Rheum Flashcards
5-day history of pain behind the left eye
pain across the left forehead and scalp every time she brushes her hair.
more effortful when eating.
DX?
Temporal Arteritis aka GCA
clincher for temporal arteritis
rapid onset of unilateral headache(<1 month)+jaw claudication+raised esr+vision problem
temporal arteritis have 50% features of which condition?
PMR;
aching, morning stiffness in proximal limb muscles (not weakness)
Tx of temporal/GCA?
urgent high-dose glucocorticoids should be given (as soon as the diagnosis is suspected and before the temporal artery biopsy)
if there is no visual loss then high-dose prednisolone is used
if there is evolving visual loss IV methylprednisolone is usually given prior to starting high-dose prednisolone
there should be a dramatic response, if not the diagnosis should be reconsidered
swelling of the distal interphalangeal joints.
Heberden’s nodes
swelling of proximal interphalangeal joints
Bouchard’s nodes
bright red/blood crusted lesion that usually occurs follow trauma. It is more common in children.
Pyogenic granuloma
subcutaneous, cystic lesion of the joint or synovial sheath of a tendon. It most commonly occurs at the wrist.
ganglion
round, mobile cyst with a characteristic central punctum.
sebaceous cyst
old man+
bone pain+
isolated raised ALP (Even highish with in the normal range) normal calcium and phosphate.
DX?
PAGETS DIS
tx of paget’s
bisphosphonate (ORIS; either oral risedronate or IV zoledronate)
calcitonin is less commonly used now
MAJOR DIFFERENCE BETWEEN ANKYLSOING SPONDYLITIS AND OSTEOARTHRITIS IS?
OA;pain increase on exercise
AS; pain improves with exercise, worsens on sitting for a prolonged period of time.
which is the most imp investigation used for the dx of AS?
Plain XR of Sacroiliac joints; which can show S= Sacroilitis(subchondral erosions and sclerosis)
S= squaring of lumbar vertebra
bamboo spine
S= Syndesmophytes
CXR;apical fibrosis
If the x-ray is negative for sacroiliac joint involvement in ankylosing spondylitis but suspicion for AS remains high, the next step in the evaluation should be ?
initial management of AS
MRI
Swimming
NSAIDS
physio
sulphasalazine for peripheral joint involvement.
XRAY=Chondrocalcinosis OR
linear calcifications of the meniscus and articular cartilage.
DX?
Pesudogout
tx of pseudogout?
aspiration of joint fluid, to exclude septic arthritis.
NSAIDs
or intra-articular, intra-muscular or oral steroids as for gout
rhomboid crystals in?
pseudo gout
X-ray changes of osteoarthritis
decrease of joint space
subchondral sclerosis
subchondral cysts
osteophytes forming at joint margins
X-ray changes of rh arthritis
Periarticular erosions
bochards and heberden nodes are painful or painless?
painless
osler nodes and laneway lesions painful or painless and are present in which condition?
Osler;painful
Janeway;painless
both present in inf endocarditis
roughened red papules over the knuckles /
keratotic macules overlying her interphalangeal joints
DX?
Gottron’s papules.
proximal muscle weakness/tenderness + skin changes;
- gottron’s papules
- photosensitive
- macular rash over back and shoulder
- heliotrope rash in the periorbital region
- ‘mechanic’s hands’: extremely dry and scaly hands with linear ‘cracks’ on the palmar and lateral aspects of the fingers
DX?
Dermatomyositis
features associated with dermatomyositis
raynaud’s
ILD
Foods to avoid in acute attack of gout
high in purines e.g. Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products.
Alcohol
prophylactic tx of gout
tx of acute attack of gout
start allopurinol 2 weeks after acute attack is resolved
start at 100 mg OD and
titrateuntil serum uric acid level is <300
consider co prescribing colchicine when initiating
Febuxostat second line if can’t use allopurinol.
NSAIDS for 1-2 days with PPI and Colchicine
if NSAIDS and Colchicine is contraindicated;
oral steroids; prednisolone 15mg/day OR
Intrararticular steroid injection can be used.
CI in acute attack of gout
L CAP D
Losartan
Ciclosporin
cytotoxic agents
aspirin
alcohol
Pyrazinamide
Diuretics;
thiazides/furosemide
HLA B27 associated with?
AS
and reactive/reiters arthritis
Not only sacroilitis is prominent is AS but also?
enthesitis of the Achilles tendon and plantar fascia is also common.
systemic sclerosis is more common in?
females
CREST SYND?
Calcinosis
raynauds
oesophageal dysmotility
sys sclerosis
telangeictasia
there are 3 patterns of sys sclerosis
limited cutaneous SS;
1. Rynaud’s is the first sign.
2.scleroderma affects face and distal limbs
Diffuse cutaneous SS;
1. scleroderma affects trunk and proximal limbs
2. most common cause of death is now responsible;ILD and PAH
3. other complications include Renal dis and HTN
4. poor prognosis
Scleroderma;
without organ involvement
Antibodies positive in limited cutaneous SS
Anti centromere
Antibodies positive in diffuse cutaneous SS
anti scl 70
Aschoff nodules are pathognomonic of
Rheumatic fever
Muehrcke’s lines
white, transverse lines of the fingernail seen in hypoalbuminaemia
azathioprine is safe in pregnancy
yes
azathioprine should be used in lesser amount with ?
Allopurinol
side effects of Azathioprine
bone marrow suppression
pancreatitis
increased risk of melanoma cancer
imp features of AS
Presents with lower back pain and stiffness
pain at night that improves on getup up.
the A features of AS
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
drug induced SLE
is caused by hydralazine
and procainamide
features of drug induced SLE
arthralgia
myalgia
malar rash
pleurisy
ANA positive in 100%, dsDNA negative
anti-histone antibodies are found in 80-90%
anti-Ro, anti-Smith positive in around 5%
SE of Colchicine is?
Diarrhea
butterfly rash+joint pain+ proteinuria
DX?
SLE
features of SLE
fever,
fatigue,
mouth ulcers, lymphadenopathy
imp facts about sjogrens syndrome
common in females
increased risk of lymphoid malignancy
RF is positive
ANA is positive
Anti Ro antibodies is positive in 70%
Anti la 30%
can’t pee,walk and see well
which arthritis?
reactive
reactive arthritis is caused after?
post dysentry(Shigella
Salmonella
Yersinia
Campylobacter)
and post sti (chlamydia trachomatis)
tx of reactive arthritis
symptomatic:
analgesia, NSAIDS, intra-articular steroids
sulfasalazine and methotrexate are sometimes used for persistent disease
symptoms rarely last more than 12 months
antibodies in dermatomyositis
ANA positive 80%
30% ;
ANTI JP-1
ANTI MI-2
ANTI SRP
In Dermatomyositis which underlying conditions is associated with dermatomyositis and should be considered?
internal malignancy
three-week history of low-grade fevers and myalgia in the shoulder girdle. He also reports a transient loss of vision in his left eye.
DX?
Anorexia,night sweats an depression could also be the symptoms
PMR
Diagnostic test for PMR?
Tx of PMR
Raised ESR
CK and electromyography would be normal
Steroids;prednisolone 15mg OD
nail changes(pitting and onycholysis), skin changes and arthritis
Dx?
Psoraitic arthritis
dx tets for psoriatic arthritis
x ray; pencil in cup appearance
tx of psoriatic arthritis
similar to rheumatoid arthritis;
mild peripheral arthritis/mild axial disease may be treated with ‘just’ an NSAID, rather than all patients being on disease-modifying therapy as with RA
use of monoclonal antibodies such as ustekinumab
livedo reticularis is associated with ?
antiphospholipid syndrome
lupus vulgaris is associated with?
tb
features of Antiphospholipid synd?
venous/arterial thrombosis
recurrent fetal loss
imp; livedo reticularis
thrombocytopenia
imp; prolonged APTT
other features: pre-eclampsia, pulmonary hypertension
tx of Antiphospholipid syndrome
primary thromboprophlyaxis;low dose aspirin
secondary thromboprophylaxis;
initial venous thromboembolic events: lifelong warfarin with a target INR of 2-3
recurrent venous thromboembolic events: lifelong warfarin; if occurred whilst taking warfarin then consider adding low-dose aspirin, increase target INR to 3-4
arterial thrombosis should be treated with lifelong warfarin with target INR 2-3
