OA, SepticA and RA Flashcards
LOSS
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts
TOLD
Tissue swelling
Osteopenia (Juxta-articular)
Loss of joint space
Deformed joint
NET
Normal joint space
Erosions
Tissue swelling
20
55
Gelling (stiffness)
Herbedens nodes
Bouchards nodes
LOSS
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts
[OA}: Core treatments for OA involve 2 main lifestyle changes irrespective of age/co-morbidity. What are they?
Weight loss
Exercise
[OA}: 1st line tX
Paracetamol (+- topical NSAIDs)
[OA}: If 1st line tx is inneffective you use …. or ….
Codeine
short term ORAL nsaid (+PPI)
[OA}: If severe what can you use to non-surgically tx the pt
Intra-articular steroid injections
[OA}: If substantially decreased QOL what is indicated
Joint replacement
[OA}: What is the pattern of morning stiffness
<30 mins
It can destroy a joint in <24hrs
RA
Infection is difficult to treat there.
Synovial fluid (via aspiration)
Straight after aspiration
Staph Aureus
Streptococci
Neisseria Gonnococcus
Gram -ve
Flucloxacillin
Clindamycin
Vancomycin
Cefotaxime
Pt is immunocomromised
HLA DR4
HLA DR1
Recurring rapid attack of mono (poly) arthritis of various joints.
Dorsal wrist
Atlanto-axial (! - threatens spinal cord)
extensor tendons
Ulnar deviation
Z-thumb
Swan-neck
Boutonierre
RA
splenomegaly
Neutropenia
elbows
lungs
Fibrosing alveolitis
obliterative bronchiolitis
pleural effusion
Lung nodules
RhF
70
Anti-cyclic citrullinated peptide antibodies are abbreviated to anti-CCP/ACPA. (98%)
[RA}: Why would RA cause decreased Hb
Anaemia of chronic disease
[RA}: how is disease activity measured
DAS28
[RA}: What DAS28 should you aim for
<3
[RA}: What are the 4 criteria for diagnosing RA
Joint involvement
Serology
Acute Phase reactants
Duration of symptoms
[RA}: In the diagnostic criteria what does serology look at
RhF
Anti-CCP
(looking at absent, low or high levels)
[RA}: In the diagnostic criteria what does APR look into
CRP
ESR
[RA}: In the diagnostic criteria what are the duration of symptom cut offs
6 weeks
[RA}: In the diagnostic criteria how do they differentiate between number of joints
1 large joint = 0 2-10 large joints = 1 1-3 small = 2 4-10 small = 3 >10 (one has to be small) = 5
[RA}: 1st line tx is … and …. and …
Methotrexate
Sulfasalazine
Hydroxychloroquine
[RA}: Why do DMARDs require frequent FBCs
Immunosuppresive leading to pancytopenia and neutropenic sepsis
[RA}: When can you use the TNF-a inhibitor infliximab (+methotrexate)
After Tx with 2 DMARDs with a DAS28 of >5.1
[RA}: If tx with DMARDs alone, and then with infliximab has failed what can you use
Rituximab (B cell depeletion)
+methotrexate
[RA}: If tx with DMARDs alone, and then with infliximab and then rituximab has failed what can you use
Tocilizumab (IL-6 blocker)
+methotrexate
[RA}: The major SE of DMARDs is reactivation of … and ….
TB
Hepatitis C
[RA}: What is 1st line in treating an acute flare of RA
Methylprednisolone IM depot
Scleritis
Episcleritis
Keratoconjuctivitis Sicca
Scleromalacia
Pneumonitis
Oral Ulcers
hepatoxicity
Rash
Sperm count decreased
oral ulcers
Irreversible retinopathy
