Muscle Disease, Back Pain and Vasculitis Tutorial Flashcards
useful investiagtions for suspected RA?
FBC inflammatory markers anti-CCP ANA X rays US
why would you test for ANA antibody in a suspected RA patient?
CT disease is a differential
what would you expect on X ray of someone with RA?
peri-articular osteopenia
erosions in MCP joint
what blood results suggest anaemia of chronic disease
low Hb but normal MCV
can you get seronegative RA?
yes
is anaemia of chronic disease common in RA?
yes
where does back pain tend to radiate to?
buttocks
what would you suspect in a young person (20-40) with a 3 month history of back pain?
ankylosing spondylitis
what is the significance of back pain radiating to the buttocks?
suggests involvement of the sacroiliac joint which is common in seronegative arthritis and ank spond
cause of a bamboo spine?
too much calcium
questions to ask in a history of someone with suspected AS?
stiffness > 30 mins
better with exercise?
pain at night?
is ank spond an inflammatory arthritis?
yes
define polyarthritis?
> 4 joints affected
define oligoarthritis?
1-4 joints affected
define monarthritis?
only 1 joint affected
name the main 4 types of seronegative arthritis?
psoriatic arthritis
reactive arthritis
enteropathic arthritis
ankylosing spondylitis
what is enthesitis?
inflammation at the points where tendons and ligaments attach to bone
what is the disease process behind tennis elbow and achilles tendonitis?
enthesitis
what causes the spinal involvement in AS?
enthesitis
why can you get achilles tendonitis along with AS?
both caused by enthesitis
tests for AS?
modified schober’s test
MRI
HLA B27 test
why is CRP not that useful in AS?
enthesises are very avascular so inflammation there wont show up
what should you do an MRI of and why?
whole spine and sacroiliac region to see enthesitis
management for AS?
- NSAIDs eg diclofenac, naproxen
- add another NSAID
- anti-TNF
go-to treatment for spinal disease?
NSAIDs
treatment for synovitis?
methotrexate
steroids
what disease commonly presents with hip and shoulder pain?
polymyalgia rheumatica (PMR)
what is polymyalgia rheumatica?
muscle pain because of an inflamed JOINT
what is polymyositis?
muscle pain/weakness because of inflamed muscle fibres
do you get pain/stiffness in the morning with polymyositis or PMR?
polymyositis
do you get muscle wasting in PMR or polymyositis?
polymyositis
is there an age group limit on PMR? if so, what is it?
yes, over 50s
is there an age group for polymyositis? if so, what is it?
no
why would you not include fibromyalgia in a differential of an elderly woman with weight loss, myalgia, pain in hip/shoulder and fatigue?
only affects younger people
pain is everywhere, not localised
don’t get weight loss in fibromyalgia
examination in someone with suspected PMR/polymyositis?
muscle power reading
joint/muscle examination
what investigation could you do to differentiate between polymyositis and PMR and why?
CK, it is high in polymyositis but normal in PMR
treatment for PMR?
start on low dose prednisolone 15mg daily
when should the patient’s symptoms stop when taking meds for PMR?
1 week
if the patient didnt take medication for PMR, how long woudl it take for their symptoms to go away?
2 years
what should be done if a diagnosed PMR patient doesn’t respond to low dose steroids?
reconsider diagnosis
complications of steroids?
osteoporosis cataracts diabetes skin thinning muscle atrophy diabetes peptic ulcers CVD risk
what should do to protect a patient from osteoporosis if they’re on steroids?
give:
bisphosphonates
calcium
vit d
common complication of PMR?
giant cell arteritis
where does giant cell arteritis get to the temporal artery?
vasculitis of large vessels -> aorta -> external carotid artery -> temporal artery
what clinical symptom do you get from facial artery vasculitis?
jaw claudication
is the pronounced artery in giant cell arteritis pulsatile or not?
no
treatment for giant cell arteritis?
- temporal artery biopsy
- increase steroid dose to 1mg/kg
- check CRP and PV
investigations for suspected fibromyalgia?
fibromyalgia tender points exclude CT disease by checking: ANA ENA CK CRP PV
treatment for fibromyalgia?
gabapentin
pregabalin
antidepressants
cognitive behavioural therapy
what is dermatomyositis?
polymyositis with skin features
what skin features can be present in dermatomyositis
heliotrope rash
what investigations should you do for suspected PMR or polymyositis?
PV/CRP FBC U+E LFT CK Anti-Jo-1
what monitoring should be done for a patient on steroids?
blood glucose for diabetes
CV monitoring
give bone protection
why should you be worried about weight loss in dermatomyositis?
it is associated with malignancy
investigations for someone with weight loss and dermatomyositis?
colonoscopy
endoscopy
CT chest/abdo/pelvis
mammogram
investigation for dermatomyositis?
CK ANA Anti-Jo-1 EMG test for electrical activity MRI
what would you expect to see on MRI of someone with dermatomyositis?
white muscle from oedema
damaged muscle -> get fat and fibrous tissue forming
treatment for dermatomyositis?
- steroid + azathioprine long term
bone protection - long term immunosuppression
at what times is the risk of cancer in dermatomyositis highest?
2 years before and after diagnosis
what should you suspect in someone who has joint pain and ENT involvement?
granulomatosis with polyangiitis
tests for someone with suspected vasculitis?
1. urinalysis FBC U+E LFT ANCA PR3 MPO urinalysis CT chest biopsy of rash or lung lesion
what could you see on CXR of someone with GPA?
necrotising granulomatous cavities in the lower lung fields
is GPA ANCA+ve or -ve?
positive
what does a vasculitic rash look like?
purpuric
inflamed leaky capillaries
non blanching
what inflammatory marker results would you expect to see in vascultis?
increased CRP and PV
decreased C3/4
what urinalysis result would prompt you to do a renal biopsy?
> 500mg in urine over 24 hours
treatment for severe vasculitis?
high dose steroid + cyclophosphamide
treatment for mild/moderate vascultis?
methotrexate
oral steroids
bone protection
