rheum Flashcards
OA features
joint pain, crepitus, stiffness afte rmobility, limited motioned
Involves DIPs and 1st CMC joint
Loss of joint space
Osteophytes
Subchondral sclerosis
Bony cysts
Arthritis mutilans
psoriatic arthritis
osteolysis of DIP and PIP joints
telescoping of digits
calcinosis and resoption tufts on xray in patients with scleroderma
features of RA
RA is an erosive inflammatory disease
Classic feature is per-articular erosions
Features of gout
monoarthritis
bony erosions are typically punched out with sclerotic margins and overhanging edges, sometimes termed rat bite erosions.
what is cryoglobulinemia
immunoglobulins which precipitate in the cold. They can be
• Type I (monoclonal)
• Type II (mixed monoclonal and polyclonal) or
• Type III (polyclonal).
Type I cryoglobulinaemia is associated with haematological diseases such as myeloma and Waldenstrom’s.
Type II and Type III cryoglobulinaemia can be associated with many connective tissue disorders, chronic infections and most importantly, hepatitis C infection which should always be excluded.
Treatment of cryoglobulinaemia would include plasmaphoresis, high dose steroids and cyclophosphamide.
Behcets disease
Behcet’s disease which is a rare multisystem vasculitis.
Clinical features include the classical triad of:
Recurrent oral ulceration
Recurrent genital ulceration, and
Iritis.
Arterial and venous thromboses are well recognised.
Patients may exhibit pathergy (development of pustules at venepuncture sites).
HLA B5 is associated with ocular disease; HLA B5 is associated with recurrent oral ulcers.
side effects of hydroxychloroquine
Hydroxychloroquine ocular toxicity includes:
Keratopathy
Ciliary body involvement
Lens opacities, and
Retinopathy.
reactive arthritis
clinical triad of urethritis, conjunctivitis and seronegative arthritis, mainly affecting the large weight-bearing joints (usually knee and ankle).
riggered by either a dysenteric infection or a sexually transmitted infection.
The characteristic rash seen is keratoderma blenorrhagica, a brown macular rash usually seen on the palms and soles.
Non-steroidal anti-inflammatory drugs (NSAIDs) are the mainstay of therapy. Antibiotics given at the time of the non-gonococcal venereal infection will reduce the likelihood of that person developing reactive arthritis.
granuloatosis with polangitis
c ANCA, PR3 purpuric rash UTRI involvement pulmonary haemorrhage glomerulonephritis
criteria for AOSD
Diagnostic criteria include: total of more than five criteria (including two major). Major Criteria: • Fever >39°C • Arthralgia >2 weeks • Still's rash, and • Neutrophilic leukocytosis. Minor Criteria: • Sore throat • Lymphadenopathy or splenomegaly • Liver dysfunction, and Negative RF & ANA.
inclusion body myositis
The diagnosis is inclusion body myositis (IBM). This is an inflammatory condition that affects the over 50s.
Proximal muscles and finger flexors are predominantly involved, but distal muscle groups may also be involved. The onset of muscle weakness in IBM is generally gradual (over months or years).
IBM occurs more frequently in men than women. Creatine kinase (CK) may be normal.
Biopsy in IBM shows intranuclear or cytoplasmic tubofilaments on electron microscopy.
management of PMR
- steroids, vit D and calcium
if good response taper steroids - if refractory add methotraxate/azathioprine and then start to taper steroids
Add bisphosphonate if on long term steroid
Methotrexate/Azathioprine can be stopped if good redpsonse
Drug induced lupus
The following cause drug induced lupus (DIL):
Procainamide Hydralazine Sulfasalazine Carbamazepine Phenytoin Minocycline Isoniazid Interferons, and Anti-TNFα drugs. DIL presents with purpuric, erythematous, papular rash. They do not have a malar or discoid rash. anti-ssDNA antibody, antihistone antibody
CMT joint stages
- Stage 0 (inflammation) - characterised by erythema and oedema, but no structural changes.
- Stage 1 (development) - bone resorption, fragmentation and joint dislocation. Swelling, warmth and erythema persist but there are also radiographic changes such as debris formation at the articular margins, osseous fragmentation and joint disruption.
- Stage 2 (coalescence) - bony consolidation, osteosclerosis and fusion are all seen on plain radiographs.
- Stage 3 (reconstruction) - osteogenesis, decreased osteosclerosis, progressive fusion. Healing and new bone formation occur, and the deformity becomes permanent.
CMT management
Radiographs are an important part of investigating a patient with possible Charcot arthropathy. All radiographs should be taken in the weight-bearing position. MRI can demonstrate changes in the earlier stages of the condition, and is therefore important in allowing treatment to be instigated earlier.
In stages 0 and 1 the treatment is immediate immobilisation and avoidance of weight-bearing. A total contact cast is worn until the redness, swelling and heat subside (generally eight to 12 weeks, changed every one to two weeks to minimise skin damage). After this the patient should use a removable brace for a total of four to six months.
