Polyarthritis Tutorial Flashcards
what is polyarthritis?
arthritis affecting more than 1 joint
differentials for RA?
psoriatic arthritis CT disease (esp. lupus)
investigations for RA?
anti-CCP, ESR, CRP
ultrasound
x ray
DAS score
how could you differentiate RA from psoriatic arthritis using autoantibodies?
RA has anti CCP, psoriatic is seronegative so won’t have any autoantibodies
how should you use ANA in clinical practice?
use its absence to rule out lupus
early presentation of inflammatory arthritis on x ray?
soft tissue swelling periarticular osteopenia (bone thinning)
what does osteopenia look like on x ray and why?
dark areas as thinner bone comes out darker and thicker is whiter
what would you expect to see on hand examination of someone with inflammatory arthritis?
swollen PIP and MCP joints
why is ultrasound a good investigation for RA?
picks up inflammation
late presentation of RA on x ray?
erosion
what would a low Hb and normal MCV indicate on FBC
anaemia of chronic disease
why is methotrexate the preferred DMARD
only have to take it once a week
works within 6 weeks- quicker than others
what treatment should be given in a severe flare up of arthritis
- add sulfasalazine
2. add biologic id DAS >5.1
when is the only time a biologic should be considered in arthritis
if DAS >5.1
how would you measure disease activity and response to treatment in a patient on a DMARD
DAS score
do you need to stop drinking alcohol on methotrexate
no, but limit it to avoid hepatitis
what conditions are biologics not suitable for
heart failure lung disease chronic infection previous/latent TB demyelinating disease eg MS
2 main contraindications of biologics?
immunosuppression
reactivation of TB
which condition is worsening pain when walking downhill common?
osteoarthritis
is a serum ANA of 1 : 80 high or low
low, just past upper limit of normal
should you use steroids in mild lupus?
no, only moderate
why can complement be low in lupus?
it is consumed by the autoimmune process
what effect would active lupus have on double stranded DNA and complement?
low complement
high dsDNA
1st and 2nd line tests if kidney involvement in lupus?
- urinalysis
2. renal biopsy
treatment for severe lupus?
IV cyclophosphamide
IV steroids
hydroxychloroquine
- rituximab if cyclo not working
what does cyclophosphamide do?
potent immunosuppressant
is raynauds pathological if it appears in older ages?
yes, usually secondary to something
what would you suspect in a patient with shiny, tight hands and raynauds?
systemic sclerosis
secondary presentations of systemic sclerosis
telangiectasia
raynauds
pulmonary fibrosis
pulmonary hypertension
what is diffuse systemic sclerosis?
SS affecting any skin especially trunk and internal organs
what is limited systemic sclerosis?
SS only affecting knees, face, arms,
what would you hear on auscultation of pulmonary fibrosis in SS?
bilateral crackles in lung bases
investigations for SS
anti-CCP anti-Scl-70 HRCT chest ECHO Pulm function test
what CT disease is oesophageal dysmotility common in?
systemic sclerosis
treatment for raynauds?
- calcium channel blockers
- suldenifil
- phosphocycline
