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
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
Osteoporosis score if on steroids
Treat if -1.5 or more BUT should treat immediately before DEXA score
SLE
Medication at risk of causing osteoporosis
taking 7.5mg prednisolone daily 3 months or longer
Key features Pagets disease
Old man, bone pain, raised ALP
Osteoporosis Monitoring
10y fracture risk reassessed after 5 years treatment with alondrenate
Taking Alondrenate
Take 30 mins before breakfast with plenty of water and sit upright for 30 mins
Monitoring on Leflunomide (DMARD)
FBC, LFT, blood pressure
Discoid Lupus Erthyrymateous
pathophys: 20-40yo
symptoms: lesions on face, ears, scalp that cause scarring alopecia
management: sun protection, topical steroids, steroid injections, hydroxychloroquine
Bone protection guidelines DEXA scans
- On steroids over 65 - treat
- On steroids under 65 - DEXA
- Fragility fracture + over 75 - treat
- Fragility fracture + under 75 - DEXA
- Frax assessment - for all women over 65 / men over 75 or younger patients (over 40) with risk factors
- Younger patients under 40 with major risk factors (prednisolone more 3 months)
Before bisphosphonates are started ___ must be corrected
Calcium
What antibiotic should not be prescribed with methotrexate? Why?
Trimethoprim
Bone marrow suppression
People with Schrogens have increased risk of ____
Lymphoma
Name of the nodes present in osteoarthritis?
Herbedens Nodes: DIP joints
Bouchards nodes: PIP joints
Methotrexate Monitoring
FBC, U&E, LFT
Raloxifene increases risk of… so is contra indicated in…
Thromboembolism … history of VT
Medication at risk of causing pulmonary fibrosis:
Methotrexate
How long to wait to conceive coming off leflunomide
2 years
leflunoMIDE = thalidIMIDE
Enthesitis
Inflammation of enthesis (where ligament attaches to bone)
myosotis
Cause
Types
Inflammation in muscles. Caused by virus. Polymyositis and dermatomyositis
Extra articular manifestations of spondyloarthropathy
Psoriasis, inflammatory eye disease, dactylitis, plantar fasciitis, colitis
