Hands rheumatology Flashcards
What would you expect to see in the hands of a pt w/ RA?
Inflamed joints - red, hot, swollen, tender pain on passive movement increased duration of morning stiffness raised ESR anemia
What are the extra-articular features of RA?
general - malaise, lethargy, low grade fever, weight loss
CVS - pericarditis, pericardial effusion
RS - nodules, pleural effusion, plmn fibrosis, pneumoconiosis (Caplan’s syndrome)
GUS - renal amyloid
NS - polyneuropathy, mononeuritis multiplex, carpal tunnel, atlanto-axial sublux
eyes - scleritis, episcleritis, keratoconjunctivitis sicca, Sjogrens
blood - anemia, thrombocytosis, low WCC (Felty’s syndrome)
Types of anemia in RA?
Anemia of chronic disease
IDA secondary to NSAID-induced gastritis/peptic ulcer
Aplastic anemia secondary to DMARDs
Macrocytic anemia secondary to MTX (folate metabolism)
Pernicious anemia (assoc w/ RA)
RA features in X-ray?
loss of joint space bony erosions periarticular osteoporosis deformity (eg sublux) soft tissue swelling
OA features in X-ray?
loss of joint space
osteophytes
subchondral sclerosis
bone cysts
psoriatic arthropathy features?
asymmetrical oligoarthritis - mainly hands & feet (dactylitis) - sometimes larger joints lone DIP disease Rheumatoid pattern Arthritis mutilans Sacroiliitis
features of Sjogrens syndrome?
may occur independently may be assoc w/ RA/SLE/scleroderma features - dry eyes (keratoconjunctivitis sicca) - dry mouth (xerostomia) - parotid gland enlargement
side effects of DMARDs?
marrow suppression
hepatotoxicity
rash
GI upset (esp nausea & oral ulcers)
side effects of MTX?
pneumonitis & Plm fibrosis
megaloblastic anemia
side effects of hydroxychloroquine?
retinopathy
side effects of sulfasalazine?
oligospermia
side effects of intramuscular gold injection?
nephrotic syndrome
side effects of penicillamine?
nephrotic syndrome
altered taste
myashenia gravis-like syndrome
side effects of ciclosporin
renal impairment
HTN
gum hypertrophy
