MIca week 8 Flashcards
What is this rash?
butterfly
SLE
What is the antibody in SLE
Anti nuclear
IN what demographic is SLE?
chcinese, asian, afrocaribean
What are characteristics of SLE
Serositis
Oral ulcers
Arthritis
Photosensitivuty
Blood
Renal
ANA
Immune
Neurologoic
Malar
Discoid
What are tests yo woudl like to do
FBC normochromic normocytic anaemia, ESR, ANA,anti-dsDNA
Auto antibodies- anti-SM, anti dsDNA,
complement
CXR
renal biopsy
MRI/CT
What conditions that are associated with SLE
Autoimmune: scleroderma, polymyositis, Rheumatoid, Sjogren
anti phospholipid syndrome
CVD, HTN, OSteoporosis, Non Hodkiin Lymphoma
What is the mangement of SLE
carful counselling
lifestyle- diet exercise, mentalwellbeing, flu jab, family planning
symptomatic- pain control, NSAIDS, analgesia, physiottherapy
Specialist- steroid, hydroxychlorouiune,cyclophosphamide,mycophenolate, azathioprine, boilogics
what is a poor indication in SLE?
renal involvement
What is Sjogren disease?
What are the types
lymphocytic infiltration of exocrine glands
primary
secondary: rheumatoid artrithis,SLE, systemic, sclerosis
What are the symptoms of Sjogrens?
raynauds
dysparunia
eye dry
dry mouth - drink a lot
dry skin
fatigue
PArotid or submandibular swelling
What do you do in examination of Sjogrens?
Schirmer’s test- filter paper put in lower conjuctiva
drool test
submandibular or parotid swelling, lymphadenopathy
What investigation would you do for Sjogrens
anti Ro, Anti La antibodies
FBC- anaemia of chronic disease
U&E
ESR - high
LFT’s
immunoglobulin (RhF +, ANA+, anti Ro/ La ab +)
USS of salivary gland
biopsy and immunohistology
What is the managementof Sjogren’s
mouth- artificial saliva, good dental hygien, hugh fluoride
- Eyes- artificial tears, ophtalmology- puntal plug, cyclosporin eue drops
- Other symtoms- analgesia for arthralgia, emolient for skin, raynauds specific
4,- systemeci therapy - Hydroxychloroquine
WHat are patietns with Sjoegren at higher risk of getting?
non Hodgekin Lymphoma
What are distinguishing feature between OA and RA
OA: unilateral, worse at night, weight baring joints (heberden adn bouchards)
RA: symmetrical, better in the morning, (swann neck deformity, boutonniere, z thumb, ulnar deviation), poly
loss of joint space
subchondral cyst
osteophyte
What does the trendelenberg test and what condition does it show
stand but one leg up
look at the hip adductors
missalignement
DAMAGED in osteoarthritis
What is the thomas test
ask patient to bring knee to the chest when lying down
Can not keep the other leg hanging down
SIGN OF osteoarthritis
What is polymyalgia rheumatica
inflammatory condition
with severe bilateral pain and stiffness in the morning
Hip and shoulder and neck
in what demographic do you find patients with polymyalgia rheumatica?
old lady
what does polymyositis present with?
weakness
NOT really pain
What is the treatment for patients with polyathraliga rheumatica
RISk of diabetes melitus
prednisolilone 3 weeks and wean them down
treatment for 1-2 year
Bisphophonates, Vit D3
Diet exercise
PPI
lipid and BP
in polymyaligia rheumatica what are the marker you use to identify if your treatemnt is working?
ESR
symptoms
What are symtpoms of Giant cell arteritis
unilateral headache
vision changes- shades, blurred, double vision, visual loss
jaw claudication
scalp tenderness
PMR
How do you manage a patient with GCA
no visual sympoms- 40-60 mg prednisolone , PPI and arrange bloods if possible - refere urgently to rheumatology within 3 days- may arrange biopsy
if visual symptoms- start prednisolone 60-100mg, PPI cover and same day assesment with ophtalmology
reactive arthrits
seronegative clinically associatedwith inflammationback pain
What are symptoms seen in reactive arthritis
FEVER,
Malaise
GU/GI
lower back pain
heel pain - achilles tendonitis
erythema nodosum
uvitis
urethritis
arthritis
can’t see, can’t pee and climb a tree
WHat are investigations for a monoarthritis
Esrr/ CRP
FBC
HLA B27
Joint aspiration
underlying GI/GU
What are management
treat infection
phy
What are bloods to monitor paitients on methotrexate
FBC
U&E- look at creatinine
LFT
What are drugs you can not give patientts on methotrexate
trimethoprim
What areside effect
photosensitivity
agranuloysitossi
liver imparement
lung fibrosis
What areinvestigations for GOUT
exclude: septic arthritis, pseudo gout adn RA or OA
serum urate
What is the management for gout
RICE: rest, ice, compression and elevation
NSAIDS,colchicine, steroids think of PPI
Allopurinol for prevention but not in acute episode because precipitates symptome
