Rheum Flashcards
What form is Zoledronic acid
IV
Polymyalgia rheumatica and features
PMR is an inflammatory disorder that causes muscle pain and stiffness.
- Shoulder and hip stiffness
- Lethargy
- Raised ESR
PMR mx
Prednisolone
Acute gout mx
Strong NSAID (e.g., naproxen) + PPI until infx settled
or colchicine 5-7days
— if CKD/MM :PREDNISOLONE
Acute gout trx, but CKD :(
PO Prednisolone or colchicine
Osteomalacia and features
Bones become weak and soft due to Vit D def
- Pain affecting hips and lower back
- Proximal muscle weakness
- Hypocalcaemia
Granulomatosis with polyangiitis (Wegener’s granulomatosis) and features
autoimmune disease that causes inflammation in small and medium-sized blood vessels, resulting in damage to various organs and tissues
- Upper resp tract: SINUSITIS, epistaxis, SADDLE SHAPED NOSE
- Lower resp tract: HAEMOPTYSIS, nodules/cavities (CXR)
- Eyes: red/dry
- Kidneys: Proteinuria/haematuria - nephritic syndrome
- Skin: rash/ulcers/nodules
+ joint pain
Osteoarthritis features
- Pain of weight bearing joints
- Stiffness in AM but less in duration than RA
- Reduced ROM on passive movement - elicits pain
OA initial mx
NSAIDs
(alt paracetamol)
PMR v dermatomyositis
Dermato
- Muscle weakness
- Skin involvement - rashes
OA analgesia mx
PR diclofenac
What should be given to prevent steroid induced osteoporosis?
a. Alendronic acid + vitamin D
Ankylosing spondylitis mx
- NSAIDs
- DMARDs
- Biologics
- Steroids - only for short amounts of time
Which ix confirms polymyositis?
Muscle biopsy
What type of eye changes in ank spond?
anterior uveitis
CREST syndrome
Associated with ltd systemic sclerosis
- Ca deposits
- Raynaud’s
- Esophageal dysmotility ± GERD
- Sclerodactyly (thickening and hardening of skin on finger/toes -> may appear shiny)
- Telangiectasia (face/hands/body)
asthma + eosinophilia + ANA +ve
eGPA (Churg Strauss)
Telescopic digit
arthritis mutilans (psoriatrics arthr)
Red, scaly lesions on finger joints
Gottron’s papule (dermatomyositis)
RA ix
- XR
- RhF, anti-CCP
RA mx
- lifestyle mods
- analgesia
- DMARDs
- bridging steroids
Gout chronic mx
allopurinol
/ febuxostat
Gout v pseudogout deposits
Gout: urate crystals
pseudogout: calcium pyrophosphate
Reactive arthritis fluid aspirate
straw coloured
Septic arthritis mx
Aspirate to dryness + IV abx based on culture
Reactive arthritis mx
Treat underlying infx + NSAIDs ± steroids/DMARDs
Pseudogout mx
NSAIDs/ colchicine
Skin and nail diseases for psoriatic arthritis
- dactylitis
- Onycholitis (nail separates from bed)
- Pitting
SLE manifestation
- Arthritis
- Malar + discoid rashes
- Constitutional syx
SLE mx
High dose steroids + hydroxychloroquine + biologics
Ankylosing spondylitis mx
NSAIDs/analgesia
Osteoarthritis v RA xr
Osteoarthritis
- Some normal joints
- More DIPJ, rather than PIPJ
RA
- Erosions
Rheum ABs
1RF
2 anti-CCP
3 anti-dsDNA & anti-Smith
4 anti-centromere
1 RA + Sjogrens
2 RA
3 SLE
4 Limited systemic sclerosis
Rheum ABs
1 Anti-Scl70 (anti-topoisomerase)
2 Anti-ro and anti-La
3 Anti Jo and Anti Mi2
4 Anti histone
5 ANCA
1 diffuse systemic sclerosis
2 Sjogrens
3 Poly/dermatomyositis
4 drug induced lupus
5 Vasculitides
What are the ABs for
1 RA + Sjogrens
2 RA
3 SLE
4 Limited systemic sclerosis
1 anti RF
2 anti CCP
3 anti dsDNA and anti Smith
4 anti centromere
What are the Abs for
1 diffuse systemic sclerosis
2 Sjogrens
3 Dermato/polymyositis
4 Drug induced lupus
5 vasculitides
1 Anti-Scl70 (anti-topoisomerase)
2 Anti-ro and anti-La
3 Anti Jo and Anti Mi2
4 Anti histone
5 ANCA
3 small vessel vasculitides
1 granulomatosis with polyangiitis
2 microscopic polyangiitis
3 eosinophilic granulomatosis with polyangiitis
Mx for small vessel disease - treating for remission
cyclophosphamide and corticosteroids
heavy smoker with recurrent digit ischaemia
Thromboangiitis obliterans (Buergers)
haemoptysis, haematuria and anti GBM
goodpasture’s syndrome
transmural inflammation, ‘beads on a string’ angiography
polyarteritis nodosa
Recurrent mouth and genital ulcers not due to infx
Behçet syndrome
psoriatic arthritis mx
Treat to target
1st line DMARD - methotrexate (+bridging steroids)
(2nd biologics - adalimumab)
Syx control
- Pain and swelling: NSAIDs
- Scaly skin/psoriasis: topical steroid
(Treatment of PsA aims to:
Reduce inflammation.
Clear skin and nails.
Relieve pain.
Protect joint mobility.
Make it less likely that you develop other health conditions.)
