Rheumatoid Arthritis, Spondyloarthropathies and septic arthritis

Clinical feature of axial joint involvement

Back pain, morning stiffness, reduced spine mobility, limited chest expansion

Clinical feature of peripheral joint involvement

Pain, swelling, decreased range of motion

Inflammatory arthritis sign

Warmth + swelling + morning stiffness; synovial inflammation

Non inflammatory arthritis sign

Pain worsens with activity, cartilage degeneration or mechanical factor

RA Pathophysiology

Autoimmune RF and ACPA → Inflammatory cascade → Synovial proliferation _> Pannus formation (synovial invasion of cartilage and bone) → Joint destroyed

Classic Joint deformities

Swan neck, Boutonniere, Ulnar deviation of finger

Swan neck deformity

PIP hyperextension, DIP flexion

Boutonniere deformity

PIP flexion, DIP hyperextension

Associated RA conditions

Felty, secondary amyloidosis

Felty syndrome

RA + pretibial ulcer + splenomegaly + neutropenia

onychodystrophy (Psoriatic Arthritis)

dactylitis (Psoriatic Arthritis)

Nonexistent joint seen in X ray

Pencil in cup deformities (Psoriatic Arthritis)

Pathophysiology of reactive arthritis

Triggering infection (Chylamydia, Salmonella, Shigella, Yersinia, Campylobacter);, HLA-B27 positive (30-50%), molecular mimicry, inflammatory cascade

Psoriatic arthritis classic triad

Can’t see, can’t pee, can’t climb a tree; conjunctivitis/uveitis + urethritis + arthritis

On pressure points

Rheumatoid nodule

Association of rheumatoid nodule

SeroPOSITIVE (RF and anti-CCP)

What are some spondyloarthropathies

Ankylosing spondylitis, psoriatic arthritis, reactive arthritis

Ankylosing spondylitis

Anterior uveitis, Chronic lower inflammatory back pain

Diag of Ankylosing spondylitis

HLA-B27 POSITIVE, Sacroiliitis, syndesmophytes, BAMBOO SPINE

Keratoderma blennorhagicum of Reactive Arthritis/Reiter Syndrome

Circinate balanitis of Reactive Arthritis/Reiter Syndrome

Characteristic finding of ankylosing spondylitis

Bamboo spine

Characteristic finding of psoriatic arthritis

Dactylitis, nail change, psoriatic plaque

Characteristic finding of reactive arthritis

Keratoderma blennorhagicum, circinate balanitis, urethritis