Medicine (9) Flashcards
Methotrexate
- SEs
- Monitoring
Sulfasalazine
- SEs
- monitoring
Hydroxychloroquine
- SEs
- monitoring
Leflunomide
- SEs
- monitoring
Causes of primary and secondary osteoarthritis
Primary
age, obesity, occupation
Secondary:
- Paget’s disease
- Acromegaly
- haemochromatosis
- Wilson’s disease
What’s that?
Osteoarthritis:
- Heberden’s nodes: DIP
- Bouchard’s nodes: PIP (“B before H”)
Characteristic changes on X-ray of osteoarthritis
Management of OA
Conservative
- Education
- Exercise (strengthening and aerobic)
- Weight loss if overweight
Non-pharmacological: Heat/Ice packs, Physiotherapy, Joint support
Medical
Analgesia treatment ladder
Surgical
Joint replacement
OA vs RA
What ar seronegative spondylopthies? (mnemonic)
(PEAR)
Psoriatic Arthritis
Enteropathic Arthritis
Anklyosing Spondylitis
Reactive Arthritis
Red flags for back pain
- Hx of malignancy
- Neurological disturbance
- Sphincter disturbance
- Morning stiffness
Psoriatic arthritis
- background
- clinical features
- investigations
- management
Ankylosing spondylitis
- background
- clinical features
- investigations
- management
Reactive arthritis
- background
- clinical features
- investigations
- management
Gaut vs Pseudogout
Management of Gout
- conservative
- flare-ups
- prophylaxis (2 drug choices)
Conservative:
- Diuretics, alcohol → reduce, eliminate
- weight loss
- avoid dehydration
- Treat associated factors→ hyperlipidaemia, hypertension, hyperglycaemia
Management of flare: (any of) SEs: diarrhoea
- High-dose NSAIDs
- Colchicine
- Oral Steroid
- Canakinumab (IL-1B)
Prophylaxis:
Urate lowering therapy →xanthine oxidase inhibitors
- Allopurinol
- Febuxostat
When shall we start prophylactic treatment for gout?
Prophylactic treatment with Allopurinol or Febuxostat (xanthine inhibitors - urate-lowering therapies)
- therapy should be started if a second attack, or further attacks occur within 1 year
- allopurinol should not be started until 2 weeks after an acute attack has settled as it may precipitate a further attack if started too early
History, aetiology, ethnicity typical for SLE
SLE
- what can be seen on examination
- investigations
- management
Drugs that cause drug-induced lupus
Drug-Induced SLE:
- Procainamide
- Hydralazine
- Isoniazid
- Minocycline
- Phenytoin
ANTI-HISTONE ANTIBODY (95%)
What’s polymyositis and dermatomyositis?
History in Polymyositis/Dermatomyositis
- Proximal muscle weakness
- swelling/tender muscles
- Fever, weight loss
- interstitial lung disease
- Skin: Heliotrope rash of the eyelids, Gottron’s papules
Ix in Polymyositis/Dermatomyositis
- Blood tests: CK ↑, Autoantibodies (ANA, Anti-Jo1 with specific myositis)
- Special tests: EMG, biopsy
- Investigate for malignancy → Poly/Dermatomyositis have ↑ prevalence of cancer
Management of Polymyositis/Dermatomyositis
- Corticosteroids (CK rapidly falls but muscle power takes weeks to improve)
- Immunosuppressives for resistant cases
History/presentation in systemic sclerosis
- Raynaud’s phenomenon (initial presentation in 70%), arthralgia, oesophageal symptoms (dysphagia, reflux), rapid renal impairment, dysponoea
Investigations in suspected systemic sclerosis
- Bedside: urinalysis (proteinuria/haematuria)
- Bloods: ESR/CRP
- Autoantibodies:anti-centromere, anti-Scl70, ANA
Management of systemic sclerosis
- Monitor renal involvement
- Corticosteroids
- Supportive – PPI for reflux, vasodilators for raynaud’s
- Specific – immunosuppressants
Limited systemic sclerosis vs diffuse systemic sclerosis
