amk day Flashcards
RA leads to inflation of the synovium and affects women more.
what are the features
swollen painful joints in hands and fit
stiffer in the morning -due to cortisol levels as higher in the morning so reflects progression of stiffening - cortisol glucticocord ( management)
ulnar deviation
swan neck deformity - DIP flexion and PIP hyperextension
boutonniere deformity ( PIP flexion and DIP hyperextension)
PIP and MCP swelling and DIP sparing
what finger joints does RA affect
PIP and MCP
investigations for RA
Rheumatoid factor - can be found in other though
Anti-CCP - detected 10 years before
x-rays of hands and feet
diagnosis made off one joint with an ifnammed synovitis
use DAS28 score specific for rheumatoid arhtiris
scoring system for RA
DAS28
what do you treat fro RA
DMARDs
methotrexate
also use prednisone
and TNF inhibitors as a biologic if no response to DMARD
methotrexate problems
antifolaxe - need to give folate acid
myelosuppreion
how to monitor RA and what for flair ups
DAS28 and CRP
corticosteriods
OA is a disorder fo synovial joint due to excessive stress and loading - gradual loss of cartilage
what are the features
pain worse on movement and better at the end of day
improved with rest
morning stiffness not prolonged - major diffence with RA
muscle wasting
nodules on PIP and DIP
c-ray features -LOSS loss of joint space osteophytes subchrnial cysts subchrodral sclerosis
investigate OA
xray - LOSS
manaagmetn of OA
los weight if big
1st line is NSAIDs and paracetamol
then cox-2 inhibitors if not working
psoriatic arthritis is an infalmmotry arthritis with psoriasis features are
symmetric poly arthritis
psoriatic lesion - itchy
DIP involvement - (again not rheumatoid )
ifnalmmtion of insertion point of tendons and ligaments)
dactyltiis - sausage fingers
nail changes - pitting , onycholysis( elevation of the nail) and nail colour and ridges
pencil in cup appearance - serve
how do you management PA
DMARD plus a steroid
pain relief
reactive arthritiss is a HLA-B27 seronegative onset with other infection such as
STI and gastroenteritis
classi triad of symptoms
urethritis
conjuctivitis
arthriits
can’t see can’t pee can climb a tree
treat with pain relief and if persists DMARD
septic arthritis is infection of synvoium most common organism
staph aureus
features of septic arthritis
acute, inflamed, tender joint , reduced range of movement , systemically unwell
test for septic arthritis
join aspiration and blood tests
gout is a microcrystal synovitis caused by deposition of monosodium urate in the synvoium caused by hperuricaemia
RF
increased uric acid production - myeloprolfieration
cytoctociv drugs
severe psoriasis
what decrease uric acid excretion
diuretics
CKD
lead toxicity
features of gout
MTP generally affected pain swellign episdoes eryhtmea pockets of uric acid
X-ray looked punched off erosion appearance
joint space reduction
manaagmetn of gout
Nsadi or colchine
2nd - oral steroid
pseudo gout is caused by calcium pyrophosphate and affects the knee most commonly
what are the crystal shape
rhomboid
needle in gout
analysing spondylitis associated with what HLA
HLA-B27
features of ankylosing spondylitis
inflammatory back pain
affects sacroiliac joint
Achilles tendontisi
plantar fasciitis
extra articular features include anterior uveitis and pulmonary fibrosis
looked crouched and question mark back
bad posture
HLA-B27 associations
anterior uveitis - common eye problem
reactive arthritis
enteric arthipathy
sporadic arthtiris
management of AS
NSaids
DMard
local steriods
difference between dermatomyositis and polymyositis
dermatomyositis has skin involvement
what is myositis
inflammation of muscles and bilateral muscle weakness and myalgia and tenderness
systemic upset - fever
raynauds - vasospasm of arterioles decreasing blood flow to the skin - treated with CCB
interstitial lung disease
what antibodies indicate myositis
anti-jo1 and Mi2
creatine kinase
serum enzymes
Polymyalgia reumatica PMR
is inflammatory conditions only affecting over 50
features are
shoulder and hip girdle structures usually in morning
fever and weight loss
investigation include ESR and CRP and FBC and bone profile
management of PMR
steroids
- frax scan ( fracture risk for osteoporosis whilst using steroids)
screen for other complications of steroids such as diabetes and mental health
how to differeniate between myosotis and PMR
myositis - bilateral muscle weakness - patients struggle to move
PR - no muscle weakness - can still do tasks like vacuuming
giant cell arthritis is temporal arteritis - inflammation of vessel present with skip lesions
features
temporal headache jaw claudication monocular blindness thickened temporal artery scalp tenderness can also have signs of PMR
management of giant cell arteritis
high dose steroids to reduce risk of strokes and blindness
also give bsphosphoante and PPI -associated symptoms
enteropathic arthritis
if very specific gastro problems
umbrella term to describe various arthritis’s
how do you test for gout - most appropriate
joint aspiration
then microscopic analysis looking for uric acid crystals
myositis - what investigation would reveal this
muscle biopsy
what in examination is specific of psoriatic arthritis
onchlyosis
perthes disease is associated with a
painless limp
reactive arthritis commonly occurs after a
STI or gastro infection
septic arthritic patients are
reluctant
Slipped capital femoral epiphysis
obese
most common hip disorder in the adolescent age group. It occurs when weakness in the proximal femoral growth plate allows displacement of the capital femoral epiphysis. Weakness in the growth plate can be caused by a variety of factors, including stress on the growth plate due to obesity, and endocrine disorders such as panhypopituitarism, hypothyroidism, and renal osteodystrophy.
dermatomyositis what autoantibodies
antibodies against histidine-tRNA ligase (also called Jo-1)
antibodies to signal recognition particle (SRP)
anti-Mi-2 antibodies
