Finals Flashcards
Gout ivx
CRP
URate
Mx
NSAIDS
Colchicine
Prevention - avoid purine in alcohol, beer, red meat, shellfish, pulses, spinach, asparagus
Weight loss to reduce
Rheumatoid investigations
CRP and ESR
CCP antibody and RF positive
US - synovitis
XR - for erosive damage
Generic ladder of support in rheum
analgesics
NSAIDS
Steroids to damp down inflammation
Conventional DMARD - methotrexate
DMARDS - synthetics - Jakinib
Biological DMARDs - TNF
When do you move onto biological DMARDS?
If two conventional DMARDS haven’t worked e.g. methotrexate and sulfasalazine
Refer to physio, support groups
Symptoms in axial spondyloarthritis
Pain worse in the morning
Movement findings in axial spond
Occiput to wall disatance
Thoracic expansion an drotation
Lumbar spine forward flexion and lateral flexion
Axial spond investigations
CRP, HLA B27
MRI to detect pre-radiographic changes
MRI and X ray findings for ax spond
Shiny corners - oedema
Sacroilitiitis
X ray
Widening of joints
Fusion of joints
Mx of ax spond
Analgesics
NSAIDS
Steroids
Biologics
DMARDS DO NOT WORK GO STRAIGHT TO BIOLOGICS
Joint distribution of psoriatic arthritis
PIP, DIP, dactylitis
Psoriatic nail changes
Oncholysis
Pitting
Subungal hyperkeratosis
Discolouration
Psoriatic investigations short and long term
Short term - soft tissue changes - US, MRI for synovitis
X ray in longer term
Invs for reactive arthritis
CRP, HLA-B27
ASOT for strep
Lyme serology - chronic lyme disease
GUM - Chlamydia
Reaactive
Osteopenia vs osteoporosis
T score -1 to -2.5 = osteopenia
T score -2.5 or below = osteoporosis
After a fracture how do you manage
T score
Input data into FRAX score
NOGG guidelines
Low risk osteoporosis mx
Oral alendronic acid
High risk osteoporosis mx
IV zolendronic acid annually
SC denosumab 6 monthly
PTH analogue - SC teriparatide
Anti sclerostin antibody - romosozumab monthly for 1 year then bisphosphonate
Connective tissue disease/small vessel vasculitis investigation
Urine dip for nephritis
ANA for connective tissue
ANCA for subset of small vessel vasculitis
SLE investigations
dsDNA = SLE
ENA - Ro, La, Sm, RNP
Full blood tests incl. LFT
Management of SLE
Pred
Hydroxychloroquine
Steroid sparing - methotrexate, mycophenolate, tacrolimus
Severe disease - cyclophosphamide
Anti centromere abx is for
Limited scleorderma
anti scl70
specific for diffuse cutaneous scleroderma
Idiopathic inflammatory myositis
Dermatomyositis + polymyositis
Invs for Idiopathic inflammatory myositis
Creatinine kinase
ANA and myositis antibody panel
MRI scan involving muscles
EMG
Muscle biopsy
PET scan to investigate for underlying malignancy
Mx of dermatomyositis/polymyositis
Prednisolone
Steroid sparing agents
cANCA
GPA
p-ANCA
eGPA
Another name for HSP
IgA Vasculitis
When does IgA vasscsulitis present
After an infection, with purpuric rash, glomerulonephritis, abdo pain, joint pain
Investigation for IgA vasculitis
Urinalysis
IgA
CRP
Renal function
Skin/kidney
Mx of IgA vasculitis
Conservative in adults
monitor urinalysis, consider nephrology follow up
When do you do a PET scan for GCA?
if it’s large vessel
when do you refer to opthal for GCA
SAME DAY opthal review
How much prednisolone for GCA
40mgs OD or 60mgs if visual symptoms)
Biopsy
pseudogout
knees and wrists
Calcium pyrophosphate crystals
positive birefringent
Rhomboid crystals
gout
first MTP
Negative birefringent
