Other Conditions Flashcards
What are the types of Raynaud’s Phenomena?
- Primary (Raynaud’s disease)
- Secondary
Raynaud’s disease: presentation
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.
What is the conservative treatment for Raynaud’s disease?
- Avoidance of smoking
- Keeping warm
What is Raynaud’s Phenoma?
- 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).
What are caueses of with Raynaud’s phenomena?
-
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
What factors suggest connective tissue disease in Raynaud’s phenomena?
- Onset after 40 years
- Unilateral symptoms
- Photosensitive rashes
- Puffy fingers
- Abnormal nail fold capillaries
- Presence of autoantibodies
- Digital ulcers
- Calcinosis
- Chilblains (very rare)
How is Raynaud’s phenomena treated?
Keep warm and avoid smoking
- 1st line: Calcium channel blockers e.g. nifedipine
- 2nd line: Phospohodiesterase-5 inhibtiors
- Sildenafil
- IV prostacyclin (epoprostenol) infusions
What is Reactive Arthritis?
- 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
What is Reiter’s Syndrome?
Classic triad of:
- Urethritis
- Conjunctivitis
- Arthritis
What can cause Reactive Arthritis?
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
What are features of Reactive Arthritis?
- 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
What are investigations of Reactive Arthritis?
- Serology/Microbiology
- Inflammatory markers raised
- May need joint aspiration to rule out septic or crystal arthritis
What is the management of Reactive Arthritis?
Symptomatic:
- Analgesia: NSAIDS
- Intra-articular steroids
- sulfasalazine and methotrexate are sometimes used for persistent disease
Most resolve within 2 years