Deck 2 Flashcards
Name 3 diseases related to Calcium pyrophosphate deposition
Acute CPP crystal arthritis (previously pseudogout), provoked by illness/surg/trau
Chronic CPD: inflammatory like RA, polyarthritis and synovitis
Osteoarthritis with CPPD
Risk factors for CPPD
Old age
Hyperparathyroidism
Haemochromatosis
Hypophosphataemia
Rx of CPPD
Polarised light microscopy
X-ray
RICE
Aspiration
Intra-articular steroids
NSAIDs +/- colchicine
Ankylosing Spondylitis typical presentation
<30yo male with gradual onset of back pain, worse at night, relieved by exercise, morning stiffness
Progressive loss of spinal movement, thus decreased thoracic expansion
Enthesitis: inflammation of a site of insertion (plantar fasciitis, achilles tendonitis)
Acute iritis – leads to blindness
Tests for Ankylosing Spondylitis
FBC + ESR + CRP
HLA B27+ve
X-rays: sclerosis, erosions
Calcifications of ligaments
Management for Ankylosing spondylitis
Exercise (intense regiments) Maintain posture and mobility NSAIDs remove pain in 48h TNF-alpha blockers Local steroid injections Surgery: hip replacement
What is enteric arthropathy
IBD, GI bypass, coliac and whipple’s
Treat bowel symptoms (beware NSAIDs)
What is Psoriatic arthritis
Arthritis that presents before skin changes Can be both a/Symmetrical DIP joints Spinal X-ray: pencil in cup
Management of Psoriatic arthritis
NSAIDs Sulfasalazine Methotrexate Ciclosporin Anti-TNF agents
Reactive arthritis
Sterile arthritis affecting lower lib after urethritis or dysentery
Chronic or relapsing
Ass/w iritis, keratoderma blenorrhagica, circinate balanitis
Reiter’s syndrome: urethritis, arthritis, conjunctivitis
Tests for Reactive arthritis
ESR
CRP
Culture stool if diarrhoea
X-ray: enthesitis with periosteal reaction
Management of Reactive arthritis
Splint
NSAIDs or topical steroid injections
Sulfasalazine/methotrexate
Name 4 Spondyloarthritides
Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis
Enteric arthropathy
What are the shared features of spondyloarthropathies
Seronegativity (RF -ve) HLAB27 Axial arthritis Asymmetrical Enthesitis Dactylitis Extra-articular manifestation
Name 3 connective tissue diseases
Systemic sclerosis
- limited
- diffuse
Mixed connective tissue disease (combined ft of SS, SLE, polymyositis)
Relapsing polychondritis (attacks all cartilage)
Presentation of Limited Cutaneous systemic sclerosis
Rx
Calcinosis (subcut tissue) Raynaud’s Esophageal + gut dysmotility Sclerodactyly Telangectasia
Anti-centromere antibodies
Rx: sildanefil/bosentan
Presentation of Diffuse Cutaneous systemic sclerosis
Rx
Early organ fibrosis: lung, cardiac, GI, renal
Anti-topoisomerase-1 antibodies
Anti-RNA polymerase
Rx: Nil
Name 5 Dermatomyositis features
Macular rash Lilac-purple heliotrope with oedema Nailfold erythema Gottron’s papules Subcut calcifications
Tests of Polymyositis and dermatomyositis
Plasma Muscle enzymes: ALT, AST, LDH, CK, Aldolase
MRI
Autoantibodiy associations: anti-Mi2, Anti-Jo1
How does SLE present
Variable presentation with malaise, fatigue, myalgia, fever
Lymphadenopathy, wt loss, alopecia, nail-fold infarcts, non-infective endocarditis, Raynaud’s migrain, stroke
Can be drug induced
Ass/w Antiphospholipid syndrome
Diagnosis for SLE
Anti-dsDNA antibody
Complement C3 and C4
ESR
Malar rash Discoid rash Photosensitivity Oral ulcers Non-erosive arthritis Serositis Renal disorder CNS disorder Hameatological disorder Immunological disorder Antinuclear antibody (ANA) +ve
Rx for SLE
Acute? Cyclophosphamide + high dose prednisolone
Cutaneous? Topical steroids
Maintenance: NSAIDs, hydroxychloroquine, azathioprine
Interferon A
Antiphospholipid syndrome present with…. CLOTS
Coagulation defect
Livedo reticularis
Obstetric (recurrent miscarriage)
Thrombocytopenia
Presentation of vasculitis
Overwhelming fatigue
Inc ESR/CRP
Systemic – skin – eyes
ENT – Pulmonary - Cardiac
GI – Renal – Neurological
GU
Classification of Vasculitis
Large: Giant cell arteritis, Takayasu’s arteritis Medium: polyarteritis nodosa, Kawasaki Small - ANCA +ve: resp tract + kidneys - ANCA -ve: Henclock Schonlein purpura
Presentation of Polyarteritis nodosa
Aneurysms, thrombosis Severe systemic symp Ass/w hep B Skin (rash/punched out ulcers) Renal – Cardiac – GI – GU
Inv For Polyarteritis nodosa
Inc WCC Mild eosinophilia Anaemia Inc ESR Inc CRP ANCA -ve
Rx for polyarteritis nodosa
Control BP
Corticosteroids, Cyclophosphamide
Features of Fibromyalgia
Chronic pain which is widespread with normal investigation results. Requires Cognitive behavioural therapy, exercise programs, low-dose antidepressants and pregabalin.
Name 8 amount of skin manifestations of systemic diseases
Erythemia nodosum (crohns) Erythema multiforme Erythema migrans Erythema marginatum Pyoderma gangrenosum (Crohns) Vitiligo Dermatitis herpetiformis (coeliac – gluten-sensitive enteropathy – Rx: dapsone) Pretibial myxoedema (Hyperthyroidism)
