investigations and Management Flashcards
How would you investigate for RA?
- Bedside - None
- Bloods - FBC, LFTs, CRP, ESR, RF, Anti-CCP, ACPA
- O - none
- X - Chest X-ray, dorsopalmar x-ray, MRI, USS
- ECG
- S - synovial fluid analysis
How would you manage RA?
- Physical actviity
- Acute flare - Steroids
-
Remission - 2 DMARDS
- Methorexate
- Sulfasalzine
- Analgesia - NSAIDs + PPIs
- Biologic therapy
How would you investigate suspected gout/pseudogout?
- Bedside
- B - Urate levels, FBC
- O - None
- X - USS, MRI, CT, X-ray
- E - No
- S - Arthocentesis
How would you treat someone with gout?
Acute Gout
- NSAIDs
- Colchicine
- Steroids
Chronic Gout
- Treat hyperuricaemia if symptomatic
- Prevention measures
What prophylaxic medications would you use for someone with gout?
Medications - >1 attack in 12 months
- Allopurinol
- Febuxostat
- Uricosuric drugs - increase excretion
What is the treatment for pseudogout?
- NSAIDs
- I/A Steroids
- No prophylactic therapies
How would you investigate for ankylosing spondylitis?
- Bedside - examination, slit lamp
- B - FBC, CRP, ESR, RF, HLA-B27
- O - none
- X - Spine X-ray, MRI
- ECG - no
- S - none
How would you manage ankylosing spondylitis?
- Physical therapy
- NSAIDs
- TNF inhibitors
- Intrleukin 17A inhibitors
- Steroid injections
What investigations would you consider doing for psoriatic arthritis?
- Bedside - examination
- Bloods - ESR, CRP, RF
- O
- X - x-rays
- ECG - no
- S - no
How do you treat PsA?
- DMARDs - Sulfasalazine, Methotrexate, Leflunomide
- Cyclosporine
- Anti-TNF therapy
- Steroids
- Physio + OT
- Axial disease treated similar to AS
What tests can be done in the context of suspected reactive arthritis?
- Bloods - ESR, CRP, Infectious serology
- Orifices - Stool culture, chlamydia swab
- X-Ray - look for enthisitis
- ECG - no
- Specific - no
How would you treat Reactive Arthritis?
Acute
- NSAID
- Joint injection (if infection excluded)
- Antibiotics - chlamydia infection (contacts as well)
Chronic
- NSAID
- DMARDs
How would you manage someone with Enteropathic Arthritis?
- Treatment of bowel disease - can improve arthropathy
- DMARDS - in resistant disease
- Steroids
- Anti-TNF
What tests would you do when presented with symptoms associated with PMR?
No specific diagnostic test
Risk factors present - Age > 50, female
- Bloods - FBC, CRP, ESR, ALP, CK
- O - none
- X - none
- E - none
- S - none
Dramatic steroid response
How would you manage someone with PMR?
-
Prednisolone - 15mg/day - 18-24 months
- Gastric and bone protection due to prolonged use
How would you diagnose GCA?
- Bedside - nil
- B - ESR + CRP, ALP, FBC
- O - Nil
- X - Nil
- E - Nil
- S - temporal artery biopsy within 7 days
Diagnosis
- Temporal Artery Biopsy - within 7 days of starting steroids
How would you treat someone with suspected GCA?
-
High Dose Steroids - Prednisolone 60mg/day - immediately
- Gastric and bone protection in prolonged use
- Low dose aspirin
How would you investigate for lupus?
- Bedside
- B - FBC, U+E’s, CRP, ESR, ANA, Anti-dsDNA, Anti-Sm/ro/la, complement
- O - nil
- X - joint x-ray, USS kidney
- ECG - nil
- S - kidney biopsy
How would you manage lupus?
- Avoid sun expoure
- Stop smoking
- Immunize
- Steroids +/- immunosuppresant - induce remission
- Hydroxychloroquine - maintain remission
What investigations would you do if you suspected Sjogren’s?
- Bedside - urinalysis
- B - Ig, Anti-Ro, Anti-La, ANA, RF, ESR, CRP, FBC
- O - nil
- X - nil
- ECG - nil
- Specifc - Schirmers tear test, Slit lamp/Rose Bengal staining,Biopsy
Which Antibodies are most commonly associated with Sjogren’s?
- Anti-Ro - 40%
- Anti-La - 26%
- ANA - 74%
- RF - 38%
How wouldd you manage Sjogren’s?
- Treat Sicca - Artificial tears/saliva, frequent drinks, gland stimulation (pilocarpine or cevimeline)
- NSAIDS and Hydroxychloroquine - Arthralgia
- Immunosuppression - Severe disease
How would you investigate someone with suspected polymyositis/dermatomyositis?
- B - CK, Aldolase, myoglobin, LDH, AST, ALT, ESR + CRP, ANA, AntiMi2, anti-Jo-1
- O - nil
- X - PET, MRI
- ECG - nil
- S - EMG, Biopsy
How would you manage dermato/polymyositis?
- Prednisolone - drug of choice
- Immunosuppression if resistant
- Topical tacrolimus/ hydroxychloroquine for skin disease
- IVIG
- Plasmapheresis
SCREEN FOR MALIGNANCY
What antibodies are associated with dermatomyositis?
- Anti-Mi2
- Anti-Jo1
What antibodies are implicated in both dermatomyositis and polymyositis?
Anti-synthase antibodies
What diseases can dermatomyositis be associated with, and what investigations would you consider doing to look for a cause?
Cancers:
- Imaging e.g. CXR, MRI/CT, Endoscopy etc.
What Tests would you do if you suspected vasculitis?
- Bloods - ESR, CRP, FBC, U+E’s, LFTs, ANCA, ANA
- Urinalysis
- CXR
- Renal Biopsy
