locomotor Flashcards
1
Q
rheumatoid arthritis:
- age + gender affected most?
- other risk factors?
- typical presentation?
A
- female (3:1)
- peak onset 40-50
- smoking
- HLA DR4/DR1
- symmetrical swollen painful + stiff small joints of hands + feet
- worse in morning (does not improve within 30 mins)
- can fluctuate + larger joints can be involved
- MCP + PIP (nb not DIP)
(late stage: ulnar deviation + swan neck deformity etc)
- can recur and remit
- lots of other atypical presentations
- can have extra articular manifestations (vasculitis, nodules, raynauds, neuropathy, + many others)
2
Q
rheumatoid arthritis:
- serology? 2
- other bloods? 3
- early x-ray findings?
- management?
A
- Rheumatoid factor (high sens, low spec)
- Anti-CCP (lower sens, high spec)
- FBC (high platelets, anaemia of chronic disease)
- ESR (high)
- CRP (high)
- soft tissue swelling
- juxta-articular osteopenia
- decreased joint space
nb managed by rheumatologist
- DMARDS (e.g. methotrexate) + biologic agents
- IM/intra-articular steroids (for acute flares)
- NSAIDs for pain (paracetamol + opiods not helpful)
- refer to physio
- stop smoking!!
3
Q
differentials for RA? 5
A
- symmetrical seronegative spondyloarthropathies
- psoriatic arthritis
- SLE (esp young women)
- acute viral polyarthritis
- septic arthritis (single joint)
4
Q
osteoporosis:
- risk factors? 14
A
- increased age
- FH of hip fracture +/or osteoporosis
- female sex
- LACK of oestrogen
- low BMI
- low exercise levels
- high alcohol intake
- smoking
- inflammatory conditions (e.g. RA, crohns)
- long-term steroid use
- hyperthyroidism
- primary hyperparathyroidism
- CKD
- COPD
5
Q
osteoporosis:
- presentation?
- imaging? (+result)
- treatment? 2
A
- asymptomatic
- often picked up after a fragility fracture so have a high level of suspicion, esp in elderly or with any of above risk factors
- DEXA bone scan
- < 2.5 is osteoporosis
nb osteopenia is 1 - 2.5
- calcium + vit D supplements
- bisphosphonates
