Disease profiles

Question 1

Who tends to present with ankylosing spondylitis?

Answer 1

Men more than women
Presents age 20-30

Question 2

What is the clinical presentation of ankylosing spondylitis?

Answer 2

Morning joint or back stiffness
Back or buttock pain that improves with activity
Back or joint pain at night which prompts waking
May have systemic features eg heart and eyes
‘Question mark’ posture
Positive Schober’s test

Question 3

What is the management of ankylosing spondylitis?

Answer 3

Conservative:
- Physio
- Exercise
NSAIDs
Corticosteroids
Other analgaesia
Consider biologics
Consider surgery

Question 4

Who tends to present with gout?

Answer 4

Men more than women
In women, usually post- or peri-menopausal
More common in Asians

Question 5

What are the risk factors for gout?

Answer 5

Genetic susceptibility
Overproduction or underexcretion of urate
Being male
Rich diet eg red meats, seafood, alcohol,
Associated with diabetes, heart disease and metabolic syndrome

Question 6

What is the clinical presentation of gout?

Answer 6

Acutely inflamed, hot, swollen joint that reached peak pain within 6-12 hours of onset
Most commonly affects the first MTP joint but may also affect knee
Gouty tophi

Question 7

What are the investigations and their results for gout?

Answer 7

Synovial fluid aspiration - shows negatively birefringent crystals with polarised light
Blood tests may show elevated urate
X-rays may show periarticular punched-out erosions

Question 8

What is the management of gout?

Answer 8

Maintain a healthy weight
Reduce red meat and seafood in diet
Restrict alcohol intake
NSAIDs
Colchicine
Consider steroids

Question 9

Who is typically affected by OA?

Answer 9

Older people

Question 10

What is the clinical presentation of OA?

Answer 10

Joint pain, swelling and stiffness that lasts less than 30 mins in a morning
Hip OA pain may be referred as knee pain or antero-medial groin pain
Pain worse with activity and better with rest
May have bony abnormalities eg Heberden’s and Bouchard’s nodes

Question 11

Which joints are most commonly affected in OA?

Answer 11

Knees, hips, PIPs, DIPs and carpometacarpal joint of thumb

Question 12

What is the difference between Heberden’s and Bouchard’s nodes?

Answer 12

Bouchard’s nodes affect the PIPs and Heberden’s nodes affect the DIPs

Question 13

What are the features of OA on x-ray?

Answer 13

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

Question 14

What is the management of OA?

Answer 14

Physio
Analgaesia
Consider surgery

Question 15

Which HLA is associated with rheumatoid arthritis?

Answer 15

HLA-DR

Question 16

Which HLA is associated with reactive arthritis, psoriatic arthritis, AS and inflammatory bowel disease?

Answer 16

HLA-B27

Question 17

What are the risk factors for sarcoidosis?

Answer 17

Afro-caribbean or scandinavian descent

Question 18

What is the clinical presentation of sarcoidosis?

Answer 18

Age 20-40
Flu like illness
May be pyrexial
Pulmonary symptoms most common
Dry cough
Dyspnoea
Cutaneous changes eg erythema nodosum and maculopapular rash
Associated with lyme disease
Dry eyes
Anterior uveitis
Hypercalcaemia features

Question 19

What are the investigations if sarcoidosis is suspected?

Answer 19

CXR
Blood tests
Spirometry
Tuberculin skin test (should be negative in sarcoidosis)

Question 20

What is the treatment of sarcoidosis?

Answer 20

Observe if early
Later stages - oral or inhaled corticosteroids
Consider topical corticosteroids

Question 21

What are the risk factors for osteomalacia?

Answer 21

Vit D deficiency
Disorders of phosphate wasting
Type 2 renal tubular acidosis
Excessive use of mineralisation inhibitors (biphosphonates)

Question 22

What are the clinical features of osteomalacia?

Answer 22

Bone pain and tenderness (especially in long bones or pelvis)
Muscle weakness (usually proximal)
Fractures with little or no trauma
Poor mobility and impaird gait
Signs of hypocalcaemia
May be asymptomatic

Question 23

What are the investigations if osteomalacia is suspected?

Answer 23

Calcium - reduced or normal
Phosphate - reduced or normal
Alk phos - raised
Serum 250HD - reduced
U&Es
PTH - reduced
X ray - diffuse demineralisation, pseudofractures, coarsened traberculae, insufficiency fractures