
Anti-CCP antibody positive in 75% - 11Imaging findings in rheumatoid arthritis?Soft tissue swelling
Erosions, deformity
Joint space narrowing
Periarticular osteopenia
(Bony changes all late stage) - 12Treating rheumatoid arthritisNSAIDs for symptoms
Disease modifying antirheumatic drugs e.g. methotrexate, (can't give in pregnancy), sulfasalazine
Biologics (TNF-alpha inhibitors e.g. entanercept, adalinumab. best combo with DMARD)
Corticosteroids (Oral, IM, IA)
Biologics can be used in pregnancy - 13What is gout?Inflammation of one or more joints due to deposition of uric acid crystals within joints or tissues
Most common inflammatory arthritis in men - 14Risk factors for gout?Obesity
Alcohol
Dietary purines
Chronic renal insufficiency - 15Symptoms of gout?Episodic acute joint pain (peak within 24h)
90% monoarticular
50% of polyarticular patients have 1st MTP joint affected
50% recurrence in a year
Precipitated by trauma, surgery, alcohol, infection
Associated with tophi (urate crystals deposited in soft tissues) - 16Joint fluid for gout?Crystals present=diagnostic
High WBC, above 50000, similar to septic - 17Investigations for gout?Joint aspiration; sodium urate crystals
Increased serum uric acid (may be normal serum but present in joint)
Blood culture to rule of septic arthritis - 18Gout findings on xray?Normally negative bar soft tissue swelling
Calcium in articular cartilage (chondrocalcinosis) pathognomic for pseudogout - 19Managing goutAcute: NSAIDs (not if MI, GI bleed), colchicine (dysuria, often used sparingly e.g. twice a day instead of three or four), steroids (must ensure not septic)
Prophylaxis: allopurinol, uricosuric agents, canakinumab (start after flare, use with acute drugs)
Address lifestyle factors - 20What is septic arthritis?Acute arthritis due to infection, normally bacterial, from haematogenous seeding (travel in blood)
Unusual organisms and site seen in IVDUs
Older, previous joint pathology, skin infection, DM predisposes to SA - 21Symptoms of septic arthritisAbrupt onset of joint swelling and pain
50% will occur in knee
Sternoclavicular joint in IVDU
Fever in almost two thirds
Inflammation and pain in active and passive range of movement - 22Joint fluid in septic arthritisStaph aureus most common
Pseudomonas in IVDU
Very high WCC: above 50000, virtually diagnostic if 100000 - 23Investigating septic arthritisIncreased WCC
Increased sedimentation rate
Increased CRP - 24Imaging of septic arthritisUsually negative
Soft tissue swelling - 25What is seronegative arthritis?Inflammatory arthritis without the presence of rheumatoid factor in blood
Covers ankylosing spondylitis, psoriatic arthritis, IBD-linked arthritis, reactive arthrtis and others
AKA spondyloarthritis (as it usually presents with back pain, peripheral arthritis of skin, arms, legs, eyes, gut) - 26What is spondylitis vs spondylosis?Spondylitis is inflammation affecting the vertebrae, and one or more vertebral joints
Spondylosis is the degeneration of the intervertebral discs - 27How does spondyloarthritis present?Multisystem disease
Involves axial skeleton: sacroiliitis, loss of spine curvature, fixed flexion of hips/knees as a result)
Enthesitis (inflamed entheses; where tendons and ligaments insert, leading to secondary synovitis)
Dactylitis (enthesitis plus synovitis of whole digit 'sausage digit')
Extra-articular features - 28What is ankylosing spondylitis?Type of seronegative/spondyloarthritis affecting axial skeleton and entheses along with peripheral joints
Can affect extraarticular areas such as IBD, uveitis (overlaps with IBD-related, psoriatic) - 29Treating ankylosing spondylitisPhysiotherapy
NSAIDs (not long term, as ulcers and bleeding)
DMARDs (sulfasalazine)
Biologics (anti TNF e.g. infliximab, etanercept)
Osteoporosis treatment if needed (do a DEXA, including joint replacement/fusion) - 30What is psoriatic arthritis?Inflammatory arthritis that primarily affects the skin and joints
Can affect axial skeleton (overlap with AS)
Lots of subtypes: spectrum with RA and AS - 31Symptoms of ankylosing spondylitisInflammatory back pain
Bilateral sacroiliitis
High CRP
More common in men, younger people
Predominantly affects axial skeleton - 32Symptoms of psoriatic arthritisAssociated psoriatic skin and nail changes (plaques, pitting, onycholysis)
Early morning stiffness of joints
Enthesitis
Dactylitis
Can differentiate from RA by involvement of DIP joints in 50% - 33Treating psoriatic arthritisPhysiotherapy
Occupational therapy for functional aids
DMARDs (su;lfasalazine, methotrexate)
Biologics (anti TNF)
Steroids (few IA injections per year if monoarthritis)
NSAIDs - 34What is reactive arthritis?Sterile inflammation after an infection elsewhere in the body
Infection doesn't enter joint capsule - 35Symptoms of reactive arthritis?Salmonella, shigella,, campylobacter, chlamydia, borrelia, neiserria, strep
Systemic disease
Mono/oligorthritis
Dactylitis and enthesitis
Affects skin and mucus membranes - 36Treating reactive arthritisNSAIDs
IA steroids
Antibiotics if chlamydia (high acute recurrence rate)
NSAIDs and DMARDs if chronic - 37Drugs exacerbating gout?Bendroflumethazide (thiazide diuretic, treats oedema and hypertension)
Inhibits sodium reabsorption at start of DCT - 38What is pseudogout?Type of crystal arthritis
Calcium pyrophosphate instead of sodium urate crystals present in joint
Affects knees instead of toes
Elderly women over men
Usually intercurrent illness or trauma
NOT associated with tophi (uric acid) - 39Treating pseudogoutNSAIDs
IA steroids during acute attack
Very unlikely to reoccur therefore no need for prophylaxis
Physiotherapy
Manage risk factors
Informações
- Descrição
- MSK FlashCards sobre Arthritides, criado por Phoebe Williams em 18-02-2020.
- Criado por
- Phoebe Williams
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