Connective Tissue Disorders SDL Flashcards
What do these pictures depict?
Raynaud’s
a) Define Raynaud’s syndrome
b) What are the 3 phases seen in Raynaud’s syndrome?
c) Name 3 secondary causes of Raynaud’s
a) Episodic peripheral ischaemia in response to cold or emotion
b)
- Pallor – due to vasoconstriction
- Blue – due to deoxygenation
- Red – hyperaemia due to reperfusion
c) Systemic sclerosis, SLE, Hypothyroidism, Occupational (vibrating tools)
How would you manage Raynaud’s?
Incl 2 Conservative and 2 Medical
Conservative
- Avoid cold
- Wear gloves and thick socks
- Use heat packs
- Stop smoking
Medical
- CCBs e.g nifedipine
- ACEi/ARBs e.g. losartan
- 2nd line - sildenafil
MDT: Wound care, analgesia, exclusion and management of 2o causes
List 4 Antibodies associated with SLE (Incl which are specific vs sensitive)
- 99% ANA positive
- 20% RF positive
- > 99% Anti-dsDN
- > 99% Anti-Smith
What changes may be seen to the following in SLE
- ESR and CRP
- Complement levels (C3, C4)
- Clotting
- ESR raised in acute flares of SLE. CRP normal, if raised think underlying infection
- Complement low during active disease
- Clotting - raised APTT
What is the ACR diagnostic criteria for SLE
(SOAP BRAIN MD)
Requires 4, one symptom must be clinical and one laboratory
- Serosisitis (pleurisy/pericarditis)
- Oral ulcers (apthous ulcers)
- Arthritis
- Photosensitivity
- Blood (anaemia, thrombocytopenia, leukopenia)
- Renal disease (lupus nephritis on biopsy)
- ANA +ve
- Immunologic (Anti dsDNA, antiphospholipid, anti smooth muscle antibodies and decrease C3/C4)
- Neurologic (psychosis, seizures)
- Malar rash
- Discoid lupus
List one way in which SLE may manifest in each system of the body
How would you manage acute flares of SLE?
- NSAIDS for pain and joint symptoms
- Hydroxychloroquine for pain and cutaneous manifestations
- Steroids - topical for rash, oral for serositis and constitutional upset, IV for CNS Lupus
- Cylosporin, Azathioprine, methotrexate, as steroid sparing agents (helpful in haematologic and renal disease)
- Low dose aspirin when pregnant
- Anticoagulation if APLS
- Symptomatic treatment of BP depression, seizures
A 60 year old female presents with aching around her shoulder and her hips. A GALS examination is performed
What are the 3 screening questions involved?
What are the 5 components?
Screening Questions
- Do you have any pain or stiffness in your muscle joints or back?
- Can you dress yourself completely with no difficulty?
- Are you able to walk up and down stairs without any difficulty?
Examination: Gait, Inspection (Head to Toe), Arms, Legs, Spine
What is Polymyalgia rheumatica
List 4 typical features on presentation
Condition characterised by pain, muscle stiffness and inflammation
- > 60 years old
- rapid onset (< 1 month)
- aching, morning stiffness in proximal limb muscles (shoulders, neck and hips)
- mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats
How would you manage Polymyalgia Rheumatica
Conservative vs Medical
Conservative
- Manage tasks and workload to start later in the day
Medical
- 15mg prednisolone until remission, then gradual reduction to lower maintenance dose (maintains remission)
- Osteoporosis prevention due to long term steroid use
- Analgesia as needed
MDT: Physiotherapy/ OT if needed
A patient with a diagnosis of PMR prestns to you with a right sided headache. She reports it is a sharp pain behind her right eye and her vision feels blurry. She has also been feeling nauseous with the headache.
What diagnosis would you like to rule out?
Giant cell arteritis (associated with/more common in PMR)
List 4 specific features to equire/ask about for suspected GCA
- Unilateral headache
- Pain on brushing hair
- Jaw claudication (pain on chewing)
- Sudden visual loss in one eye
List 4 Red flag symptoms for headache
