Inflammatory arthritis disorders Flashcards
1
Q
Rheumatoid Arthritis
A
An autoimmune and inflammatory disease which mainly attacks the joints, usually many joints at once.
2
Q
Epidemiology of Rheumatoid arthritis
A
- Females affected more than men
* Peak incidence in the 50’s
3
Q
Describe the clinical features of RA.
A
- Pain worse in the morning (morning stiffness lasting greater than 1 hour)
- Relieved by exercise
4
Q
Describe the hand changes in Rheumatoid Arthritis
A
- Symmetrical joint tenderness, redness and swelling
- Sausage shaped fingers
- Loss of valleys around the knuckles
- Swan neck deformity
- Boutonniere deformity
- Carpal tunnel syndrome
- Ulnar deviation of MCPs
- Radial deviation of wrist
- Rheumatoid nodules
5
Q
What is swan neck deformity?
A
Hyper-extension at the PIP joint and flexion of the DIP joint
6
Q
Boutonniere deformity
A
Flexion of the PIP joint and hyper-extension of the DIP joint
7
Q
X-ray changes in RA
A
Periarticular osteoporosis
Erosions
Increased joint space
Soft tissue swelling
8
Q
Investigations in RA.
A
- FBC – anaemia of chronic disease
- ESR/CRP – raised
3, Positive RF - Positive anti-CCP
- CXR
- Pulmonary effusion
- Pulmonary fibrosis (caused by methotrexate)
9
Q
Rheumatoid nodules
A
Firm lumps that appear under the skin in up to 20% of patients with RA. They usually occur overexposed joints that are subject to trauma, such as the finger joints and elbows.
10
Q
What antibodies are present in RA
A
RF
AntiCCP
11
Q
Management of RA
A
NSAIDs (+PPI)
Steroids
DMARDs
Anti-TNFs inhibitors (biological drugs)
12
Q
First line DMARDs in RA
A
Methotrexate
13
Q
Side effects of Methotrexate
A
Bone marrow suppression
Pulmonary fibrosis
Renal failure
Hepatotoxicity
14
Q
Second line DMARDs in RA
A
Sulfasalazine
15
Q
Side effects of Sulfasalazine
A
Oligospermia
Hepatotoxicity
Bone marrow suppression
16
Q
How is the effectiveness of DMARDs measured?
A
CRP
17
Q
Side effects of Azathioprine (DMARD)
A
Hepatotoxicity
Bone marrow suppression
18
Q
Side effect of Penicillamine
A
Nephrotic syndrome
19
Q
Side effects of Gold
A
Nephrotic syndrome
Skin reaction
20
Q
Side effects of Hydroxychloroquine
A
Corneal micro deposits
Retinopathy
Tinnitus
21
Q
Side effects of Anti-TNF inhibitors (etanercept, adalimumab, infliximab)
A
Blood dyscrasias
Reactivation of TB
Anaphylaxis
22
Q
What investigation needs to be done before prescribing Anti-TNF inhibitors?
A
Chest Xray (reactivation of latent TB)
23
Q
Examples of Anti-TNF inhibitors
A
Etanercept, adalimumab, infliximab
24
Q
When can Anti-TNF inhibitors be prescribed in RA?
A
Only if 2 DMARDs have failed (with 1 of them being methotrexate).
25
Difference in symptoms between RA & OA.
Pain worse in the morning (morning stiffness lasting greater than 1 hour)
Relieved by exercise
--> In RA
Pain and stiffness less than 30 minutes in the morning, Pain worse with movement, and improves with rest.
--> OA
26
What is Gout?
Inflammatory arthritis
| Results from uric acid deposition in synovium
27
What enzyme leads to the production of uric acid?
Xanthine oxidase
28
Risk factors for Gout
```
o Male
o Obesity
o Alcohol
o Purine rich diet
o Thiazide diuretics
o Renal insufficiency
o Cyclosporine
o Salicytates
o Hereditary
o Occupational lead exposure
```
29
What drugs lead to gout?
Thiazide diuretics
Cyclosporine
Salicytates
30
Example of salicytates
Aspirin
31
What kind of diet leads to gout?
Purine rich diet
32
Symptoms of Gout
```
Acute onset
Hot
Swollen
Red
Tender joint
Very painful
```
33
Where do the majority of gout attacks arise?
60-70% of attacks occur on big toe (known as podagra)
First metatarsalphalangeal joint
34
What joint does gout usually affect?
First metatarsalphalangeal joint
35
Gouty Tophi
Indicates chronic deposition of urate
36
Investigations in Gout
```
Elevated serum uric acid
Xray
Soft tissue swelling
Polarised microscopy of synovial fluid
Negatively bifringent, needle shaped crystals
```
37
What does the polarised microscopy of synovial fluid in Gout show?
Negatively bifringent, needle shaped crystals
38
Management of gout
NSAIDs (1st line)
Colchicine (2nd line)
Corticosteroids (oral or intraarticular)
39
What is the preventative prophylaxis for gout?
Allopurinol - Do not start during flare-up as can potentiate further flare
Diet advice
40
Mechanism of action of Allopurinol
Xanthine oxidase inhibitor
41
Calcium pyrophosphate dehydrate disease (CPPD) aka Pseudogout
Calcium pyrophosphate dihydrate crystal deposition disease (CPPD) is a form of arthritis that causes pain, stiffness, tenderness, redness, warmth and swelling (inflammation) in some joints.
42
What is the main disease associated with CPPD?
Associated with OA
43
What disease/diseases is CPPD associated with in the elderly?
```
Haemochromatosis
Hyperparathyroidism
Hypothyroidism
Renal osteodystrophy
Wilson’s disease
```
44
Calcium pyrophosphate dehydrate disease (CPPD) is divided into 2 syndromes - what are they?
Pseduogout – in joint space
| (chondrocalcinosis) – in cartilage and soft tissue
45
What is Chondrocalcinosis?
A dorm of CPPD - Cartilage calcification is accumulation of calcium salts in hyaline cartilage and/or fibro-cartilage. It can be seen on radiography.
46
Investigations is CPPD
Increased CRP, PV, ESR
Ca2+/TSH to look for secondary causes of metabolic disease
Rhomboid shaped, positively bifringent crystals
47
What does the microscopy of the synovial fluid in CPPD/Pseudogout show?
Rhomboid shaped, positively bifringent crystals
48
Management of Pseudogout
NSAIDs
Corticosteroids – systemic & intra-articular
Colchicine
49
What is the difference in management of Pseudo-gout and gout?
Unlike gout (where you can use allopurinol) there is no prophylactic treatment for pseudogout
50
Osteoporosis
Brittle bones - Quantitative defect of bone characterized by reduced bone mineral density (BMD)
51
What are the typical fracture sites in osteoporosis?
distal radius, femoral neck, vertebral bodies
52
How is osteoporosis diagnosed?
Dexa scan to show BMD
53
What are the typical Dexa scan values in osteoporosis?
BMD >2.5 SD below normal = osteoporosis
54
What are the typical Dexa scan values in osteopenia?
BMD 1-2.5 standard deviations (SD) below normal = osteopenia
55
Osteopenia
Stage before osteoporosis is called osteopenia. This is when a bone density scan shows you have lower bone density than the average for your age, but not low enough to be classed as osteoporosis.
Osteopenia does not always lead to osteoporosis.
56
Management of osteoporosis
Calcium supplements
Vitamin D supplements
Bisphosphonates
57
Mechanism of action of biphosphonates
Acts to reduce osteoclastic resorption
58
Osteomalacia
Marked softening of your bones, most often caused by inadequate amounts of Vitamin D, calcium and phosphorus
Qualitative defect of bone with abnormal softening of the bone due to deficient mineralisation of osteoid
59
What is the name for osteomalacia disease in children?
Rickets
60
Investigations for osteomalacia
Serum alkaline phosphatase levels are usually raised in osteomalacia
Low serum calcium
61
Treatment for osteomalacia
Vitamin D supplements
Calcium supplements
Phosphate supplements
62
Paget’s disease
The pelvis, skull, spine and legs are most commonly affected.
Bone making process becomes faster and out of control.
Newly formed bone is thicker, abnormally shaped and weaker
Prone to fractures
63
Most commonly affected bones in Paget's disease
The pelvis, skull, spine and legs
64
What do the Radionuclide bone scans show in Paget's disease?
Show areas of increased uptake, caused by increased vascularity.
65
Most common site for Paget’s sarcoma
Humerus
66
Features of Paget's disease affecting the SKULL.
May cause hearing loss if it affects the bones of the skull
67
What are the Xray findings of Paget's disease?
Thickening of cortex
Areas of osteolysis
Trabecular thickening and sclerosis
68
Investigations for Paget's disease
Normal calcium and phosphate, raised alkaline phosphate
69
Treatment for Paget's disease
Bisphosphonate therapy (risedronate)
70
Osteogenesis imperfecta
Autosomal dominant bone disorder that is present at birth. It is also known as brittle bone disease. A child born with OI may have soft bones that break (fracture) easily, bones that are not formed normally,
71
What is the mode of inheritance of Osteogenesis imperfecta
Autosomal dominant
72
Symptoms of Osteogenesis imperfecta
```
Multiple fragility fractures of childhood
Short stature with multiple deformities
Blue sclerae
Loss of hearing
History of low energy fractures
Malformation of the teeth
```
73
Marfan's syndrome
A disorder of the body's connective tissues, a group of tissues that maintain the structure of the body and support internal organs and other tissues.
74
Pectus excavatum
Hollowed chest
75
Marfan's syndrome symptoms
Tall stature with disproportionately long limbs, fingers and loose ligaments, scoliosis, joint instability, high srched palate
Pectus excavatum (hollowed chest)
76
What is Gower's sign?
A sign of proximal weakness, uses hands to get up from squatting position - usually muscular dystrophy
77
Ankylosing spondylitis (AS)
Type of arthritis that causes pain and stiffness in your spine, usually starts in your lower back.
78
What is the name given to the spine in Ankylosing spondylitis (AS)?
Bamboo spine
79
Symtoms of Ankylosing spondylitis (AS)
Primarily affects the spine - “Bamboo spine”
Usually males <30
Enthesopathy
Question mark posture
Hyperextension of the neck
Severe kyphosis of the thoracic spine
Earliest changes at the sacro-iliac joints
80
What condition is associated with Ankylosing spondylitis (AS)?
Associated with UC
81
Enthesopathy/enthesitis
Inflammation of the site of insertion of tendons into bones
82
Clinical features of Ankylosing spondylitis (AS)
```
Worse in the morning
Relieved by exercise
Enthesitis
Anterior uveitis
Aortic valve incompetence
Pulmonary fibrosis (upper lobes)
Amyloidosis
```
83
What X-ray change is shown in Ankylosing spondylitis (AS)
Sacroilitis
Bamboo spine
Syndesmophytes
84
Investigations in Ankylosing spondylitis (AS)
Reduced chest expansion
ESR, CRP high
HLA-B27 positive
Xray changes
85
Treatment for Ankylosing spondylitis (AS)
```
NSAIDs
DMARDs
Anti-TNF
Steroids
Avoid bed rest
```
86
Psoriatic arthritis
A type of arthritis that affects some people with the skin condition psoriasis.It typically causes affected joints to become swollen, stiff and painful
87
What nail changes are seen in Psoriatic arthritis?
Pitting
Onycholysis
Subungal hyperkeratosis
88
Symptoms of Psoriatic arthritis
```
• Sacroilitis (asymmetrical)
• Nails
• Dactylitis (sausage fingers)
• Enthesitis
- Achilles tendonitis
- Plantar fasciitis
• Anterior uveitis
```
89
Investigations in Psoriatic arthritis
```
Synovial biopsy
X-ray changes
- Osteolysis (“Pencil-in-cup” deformity)
- Whiskering
- Enthesis
```
90
X-ray changes seen in Psoriatic arthritis
- Osteolysis (“Pencil-in-cup” deformity)
- Whiskering
- Enthesis
91
Management in Psoriatic arthritis
```
Physiotherapy
NSAIDs
Steroid injections
DMARDs (methotrexate, sulfasalazine)
Anti-TNF (etanercept)
```
92
Reactive arthritis/reiter’s syndrome
“Can’t see, can’t pee, can’t climb a tree” (conjunctivitis, urethritis, arthritis)
Infection induced systemic illness (follows a UTI or GI infection)
Symptoms appear 1-4 weeks post infection
93
Commonest microorganisms in Reactive arthritis/reiter’s syndrome
Chlamydia
Salmonella
Shigella
Yersina
94
Symptoms of Reactive arthritis/reiter’s syndrome
```
o Fever
o Malaise
o Asymmetrical mono/oligo-arthritis
o Enthesis
o Mucocutaneous lesions
Conjunctivitis/iritis
o Mild renal disease
o Keratoderma blennorrhagica
```
95
What is Keratoderma blennorrhagica?
Skin lesions commonly found on the palms and soles which may spread to the scrotum scalp and trunk. The lesions may resemble psoriasis
96
Investigations in Reactive arthritis/reiter’s syndrome
Increased ESR, CRP, PV
HLA-B27
Joint fluid analysis (to rule out septic arthritis)
97
Management of Reactive arthritis/reiter’s syndrome
Treat the original infection
o Rest/splint affected joints
o Self-limiting over months
o NSAIDs and steroid injections
98
Enteropathic arthritis
Refers to acute or subacute arthritis in association with, or as a reaction to, an enteric inflammatory condition - IBD
99
Septic arthritis
Infection of joint - Commonly causes by staphylococcus
Caused by haemophilus influenzae in those under 2.
Any joint with the following characteristics is septic arthritis until proven otherwise
o Hot
o Red
o Tender
100
What are the common organisms that cause septic arthritis?
Commonly causes by staphylococcus
| Caused by haemophilus influenzae in those under 2.
101
What is the joint most commonly affected in septic arthritis?
Knee
| Can rapidly cause irreversible joint damage
102
Investigations for Septic arthritis
Raised inflammatory markers (ESV, CRP)
| Joint Fluid analysis
103
Treatment for septic arthritis
IV flucloxacillin
Don’t give intra-articular antibiotics are they cause chemical synovitis and may worsen the infection
104
Why are intra-articular antibiotics not given in septic arthritis?
They cause chemical synovitis and may worsen the infection
105
Epidemiology of SLE
* Afro-Caribbean
* Women
* Peak age 25-35
106
What is SLE?
Autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs.
It can affect the joints, skin, brain, lungs, kidneys, and blood vessels.
107
Triggers for SLE
```
o Infection (typically EBV)
o UVA/UVB treatment
o Drugs (procainamide, hydralazine)
```
108
What drugs can trigger SLE?
procainamide, hydralazine
109
Key features in SLE
LOTS!
```
Photosensitivity
Malar --> butterfly rash --> purple scaly rash over eyes
Discoid lupus erythematosus
Raynaud’s
Polyarthritis
```
110
What are the renal features in SLE?
Proteinuria (0.5g/day)
Red cell casts in urine
Glomerulonephritis
• IgG deposition
111
Investigations for SLE
```
Urine dipstick – proteinuria
Blood – anaemia, thrombocytopenia, leukopenia, raised ESR/CRP
ANA – 90%+
dsDNA – highly specific to SLE
Antiphospholipid
Anticardiolipid
```
112
What antibodies are found in SLE?
ANA
| dsDNA – highly specific to SLE
113
What antibody is highly specific to SLE?
dsDNA Antibodies
114
Management of SLE
```
Mild disease
- No specific treatment needed
- NSAIDs
- Lifestyle (avoid sun)
Anti-malarials
- Chloroquine
- Hydroxychloroquine
Steroid
- Injections
- Oral
Immunosuppression
Protection from photosensitivity (sun block creams)
```
115
Complications of SLE
Increased incidence of atherosclerotic disease
Increased risk of thrombosis
Increased risk of infection
116
Systemic sclerosis (CREST)
Connective tissue disorder
C – calcinosis –
R – raynaud’s phenomenom
E – oesophageal dysmotility
S – sclerodactyly (thickening of the skin)
T – telangiectasia (red spots on the skin)
117
Epidemiology of Systemic sclerosis (CREST)
Women
30-50s
Smoking is a risk factor
118
Clinical signs of systemic sclerosis
```
Calcinosis of the fingertips
Raynaud’s phenomenon
Eosophogeal reflux
Sclerodactyl
Telangiectasia
```
```
Arthritis
Progressive fibrotic lung disease
Pulmonary hypertension
“Pinched face” with beaked nose
Skin pigmentation changes
```
119
Sclerodactyly
Thickening of the digits of the hands and feet (sausage fingers)
120
Investigations for Systemic sclerosis
Raised ESR and CRP
Diagnosis based on have 1 major and 2 minor cutaneous features
Major - Centrally located skin sclerosis that affects arms, face and/or neck
Minor
• Sclerodactyly & atrophy of fingertips
• Bilateral lung fibrosis
LFTs - primary biliary cirrhosis
CXR - pulmonary infiltrates
121
There are 2 types of systemic sclerosis, what are they?
Limited VS Diffuse
122
What is diffuse systemic sclerosis?
Rapid cutaneous involvement – can affect trunk as well. Organ involvement in early disease
Anti-Scl-70 (antinucleur)
123
What is limited systemic sclerosis?
Limited – cutaneous involvement confiened to face, hands, forearms and feet. Organ involvement later
Anti-centromere antibodies
124
Antibodies in limited systemic sclerosis?
Anti-centromere antibodies
125
Antibodies in diffuse systemic sclerosis?
Anti-Scl-70 (antinucleur)
126
Epidemiology of Sjogren’s syndrome
* Women
* 40-50s
Can be primary or can occur secondary to other autoimmune conditions
127
Sjogren’s syndrome
Caused by the immune system mistakenly attacking the body. It mainly affects areas that produce fluids like tears or saliva.
128
Symptoms of Sjogren’s syndrome
```
o Keratoconjunctivitis sicca (dry eyes)
o Xerostomia (dry mouth)
o Xerotrachea (dry throat)
o Vaginal dryness
o Dry eyes, mouth, vagina
o Enlargement of major salivary glands
o Sicca symptoms
o Non-specific symptoms - Arthralgia, fatigue
```
129
Investigations in Sjogren’s syndrome
```
Schirmer test – Ocular dryness
Rose-bengal’s staining
Sialometry and sialography
Anti-Ro
Anti-La
```
130
Auto antibodies in Sjogren’s syndrome
Anti-Ro
| Anti-La
131
Schirmer test in Sjogren’s syndrome
Ocular dryness - determines whether the eye produces enough tears to keep it moist.
132
Management of Sjogren’s syndrome
Lubricants
Artificial saliva and tears
Regular dental care
Pilocarpine to stimulate saliva production
Hydroxycholoroquine for anthralgia & fatigue
133
Side effect of pilocarpine
side effects include flushing
Chest pain.
diarrhea (continuing or severe)
fast, slow, or irregular heartbeat (continuing or severe)
headache (continuing or severe)
nausea or vomiting (continuing or severe)
shortness of breath
134
Antiphospholipid syndrome
Autoimmune disorder that causes an increased incidence of venous or arterial thrombosis and/or foetal loss.
Usually presents as DVT, but can be any venous or arterial thrombosis
135
Symptoms of Antiphospholipid syndrome
Increased frequency of stroke or MI in young people
Recurrently pulmonary emboli
Livedo reticularis
Pregnancy loss/misscariage
136
Investigations in Antiphospholipid syndrome
Thrombocytopenia
Prolongation of activated partial thromboplatin time (APTT)
Auto antibodies
1. Lupus anticoagulant
2. Anti-cardiolipin antibodies
3. Anti-beta 2 glycoprotein
137
Thrombocytopenia
Low blood platelet count.
138
Livedo reticularis
Is a skin symptom. Refers to a netlike pattern of reddish-blue skin discoloration. Legs often affected. The condition is linked to swollen blood vessels.
139
Management of Antiphospholipid syndrome in non pregnant woman and men.
Anticoagulation – Warfarin
| In pregnancy LMWH used as warfarin is teratogenic
140
Management of Antiphospholipid syndrome in pregnant woman
In pregnancy LMWH used as warfarin is teratogenic
141
Giant cell arteritis
Granulomatous arteritis of aorta and major branches
Transmural inflammation of intima, media and adventitia.
142
Granuloma
Small area of inflammation - InInfiltration of lymphocytes, macrophages and multinucleated giant cells
143
Epidemiology of Giant cell arteritis
* Women
| * Elderly (65+), rare before 50
144
Clinical signs of Giant cell arteritis
Headache
Tender, non-pulsatile, thickened temporal artery
Fever
Scalp tenderness
Pain on chewing
Jaw claudication (ischaemia of maxillary artery)
Amaurosis fugax (and other visual disturbances)
145
What causes jaw claudication in Giant cell arteritis
Ischemia of maxillary artery
146
Amaurosis fugax
A transient loss of vision in one or both eyes
147
Investigations in Giant cell arteritis
Increased ESR/PV & CRP
US (color duplex)
Biopsy --> definitive diagnosis - Mononuclear infiltration or granulomatous inflammation
148
What is the definitive diagnostic approach for Giant cell arteritis
Biopsy - shows mononuclear infiltration or granulomatous inflammation
149
Treatment of Giant cell arteritis
Corticosteroids – Prednisolone 40mg if no visual impairment, 60mg if.
Methotrexate
150
First line treatment of Giant cell arteritis with no visual impairement
Corticosteroids – Prednisolone 40mg
151
First line treatment of Giant cell arteritis with visual impairment present
Corticosteroids – Prednisolone 60mg
152
Takayasu’s Arteritis
Large Vessel vasculitis of the aorta
Chronic granulomatous inflammation
Affexts <40 year olds
153
Clinical signs of Takayasu’s Arteritis
Early Features - Low-grade fever, malaise, night sweats, weight loss, arthralgia and fatigue
Bruit
Claudication in upper and lower limbs
Reduced/absent peripheral pulses
Arthralgia
154
Investigations for Takayasu’s Arteritis
Increased CRP/ESV
| MR angiography – to detect thickened vessel walls and stenosis
155
Treatment for Takayasu’s Arteritis
High dose steroids then gradually reducing
| Immunosuppressants like methotrexate and azathioprine
156
Polymyositis
Disease that causes muscles to become irritated and inflamed
May be automimmune but not know - Idiopathic inflammatory myopathy - T cell mediated cytotoxic process against muscle antigens
157
Epidemiology of Polymyositis
30s-40s
| More commonly women
158
Clinical signs for Polymyositis
```
o Symmetrical Proximal muscle weakness - Upper and lower extremeties
o Muscle pain
o Fever
o Pain on brushing hair
o Pain on climbing stairs
o Weight loss
o Insidious onset
o Worsening over months
o Dysphagia secondary to oropharyngeal and oesophageal involvement
```
159
Dermatomyositis
Variant of Polymyositis causing skin symptoms
160
Clinical signs for Dermatomyositis
V-shaped rash over chest
Heliotrope rash
Gottron’s papules
Dilated capillary nail fold
161
Heliotrope rash
Purple peri-orbital rash
162
Gottron’s papules
Rough red papules on knuckles, elbows and knees
163
Dermatomyositis is associated with malignancy, what kind of malignancy?
Breast, ovarian, lung, colon, oesophagus, bladder
164
What disease is Dermatomyositis associated with?
Malignancy - Breast, ovarian, lung, colon, oesophagus, bladder
165
Investigations for Dermatomyositis/polymyositis
o Greatly increased creatinine kinase
o Increased inflammatory markers
o Biopsy of muscle (this is the definitive diagnosis)
o ANA, anti-jo-1, anti-SRP antibodies
o MRI – Localise the extent of muscle involvement
o EMG
166
Autoantibodies in Dermatomyositis/polymyositis
ANA, anti-jo-1, anti-SRP antibodies
167
What is the definitive diagnosis for polymyositis/Dermatomyositis?
Biopsy of muscle
168
Treatment for Dermatomyositis/polymyositis
Prednisolone
| Immunosuppressants (azathioprine or methotrexate)
169
Subungul hyperkeratosis
Refers to the accumulation of scales under the nail plate, which is detached and uplifted.
Results from excessive proliferation of keratinocytes and failure to shed off from the stratum corneum
170
Septic arthritis
an infection in the joint (synovial) fluid and joint tissues. It occurs more often in children than in adults. The infection usually reaches the joints through the bloodstream.
171
Sialometry
A measure of saliva flow
172
Sialography
An x-ray test using contrast to look in detail at the larger salivary glands (the parotid or submandibular)
173
Systemic sclerosis/scleroderma
A rare chronic autoimmune disease of unknown cause characterized by diffuse fibrosis and vascular abnormalities in the skin, joints, and internal organs
174
Differnce between takayasu and giant cell arteritis
The key difference between Takayasu arteritis and giant cell arteritis is the age of the patients affected by the disorders.
Takayasu arteritis affects younger patients, generally less than 40 years of age, while giant cell arteritis affects older patients, generally over 50 years of age.
175
Polymyalgia Rheumatica
Is an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders and hips.
176
What condition is Polymyalgia Rheumatica associated with?
Associated with giant cell arteritis
177
Clinical features of Polymyalgia Rheumatica
Proximal myalgia of hip & shoulder girdles
Morning stiffness
Symmetrical
Reduction of movements of Shoulder, Hips and Neck
Normal muscle strength
178
Investigations for Polymyalgia Rheumatica
No specific test for PMR - Exclude other diagnosis
High CK for polymyositis
Raised CRP, ESR
Temporal artery biopsy
179
Management for Polymyalgia Rheumatica
Steroids – very good response - Low dose prednisolone and gradually reduced. Symptoms should subside in 18 months
180
Fibromyalgia
A condition that causes widespread pain and extreme tiredness - not associated with inflammation
• Women
• 22-50
• Lower threshold of pain and other stimuli (heat, noise, strong odours)
181
Secondary causes of Fibromyalgia
Rheumatoid arthritis, SLE
182
What is the commonest cause of chronic MSK pain?
Fibromyalgia
183
Features of Fibromyalgia
```
> Persisten (>3months widespread pain
> Fatigue; disrupted & unrefreshing sleep
> Symptoms worse with exercise
> Pins and needles
> Abdominal pain/IBS
> Poor concentration/memory
```
184
Diagnosis of Fibromyalgia
o Excessive tenderness of soft tissues on palpation
o No other abnormality of MSK
o No investigations needed
o Rule out other conditions
185
Management of Fibromyalgia
o Rest
o Ice compressions
o Atypical Analgesia
o Psychological input - CBT
186
What atypical analgesics are available for Fibromyalgia?
> Tricyclics (amitriptyline),
> Gabapentin
> Pregabalin
187
Elhers-danlos syndrome (EDS)
Inherited connective tissue disorder that cause very flexible joints and stretchy and fragile skin. Caused by defective collagen synthesis - Insufficient or ineffective
188
Ehlers-danlos syndrome inheritance
Autosomal dominant
189
Clinical features of Ehlers-danlos syndrome
```
o Hyperelasticity of the skin
o Hypermobility of the joints
o Vascular (easy bruising, aneurysms)
o Kyphoscoliosis of the spine
o Bilateral congenital dislocation of the hip
o Flat feet
o Poor healing/thin skin
o GI bleeds/perforation
o Aneurysm
o Increased risk of pneumothorax
```
190
Management of Ehlers-danlos syndrome
Physiotherapy
191
Osteolysis
Osteolysis is defined as the process of progressive destruction of periprosthetic bony tissue
192
Synovitis
Synovitis (or synovial inflammation) is when the synovium of a joint becomes inflamed (swollen).
193
Tenosynovitis
Tenosynovitis is the inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon
194
Tenosynovitis vs synovitis
Both inflammation of the synovium but tenosynovitis is the inflammation of the synovium SURROUNDING a tendon
195
Polymyalgia VS Polymyositis
Polymyositis is an inflammatory, destructive, autoimmune muscle disease, usually with weakness but unusually with pain.
Polymyalgia rheumatica is an inflammatory disease of muscle that always causes symmetrically painful muscles. Polymyalgia rheumatica is not destructive to muscles.
196
Osteochondritis
A joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow.
197
Dorsiflexion vs palmarflexion of wrist
Dorsiflexion of the hand/wrist involves bending the hand upward towards the top of the forearm. This is compared to palmar flexion of the hand/wrist which is the downward bending or flexing of the hand/wrist.
198
Annulus Fibrosus
The annulus fibrosus is the tough circular exterior (ligamentous) of the intervertebral disc that surrounds the soft inner core, the nucleus pulposus.
199
What organism usually causes osteomyelitis in sickly cell patients?
Salmonella species
200
Radiculopathy
Describes a range of symptoms produced by the pinching of a nerve root in the spinal column.
