MSK Flashcards
how to treat primary Reynaud’s
calcium channel blocker
features of primary Reynaud’s
young women <30
Reynaud’s bilaterally with no other symptoms
cause and epidemiology of osteoarthritis
- wear and tear
- old obese women with overuse jobs (gardener, hairdresser)
describe 2 effects of osteoarthritis on the joint
- unilateral pain improves with rest (hip, knee, DIP, PIP)
- little to no morning stiffness
signs of osteoarthritis on examination
- Bouchard’s (PIP swelling)
- Heberden’s (DIP swelling)
how to diagnose osteoarthritis
- clinical in any patient >45 yrs with movement related joint pain and no morning stiffness
- X-ray to confirm
what do you see on X-ray in osteoarthritis
LOSS
- loss of joint space
- osteophytes
- subchondral cysts
- subchondral sclerosis
how to manage osteoarthritis
i) paracetamol
ii) oral NSAID/topical capsaicin
iii) joint replacement
what is rheumatoid arthritis and what is its epidemiology
- chronic autoimmune inflammation of joints for more than 6 weeks
- seen in females of all ages
describe 2 effects of rheumatoid arthritis on the joint
- bilateral pain and swelling of small joints (spares DIP)
- morning stiffness
what are 2 signs of rheumatoid arthritis
- Boutonniere’s: PIP flexion
- Swan neck: DIP flexion
what are 5 extra-articular features of rheumatoid arthritis
- anaemia of chronic disease
- fatigue
- rheumatoid nodules
- eye problems
- pulmonary fibrosis
what is the triad of Felty’s syndrome
- rheumatoid arthritis
- neutropenia
- splenomegaly
how would you diagnose rheumatoid arthritis
- mostly clinical
- bloods suggest aggressive disease (start biologics)
when to refer and when to do a 2ww referral for rheumatoid arthritis
- refer anyone with persistent synovitis
- 2ww if small joints, >3 weeks
what bloods would you do for rheumatoid arthritis
i) rheumatoid factor (first line)
ii) anti-CCP (more specific)
- raised ESR
- raised CRP
- FBC anaemia
- LFTs low albumin
how do you induce remission of rheumatoid arthritis
i) methotrexate + short course pred
ii) DMARD combination
iii) methotrexate + biologic
what are 3 side effects of methotrexate
- myelosuppression
- megaloblastic anaemia folate deficiency
- pulmonary fibrosis
what biologic would you use first line for rheumatoid arthritis and what would be the risk of it
- infliximab (anti-TNF alpha)
- reactivation of TB
how do you manage an acute flare of otherwise well controlled rheumatoid arthritis
IM prednisolone
4 seronegative spondyloarthropathies: what are they, epidemiology, gene
- PEAR:
Psoriatic arthritis
Enterohepatic arthritis
Ankylosing spondylitis
Reactive arthritis - rheumatoid factor negative
- gene: HLA-B27
- more common in young males
what is the main presentation of ankylosing spondylitis
- > 3 months lower back pain and stiffness
- worse in the morning
- improves with exercise
- back pain worse at night
how do you test for ankylosing spondylitis on examination
- Schober’s test
- reduced lumbar motility means distance <5cm when patient bends forwards
what are two late signs of ankylosing spondylitis
- cervical kyphosis
- loss of lumbar lordosis
what happens to the tragus to wall distance in ankylosing spondylitis
increases
what are extra-articular features of ankylosing spondylitis
- apical lung fibrosis
- aortic regurgitation
- anterior uveitis
what imaging is used for ankylosing spondylitis
- first line: X-ray (diagnostic)
- MRI if normal X-ray (early stages)
what are 4 features of ankylosing spondylitis on an X-ray
- sacroilitis
- squaring of lumbar vertebrae
- subchondral erosions
- bamboo spine (late and uncommon)
how do you manage ankylosing spondylitis
exercise + NSAIDs + physiotherapy
what happens to chest expansion in ankylosing spondylitis
reduced
what pattern can be seen in spirometry with ankylosing spondylitis and why
- restrictive
- kyphosis
what are three features of dermatomyositis
- proximal myopathy
- Gottron’s papules (fingers)
- heliotrope rash (around eyes)
what is an important screening after diagnosing dermatomyositis
malignancy screening because dermatomyositis is a paraneoplastic syndrome
what are two causes of spinal cord compression classified by epidemiology
a) young: trauma
b) older: tumour
what tumours can cause spinal cold compression
- metastatic
- multiple myeloma
which cancers commonly metastasise to bone
5 Bs
- breast
- bronchi
- bidney (kidney)
- brostate (prostate)
- byroid (thyroid)
what are 3 symptoms of spinal cord compression
- bilateral leg weakness
- lower back pain
- constipation
how do you investigate suspected spinal cord compression
- urine dip for Bence Jones proteins in multiple myeloma
- bloods for multiple myeloma
- urgent spine MRI
how to manage suspected spinal cord compression
urgent high-dose oral dexamethasone while awaiting investigations
