Common Rheumatological Conditions Flashcards
Sjögrens Syndrome
Pathophys,symtoms,investigations,management
Pathophys: exocrine glands affected
Symptoms: dry mucosal surfaces, arthralgia, raynauds, parotitis, sensory polyneuropathy
Investigations: RF>50%, ANA positive 70%, Anti-RO 70%,Anti-LA,shrimer
Management: artificial tears and saliva, pilocarpine
Gout
Pathophys
Symptoms
Investigations
Management
Pathophysiology: form of inflammatory arthritis,HIGHURicacidCausesuratecrystaldepositsinjoint
Symptoms: episodes of significant pain, swelling, erythema common in wrist, ankle and knee
Investigations: synovial fluid analysis for monosodium nitrate crystals, uric acid after episode has settles, radiology for joint effusion and erosions
Management:
1st line: NSAIDS (max dose 1-2 days) or colchicine
If contraindicated: steroid (prednisolone) 15mg
Long term uric acid control: allopurinol
Reynauds Treatment
Nifedpinine: calcium channel blocker for vasodilation
Differentiation of psoriatic arthritis to rheumatoid arthritis
Asymmetrical joints affected in psoriatic arthritis
Ankylosing Spondylitis
Pathophys: HLA-B27 associated spondyloarthropathy in males aged 20-30
Symptoms: pain at night and stiffness in morning that improves with exercise. Reduced lateral and forward flexion, reduced chest expansion
Management: NSAIDs,steroicsduringflares,Anti-TNF
Rheumatoid Arthritis
Symptoms, Investigations, Management, Monitoring
Symptoms: swollen, painful joints in hands / feet in morning develops over a few months, positive squeeze test
Investigations: RF in 70-80%
Management:
Long term - DMARD (methotrexate) +/- prednisolone
Flares - corticosteroid
Monitoring: CRP
Xray changes in osteoarthritis
LOSS
Loss of joint space
Osteophytes at joint margins
Subchondral sclerosis
Subchondral cysts
Osteoarthritis vs Rheumatoid arthritis
Rheumatoid: all ages, stiff in morning improves with use, autoimmune, MCP and PIP joints, bilateral symptoms, systemic
Osteoarthritis: elderly, more painful with use, wear and tear, small and large joints, unilateral symptoms
Reactive arthritis
Pathphys
Symptoms
Management
Pathophys: arthritis following an infection
Symptoms: develops 4 weeks after initial infection, recurrent episodes or chronic disease can follow. Utheritis, conjunctivitis, arthritis (see, pee or climb tree), keratoderma blenorrhagica
Management: NSAIDs, steroids
Osteoporosis treatment
- vitamin D and calcium supplementation and oral bisphosphonate (alendronate)
- alendronate not tolerated in 25%, switch to risedronate
Polymyalgia Rheumatica
Pathophys, Symptoms, Investigations, Management
Pathophys: muscle stiffness and raised inflammatory markers in elderly
Symptoms: rapid onset aching morning stiffness in proximal limb muscles, lethargy, depression,shoulderpainpevlicgirdlepainpresentforatleastweeks
Investigations: raised inflammatory markers ESR>40mm/hr. NORMAL creatine kinase
Management: prednisolone 15mg should respond DRAMATICALLY
Alondrenate side effects ACHOO
Atypical stress fracture
Hypocalceamia
aCute phase response: fever
Oesophageal reactions (GORD)
Osteonecrosis of jaw
Osteoarthritis management
Lifestyle advice: weight loss and muscle strengthening
1st line: paracetamol and topical NSAIDs
2nd line: oral NSAIDs/COX-2 inhibitors, opioids, capsaicin cream and intra-articular corticosteroids. A proton pump inhibitor should be co-prescribed with NSAIDs and COX-2
What medication can cause Gout flare up
Thiazide like diuretic
Osteomalacia
pathophys,symptoms,invest,management
Pathophys: vitamin D deficiency, CKD, anticonvulsants
Symptoms: bone pain, tenderness and proximal myopathy with WADDLING GAIT
Invest: low vit D, low calcium, raised ALP
Treatment: vit d supplement, calcium supplementation
