Autoimmune and Systemic MSK Conditions Flashcards
What is Polymyalgia Rheumatica?
This is essentially a systemic vasculitis owing to inflammation of the vessels
What type of arthritis is it?
Giant Cell arteritis
What is the prevalence of this disease?
This affects mainly the over 50’s with a F:M of 2:1
What is the classical presentation of the disease?
Sudden onset of severe pain and stiffness in the morning lasting longer than 45 minutes usually affecting the shoulder, hips and lumbar spine
What HALLMARK symptom do the NOT show?
No weakness
What systemic symptoms do people with PR have?
Tiredness Apetite loss Weight loss Depression Fever Malaise Noctuanl sweats
What are the main investigations of PR?
Raised ESR and CRP
FBC shows anaemia
temporal artery biopsy
CK is normal as the differential is myopathy
What is the main management of PR?
Corticosteroids = prednisone
What is giant cell arteritis ?
This is a granulomatous inflammation of the superficial femoral or occipital arteries
How does a person present with GCA?
Headache over one area Pain in the same area Tenderness Jaw claudication Painless temporary loss of vision
What is the diagnostic test for GCA?
Temporal artery biopsy
What is the treatment for GCS?
Start ASAP on prednisone to prevent blindness
Step dow the steroids within 2 years
What does SLE stand for?
Systemic lupus erythematous
What is SLE and what are the 4 key features of the disease?
This is a systemic chronic autoimmune condition which shows 4 key factors:
- Inflammation
- Fibrosis and scarring
- Vasospasm
- Vascualar thrombosis
Who tends to present with SLE?
women of reproductive age
What are the causes of SLE?
Genetics
UV light
Premenopausal
What are the 11 criteria of SLE?
How many do you need to have to have the condition?
Mary Macular Rash Did Discoid rash Pass Photosensitivity Over Oral ulcers All Arthritis Somewhat Serositis Risky Renal issues Now Neuro - psychiatric/ seizures Having Haematological = low platelets, WCC anaemia Incredible Immunology Adventures ANA+
What are the key investigations in SLE?
ANA testing Urine dip FBC Immunological testing Anti-dsSNA
What is the management of SLE?
Flare = IV prednisolone and cyclophosphamide Skin issues with topic steroids Maintenance with NSAID's Immunosupressnats Biologica Check renal function
What is systemic sclerosis otherwise known as?
Scleroderma
What is scleroderma?
This is a chronic multi-system disorder that is autoimmune has family links
What are the 5 clinical features of Scleroderma?
Calcinosis Reynauds Esophageal dysmotility SSkin thickening Telangiectasia
What re some of the associated features of scleroderma?
Mouth ulcers Dry eyes Dry mouth Hair loss Ulcers
What are the key investigations in scleroderma?
Autoantibodies - ANA
Anti-centromere antibodies
Anti - SCL - antibodies
What is the management?
Very much dependant on the type of symptoms Asprin, CCB Topicals Ulcer care Coticosteroids PPI, ACEi
What is Sjorgen’s syndrome?
This is an autoimmune condition causing fibrosis and infiltration of the exocrine glands causing lack of lacrimal and salivary secretions
What are the diagnostic features?
In the absence of RA, dry eyes is diagnostic, especially in females
What are some of the features of SS?
Dry eyes, mouth and vagina Parotid gland enlargement Athralgia Reynauds Dysphagia Pulmaory fibrosis
What test are you going to do in SS?
Schirmer test = filter paper under eyelid
Sjorgen autoantibody
What is the treatment of Sjorgens?
Artificial tears
Hydroxychoroquine
What is Dermato/polymyositis
this is a rare disorder of unknown cause which caused inflammation of the striated muscle causing proximal muscle weakness
What are the 4 clinical features?
Skin itching
Muscle weakness
Dysphagia
Athralgia
What are the diagnostic tests?
Serum CK increase
EMG
Muscle biopsy
What are you going to do for them?
Prednisolone IV
Suncream
