capsule notes - go over later Flashcards
psuedogout vs gout
Definitive identification of crystals is made using polarized light microscopy of aspirated joint fluid. Uric acid crystals are often intra-cellular and appear needle-shaped and yellow (negatively birefringent) while CPPD crystals appear rhomboid shaped and blue (weakly positively birefringent).
gout - affect toes and ankles
psuedogout - affects knees and wrist
usually.
Treatment
NSIADS
colchicine
Corticosteriods
The British Society of Rheumatology (BSR) recommend joint aspiration and injection of corticosteroid as a highly effective treatment of acute monoarticular gout and state that it may be the treatment of choice in people with acute illness and co-morbidity [Hui, 2017].
The BSR recommend that a short course of oral corticosteroid or single injection of intramuscular corticosteroid can be used in people unable to tolerate NSAIDs or colchicine and where intra-articular injection is not feasible [Hui, 2017].
Following used when acute gout episode has been solved.
Allopurinol -
is used long-term to reduce serum urate but is not used acutely as it may precipitate gouty attacks.
febuxostat
- as an alternative second-line therapy if allopurinol is not tolerated or is contraindicated (for example if renal impairment prevents adequate allopurinol dose increases).
(Hypersensitivty to allopuriol may indicate hypersenitivity to febuxostat )
polymyositis
inflammatory condition - affect both sides of body.
Immune system attacks healthy tissue
Muscle weakness
SYMPTOMS
o muscle weakness
aching or painful muscles
o feeling very tired
finding it hard to sit up, or stand after a fall
o swallowing problems, or finding it hard to hold your head up
feeling unhappy or depressed
Having this condition can make it difficult to climb stairs, rise from a seated position, lift objects or reach overhead.
poly - affects many muscles
your hips, thighs, shoulders, upper arms and neck.
Dermatomyositis, which affects several muscles and causes a rash. It’s more common in women and can also affect children (juvenile dermatomyositis).
red, purple or dark rash often appears. It is usually on the face (eyelids, nose and cheeks), and hands (knuckles). It can also sometimes be seen on the back, upper chest, elbows and knees.
Inclusion body myositis (IBM), which causes weakness in the thigh muscles, forearm muscles and the muscles below the knee. It may also cause problems with swallowing (dysphagia). IBM is more common in men and tends to affect people over 50.
Polymyotitis / dermamyotitis - all forms of myotitis
diagnosis
CK
The most sensitive and specific muscle-derived serum enzyme of disease activity.
Can be elevated as much as 50 times above normal, especially in polymyositis.
Can be normal in active dermatomyositis and rarely in active polymyositis.
Normal or only mildly elevated in inclusion body myositis.
(CK not useful for this condition )
polymyositis
inflammatory condition - affect both sides of body.
Immune system attacks healthy tissue
Muscle weakness
SYMPTOMS
o muscle weakness
aching or painful muscles
o feeling very tired
finding it hard to sit up, or stand after a fall
o swallowing problems, or finding it hard to hold your head up
feeling unhappy or depressed
Having this condition can make it difficult to climb stairs, rise from a seated position, lift objects or reach overhead.
poly - affects many muscles
your hips, thighs, shoulders, upper arms and neck.
Dermatomyositis, which affects several muscles and causes a rash. It’s more common in women and can also affect children (juvenile dermatomyositis).
red, purple or dark rash often appears. It is usually on the face (eyelids, nose and cheeks), and hands (knuckles). It can also sometimes be seen on the back, upper chest, elbows and knees.
Inclusion body myositis (IBM), which causes weakness in the thigh muscles, forearm muscles and the muscles below the knee. It may also cause problems with swallowing (dysphagia). IBM is more common in men and tends to affect people over 50.
Polymyotitis / dermamyotitis - all forms of myotitis
diagnosis
CK
The most sensitive and specific muscle-derived serum enzyme of disease activity.
Can be elevated as much as 50 times above normal, especially in polymyositis.
Can be normal in active dermatomyositis and rarely in active polymyositis.
Normal or only mildly elevated in inclusion body myositis.
(CK not useful for this condition )
Electromyography - yest electrical activity of muscle in response to nerve stimulation
small risk of ling collaspe - pneumothorax (when needle EMG is done on msucle along chest wall ) - air could leak into space bet muscle and lung
Needle EMG - needle elecrode inserted into muscle.
nerve condction studies - stickers electrodes paced on skin
