Rheum Flashcards by Maryam Iqbal

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

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clincher for temporal arteritis

rapid onset of unilateral headache(<1 month)+jaw claudication+raised esr+vision problem

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temporal arteritis have 50% features of which condition?

PMR;
aching, morning stiffness in proximal limb muscles (not weakness)

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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

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swelling of the distal interphalangeal joints.

Heberden’s nodes

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swelling of proximal interphalangeal joints

Bouchard’s nodes

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bright red/blood crusted lesion that usually occurs follow trauma. It is more common in children.

Pyogenic granuloma

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subcutaneous, cystic lesion of the joint or synovial sheath of a tendon. It most commonly occurs at the wrist.

ganglion

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round, mobile cyst with a characteristic central punctum.

sebaceous cyst

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old man+
bone pain+
isolated raised ALP (Even highish with in the normal range) normal calcium and phosphate.
DX?

PAGETS DIS

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tx of paget’s

bisphosphonate (ORIS; either oral risedronate or IV zoledronate)

calcitonin is less commonly used now

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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.

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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

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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.

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XRAY=Chondrocalcinosis OR
linear calcifications of the meniscus and articular cartilage.
DX?

Pesudogout

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tx of pseudogout?

aspiration of joint fluid, to exclude septic arthritis.

NSAIDs
or intra-articular, intra-muscular or oral steroids as for gout

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rhomboid crystals in?

pseudo gout

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X-ray changes of osteoarthritis

decrease of joint space
subchondral sclerosis
subchondral cysts
osteophytes forming at joint margins

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X-ray changes of rh arthritis

Periarticular erosions

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bochards and heberden nodes are painful or painless?

painless

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osler nodes and laneway lesions painful or painless and are present in which condition?

Osler;painful
Janeway;painless

both present in inf endocarditis

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roughened red papules over the knuckles /
keratotic macules overlying her interphalangeal joints
DX?

Gottron’s papules.

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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

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features associated with dermatomyositis

raynaud’s
ILD

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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?

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