Other Rheumatology Things Flashcards
Notes on Raynaud’s
Primary Raynaud’s (Raynaud’s disease)
- Periodic vasospastic attacks of pallor or cyanosis
- Tends to be familial → females more likely to be affected
- Normal nailfold capillary pattern
- Negative ANA, normal ESR
- Absence of pitting scars of ulcers of the skin or gangrene in the fingers of toes
Secondary Raynaud’s
- Periodic vasospastic attacks of pallor or cyanosis
- Abnormal nailfold capillary pattern
- Positive ANA, abnormal ESR
- Presence of pitting scars or ulcers of the skin, or gangrene in the fingers or toes
Nail capilloroscopy best method of distinguishing primary from secondary Raynaud’s
Causes of Raynaud’s phenomenon
Reflex
- Raynaud’s disease
- Vibrating machinery injury
- Cervical spondylosis
Connective tissue disease
- Systemic sclerosis
- Mixed connective tissue disease
- SLE
- Polyarteritis nodosa
- Rheumatoid arthritis
- Polymyositis
- Vasculitis
Arterial disease
- Embolism or thrombosis
- Leukaemia
- Dysproteinaemia
- Cold agglutinin disease
Poisons
- Drugs: beta blockers, ergotamine
- Vinyl chloride
Conditions with positive rheumatoid factor
Rheumatic
- RA - 26-90%
- Sjogren’s - 75-90%
- Mixed connective tissue disease - 50-60%
- Mixed cryoglobulinaemia (types II and III) → 40-100%
- SLE - 15-35%
- Polymyositis or dermatomyositis → 5-10%
Non-rheumatic disorders
- Indolent or chronic infection (SBE, hepatitis B or C)
- RF productions typically ceases with resolution of infection
- Inflammatory or fibrosing pulmonary disorders e.g sarcoid
- Malignancy → particularly B cell neoplasms
- Primary biliary cholangitis
RF found in up to 4% of young, healthy individuals
High titres → rheumatoid arthritis, Sjogren’s, cryoglobulinaemia
Visual complications of hydroxychloroquine
- Maculopathy → dose related
- Vortex keratopathy → non-dose related
Before starting all patients should have an initial ophthalmological exam and at 6 monthly intervals
DMARDS/Immunosuppresants contraindicated in pregnancy
- Methotrexate
- Leflunomide
Features of adult onset Still’s
- Age typically 16-35
- Arthralgia
- Elevated serum ferritin
- Rash: salmon-pink, maculopapular,
- Pyrexia
- Lympadenopathy
- RF and ANA negative
General clues to rheumatological disorders
Notes on osteitis condensans illi
- Symmetric sclerosis of the iliac side of the sacro-iliac joint found in young multiparous women
- Can be seen in males
- Felt to be a stress related phenomenon secondary to instability at the symphysis pubis
- May be painful
- May spontaneously resolve on cessation of stress or on surgical stabilisation at the symphysis pubis
Notes on mixed connective tissue disease
Clinical and laboratory features
- Raynaud’s
- Swollen hands
- Arthritis/arthralgia
- Acrosclerosis
- Esophageal dysmotility
- Myositis
- Pulmonary hypertension
- High level anti-U1-RNP antibodies
- Antibodies against U1-70 kd small nuvlear ribonucleoprotein
Pulmonary hypertension = most common disease related cause of death (IgG anticardiolipin antibodies marker for development of this)
Treatment
- Arthritis - NSAIDs
- Esophageal reflux - omeprazole
- To prevent disease flare - hydroxychloroquine
- Raynaud’s - nifedipine
- Pulmonary hypertension - PDEI, endothelin receptor antagonist, prostaglandins
- Corticosteroids mainstay of therapy during pregnancy
