Name 1 degenerative arthritis.
Name 3 inflammatory arthritides
Name 2 infective arthritides
- osteoarthritis
- Rheumatoid arthritis, seronegative spondyloarthropathies, crystal arthropathy
- Septic arthritis, osteomyelitis
Give 4 risk factors for primary osteoarthritis
Primary: obesity, occupation, age, female gender
Primary is wear and tear
Give 4 aetiologies of secondary osteoarthritis
- Inflammatory arthritides
- Metabolic conditions- haemochromatosis, Wilson’s disease
- Trauma
- Deformity- developmental dysplasia of the hip
Secondary is pre-existing joint abnormality
Give 4 features of the presentation of osteoarthritis.
What 2 types of joints does it affect
Give two signs in the hands of osteoarthritis.
- Pain worse at end of day
- joint stiffness, especially after inactivity
- Joint crepitus
- Restricted activity.
Affects asymmetrically
- Weight bearing joints- hip and knee.
- Heavy use joints- DIP, PIP, 1st CMC, wrist
Heberden’s nodes (DIP), Bouchard’s nodes (PIP).
Give 4 x-ray findings of osteoarthritis.
Give 2 joint aspirate findings of osteoarthritis.
Osteoarthritis X-ray is LOSS
- Loss of joint space
- Osteophytes
- Subchondral sclerosis
- Subchondral cysts.
Joint aspirate:
- Straw coloured fluid
- Increased viscosity
What is the definition of rheumatoid arthritis.
What two characteristics does it have?
- Chronic (>6 weeks) systemic inflammatory disease.
- Characterised by symmetrical deforming polyarthritis and extra-articular manifestations.
Give 2 risk factors for rheumatoid arthritis.
What is the ratio of male to female?
- HLA DR4 mutation
- Smoking
1:2 male:female
Give 3 presenting features of rheumatoid arthritis.
Which joints are affected?
- Pain worse at start of day
- Joint stiffness for >1hr in morning
- Restricted activity.
Joints affect symmetrically
- Small joints of hand (PIP, MCP, wrist) but NOT DIP
- Other joints: hip, knee, shoulders
Give 5 signs in hands of rheumatoid arthritis
- Wrist- radial deviation
- MCP: Ulnar deviation of fingers, Z-deformity of thumb
- PIP/ DIP: Boutonniere deformity, Swan neck deformity
- Give 2 signs of synovial inflammation in rheumatoid arthritis.
- Give 3 extra-articular features of rheumatoid arthritis
- Give 3 systemic symptoms of rheumatoid arthritis.
Synovial: tenosynovitis, bursitis
Extra-articular: rheumatoid nodules, lymphadenopathy, Felty syndrome: (splenomegaly, neutropenia, anaemia of chronic disease).
Systemic: fever, weight loss, fatigue
Give 3 blood test results reflecting rheumatoid arthritis.
Give 2 antibodies found in rheumatoid arthritis.
Give 4 X-Ray findings in rheumatoid arthritis.
- Anaemia of chronic disease, raised ESR/ CRP, low albumin.
- Rheumatoid factor (IgM against IgG).
- Anti- CCP- most specific.
- uniform joint space narrowing
- Juxta-articular osteopenia
- Joint erosions at joint margins
- Joint deformity and destruction
What is deposited in primary amyloidosis?
- Which conditions is it associated with?
What is deposited in secondary amyloidosis?
- Which conditions is it associated with?
Primary amyloidosis: AL
- Deposition of immunoglobulin light chain.
- Associated with multiple myeloma, lymphoma, Waldenstron’s macroglobulinaemia.
Secondary: AA
- Deposition of serum amyloid A: acute phase protein.
- Associated with RA, IBD, Chronic infections
Give 6 features of presentation of amyloidosis.
- Nephrotic syndrome
- Hepatosplenomegaly
- Carpal tunnel syndrome + peripheral neuropathy
- Periorbital purpura
- Restrictive cardiomyopathy (AL)
- Macroglossia (AL)
How is protein deposition determined to be amyloid?
- Demonstrates Apple-green Birefringence under polarised light with Congo Red stain
List the 4 seronegative spondyloarthropathies
PEAR:
- Psoriatic arthritis
- Enteropathic arthritis
- Ankylosing spondylitis
- Reactive arthritis
List the 5 features of seronegative spondyloarthropathies
HEADS:
- HLA B27
- Enthesitis
- Asymmetrical oligoarthritis with axial involvement and extra-articular involvement
- Dactylitis
- Seronegative
More common in men
Which demographic is affected by ankylosing spondylitis?
Which joints are affected?
Describe the pain, stiffness and spinal movement in ankylosing spondylitis.
What is the characteristic posture?
Which test assess loss of lumbar flexion?
- Young men <40
- Spine (enthesitis) and sacroiliac joints (arthritis)
- Gradual onset pain, morning stiffness
- Loss of spinal movement with eventual bone fusion- “bamboo spine”.
- Question mark posture: Loss of lordosis, kyphosis, neck hyperextension.
- Schober’s test
Give the AAA of extra-articular features of ankylosing spondylitis.
- Anterior uveitis
- Apical lung fibrosis
- Aortic regurgitation
What is the most sensitive investigation for ankylosing spondylitis?
What does a late stage X-Ray show in ankylosing spondylitis?
- MRI
- Syndesmophytes and bamboo spine.
When does reactive arthritis occur?
Give 2 GU and 2 GI infections causing reactive arthritis.
- sterile inflammation 2 weeks after extra-articular infection
- Chlamydia, gonorrhoea; shigella, campylobacter
Give 3 presenting features of reactive arthritis
- Arthritis: asymmetrical, oligoarthritis of lower limbs & spondylitis
- Enthesitis: Dactylitis, achilles tendonitis, plantar fasciitis
- Reiter’s syndrome: conjunctivitis, urethritis, arthritis: “can’t see, can’t pee, can’t climb a tree).
What are the two common causative organisms of septic arthritis?
Give 2 risk factors for septic arthritis.
- Staph. Aureus, Neisseria Gonnorhoea- usually haematogenous spread.
- Joint damage: RA, prosthetic joint, gout.
- Infection risk: immunosuppression, diabetes, IVDU.
Give 4 presenting features of septic arthritis.
Acute monoarthritis, usually affecting the knee.
- Exquisite pain
- Redness and swelling
- Restricted ROM
- FEVER
Give 2 blood results in septic arthritis.
Give 3 features of joint aspirate (before ABx).
- Increased WCC, increased CRP
- Turbid, yellow
- Low viscosity
- Increased WCC- neutrophils >90%.
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Upper GI61
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Lower GI32
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Cardiac causes of SOB43
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Acute Resp18
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Acute abdomen41
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Breast25
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Cranial Nerves and Ophthalmology47
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Renal45
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Urology28
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Endo 145
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Arthritides30
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Resp 2: Chronic SOB36
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Causes of clubbing4
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Dermatology29
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Chest pain23
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Acute medicine19
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Infectious diseases 124
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Adrenals36
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Infectious diseases 228
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Anaemia29
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Valvular and HTN20
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Headaches23
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Autoimmune21
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Chronic Neuro29
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Biliary and liver disease21
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Haematology and Oncology25
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Calcium metabolism15
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Acute Neurology31
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Vascular25
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Cough (Resp. 3)19
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A. Sam 1-423
