Other Conditions Flashcards

1
Q

What are the types of Raynaud’s Phenomena?

A
  • Primary (Raynaud’s disease)
  • Secondary
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2
Q

Raynaud’s disease: presentation

A

Raynaud’s disease typically presents in young women (e.g. 30 years old) with bilateral symptoms. May improve they get older and my be familial.

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3
Q

What is the conservative treatment for Raynaud’s disease?

A
  • Avoidance of smoking
  • Keeping warm
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4
Q

What is Raynaud’s Phenoma?

A
  • Condition due to vasospasm of the digits.
  • Painful and characterised by typical sequence of colour change in response to cold stimulus.
  • Also affected by stress
    • White- inadequate blood flow
    • Blue - venous stasis
    • Red – rewarming hyperaemia
  • Typically, in young women (30s).
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5
Q

What are caueses of with Raynaud’s phenomena?

A
  • Connective tissue disorders
    • Scleroderma (most common)
    • Rheumatoid arthritis
    • SLE
    • Sjogrens syndrome
    • Leukaemia
    • Type I cryoglobulinaemia, cold agglutinins
  • Physical causes
    • Use of vibrating tools
    • Cervical rib
    • Drugs: oral contraceptive pill, ergot
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6
Q

What factors suggest connective tissue disease in Raynaud’s phenomena?

A
  • Onset after 40 years
  • Unilateral symptoms
  • Photosensitive rashes
  • Puffy fingers
  • Abnormal nail fold capillaries
  • Presence of autoantibodies
  • Digital ulcers
  • Calcinosis
  • Chilblains (very rare)
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7
Q

How is Raynaud’s phenomena treated?

A

Keep warm and avoid smoking

  • 1st line: Calcium channel blockers e.g. nifedipine
  • 2nd line: Phospohodiesterase-5 inhibtiors
    • Sildenafil
  • IV prostacyclin (epoprostenol) infusions
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8
Q

What is Reactive Arthritis?

A
  • Reactive arthritis is one of the HLA-B27 associated seronegative spondyloarthropathies.
  • Presents a few days to 2 weeks post infection
  • Around 25% of patients have recurrent episodes whilst 10% of patients develop chronic disease
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9
Q

What is Reiter’s Syndrome?

A

Classic triad of:

  • Urethritis
  • Conjunctivitis
  • Arthritis
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10
Q

What can cause Reactive Arthritis?

A

Can be post dysenteric (equal amongst sexes) or Post-STI (more common in men)

  • Post-dysenteric form:
    • Shigella flexneri
    • Salmonella typhimurium
    • Salmonella enteritidis
    • Yersinia enterocolitica
    • Campylobacter
  • Post-STI form:
    • Chlamydia trachomatis
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11
Q

What are features of Reactive Arthritis?

A
  • Arthritis is typically an asymmetrical oligoarthritis of lower limbs
  • Dactylitis
  • Can’t see: conjunctivitis/uveitis)
  • Can’t wee: urethritis)
  • Skin: circinate balanitis (painless vesicles on the coronal margin of the prepuce), keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)
  • Enthesistis
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12
Q

What are investigations of Reactive Arthritis?

A
  • Serology/Microbiology
  • Inflammatory markers raised
  • May need joint aspiration to rule out septic or crystal arthritis
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13
Q

What is the management of Reactive Arthritis?

A

Symptomatic:

  • Analgesia: NSAIDS
  • Intra-articular steroids
  • sulfasalazine and methotrexate are sometimes used for persistent disease

Most resolve within 2 years

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