Miscellaneous

Question 1

Psoriatic Arthritis

Answer 1

Seronegative Arthropathy
- 5% of those with psoriasis will have associated psoriatic arthritis

Clinical Picture
- Sacroiliitis and spondylitis
- Other joints affected - DIP, Knees

Question 2

Reactive Arthritis

Answer 2

Seronegative Arthropathy
- Following urogenital infection (Chlamydia) or gastroenteritis (Salmonella, Shigella)

Reiter’s Syndrome
- 1-3 weeks post infection
- Sacroiliitis
- Arthropathy of large peripheral joints such as ankles or knees. Fingers and toes can be affected
- Conjunctivitis

Question 3

Ankylosing Spondylitis

Answer 3

Seronegative Arthropathy

Clinical Features
- Age < 40
- Sacroiliitis and stiffness
- Back pain persisting > 3 months
- Morning stiffness > 30 mins
- Improvement with exercise
- Not improved with rest
- 20% will have preceding peripheral joint arthropahty

Question 4

Polymyositis

Answer 4

Systemic Inflammation of skin and muscle

Clinical Features
- Symmetrical muscle weakness and wasting involving the proximal muscles of shoulder and pelvic girdle
- Any age
- Peak incidence 40-60yo
- F:M 2:1
- Muscle pain and tenderness
- Dysphagia due to oesophageal involvement
- Raynaud Phenomenon

DxT - Weakness + myalgia + arthralgia + violaceous facial rash = Dermatomyositis

Diagnosis
- CK
- Skin and muscle biopsies
- EMG studies

Treatment
- Corticosteroids
- Cytotoxic Drugs
- Early specialist referral.

Question 5

Fibromyalgia

Answer 5

• Non-pharmacological treatment
  
  • Graded aerobic exercise
  • Psychologist for CBT regarding lethargy and pain.
  • Good sleep hygiene
  • Review information on Arthritis Australia

Pharmacological
- Amitriptyline 10mg PO Nocte
- Dothiepin 25mg PO Nocte
- Gabapentin/ Pregabalin
- Duloxetine