Rheum Flashcards
What is seen on joint aspiration with Reactive arthritis ?
organism cannot be recovered from the joint aspiration
Ehler-Danlos syndrome what is defective
AD
affects type III collagen
What causes pain on the radial side of the wrist
tenderness over the radial styloid process
abduction of the thumb against resistance is painful
Finkelstein’s test: +ve
De Quervain’s tenosynovitis
sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed.
How do you distinguish btwn primary (Raynaud’s disease) or secondary (Raynaud’s phenomenon).
What causes 2nadry raynauds
Raynaud’s disease typically presents in young women (e.g. 30 years old) with bilateral symptoms.
2dary causes;
1. connective tissue disorders
- scleroderma (most common)
RA
SLE
erythematosus
leukaemia
type I cryoglobulinaemia, cold agglutinins
use of vibrating tools
- drugs: oral contraceptive pill, ergot
- cervical rib
Rx raynauds
CCB- nifedipine
double-contour sign
Gout
Ankylosing spondylitis features
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
Repeated cramping and myoglobinuria after short bouts of exercise
McArdle’s disease
autosomal recessive type V glycogen storage disease
Dermatomyositis antibodies
ANA most common,
anti-Mi-2 most specific
but seen in 25% of pts
anti-Jo-1 antibodies are not commonly seen in dermatomyositis - they are more common in polymyositis where they are seen in a pattern of disease associated with lung involvement, Raynaud’s and fever
Anti-cardiolipin antibodies and anti-beta2 glycoprotein I
Antiphospholipid syndrome: arterial/venous thrombosis, miscarriage, livedo reticularis, prolonged APTT.
SE Azathioprine
bone marrow depression
nausea/vomiting
pancreatitis
increased risk of non-melanoma skin cancer
significant interaction may occur with allopurinol and hence lower doses of azathioprine should be used.
Sulfasalazine MAO and cautions
- decreasing neutrophil chemotaxis
- suppressing proliferation of lymphocytes and pro-inflammatory cytokines.
Cautions:
- G6PD deficiency
- allergy to aspirin or sulphonamides (cross-sensitivity)
Sjogren’s syndrome has increase risk of what type of cancer
lymphoid malignancies
What is Chondrocalcinosis and what is it ass w/
pseudogout,
Calcification on articular cartilage
T-score of X indicating osteoporosis.
-2.7
mao OF Bisphosphonates
inhibit osteoclasts
abnormality in type 1 collagen
osteogenesis imperfecta
AD
Abnormal Type 4 collagen
Alport’s syndrome - thinning and splitting of the glomerular basement membrane, presenting with isolated haematuria, sensorineural hearing loss, and ocular disturbances.
What caused
1. arthralgia
2. elevated serum ferritin
3. rash: salmon-pink, maculopapular
4. pyrexia- typically rises in the late afternoon/early evening w/ worsening of joint symptoms and rash
WHAT is IX & RX
Still’s disease in adults
Ix :
RF& ANA negative
Yamaguchi criteria
RX: NSAID or steroids
Denosumab SE
Dyspnoea and diarrhoea
‘large, dark shadow’ covering the superior visual field
GCA
anterior ischemic optic neuropathy (AION).
Sulfasalazine SE
oligospermia
Stevens-Johnson syndrome
pneumonitis / lung fibrosis
myelosuppression, Heinz body anaemia, megaloblastic anaemia
may colour tears → stained contact lenses
safe to use in both pregnancy and breastfeeding.
Low serum calcium, low serum phosphate,
raised ALP and raised PTH
osteomalacia
Bone disease: causes of LOW Calcium (2)
Osteomalacia & CKD
Bone disease: causes of HIGH PTH (3)
Primary hyperparathyroidism
CKD
Osteomalacia
How do you differentiate Osteomalacia and CKD
Both will have Low Ca2+ and High PTH
But CKD has high phosphate and Osteomalacia has low Phosphate
Difference between Buerger’s & Berger’s disease
Buerger’s
(thromboangiitis obliterans) med. vessel vasculidity
commonly in the arms and leg
Men 20-40 y/o use Tabacco
Jews Indian
Berger’s disease – IgA nephropathy
defect in the FBN1 gene on chromosome 15 that codes for the protein fibrillin-1.
Marfan’s syndrome
Marfan’s syndrome heart abnormalities
heart:
dilation of the aortic sinuses (seen in 90%) which may lead to aortic aneurysm, aortic dissection, aortic regurgitation
mitral valve prolapse (75%),
What Cause
- Tingling/numbness of the 4th & 5th finger
2.wasting & paralysis of intrinsic hand muscles (except lateral two lumbricals) & the hypothenar muscles.
Froment’s test - pinch a piece of paper between the thumb and index
Cubital tunnel syndrome
What are Syndesmophytes
ossification of outer fibres of annulus fibrosus are a feature of ankylosing spondylitis
pilocarpine and what is it used for
stimulates the parasympathetic nervous system. = stimulating salivary gland secretion,
Sjogren’s syndrome
Avascular necrosis of the hip x -ray findings
-may be normal initially.
Osteopenia & microfractures -early .
Collapse of the articular surface= crescent sign
MRI is the investigation of choice. It is more sensitive than radionuclide bone scanning
Joint space narrowing, osteophytes and subchondral cysts
OA
Marginal erosions, soft tissue swelling and periarticular osteoporosis
RA
Soft tissue swelling, punched-out bone lesions and overhanging sclerotic margins
gout.
What causes back pain associated with neurological problems in Marfan’s
dural ectasia
Drug causes of gout
diuretics: thiazides, furosemide
ciclosporin
alcohol
cytotoxic agents
pyrazinamide
aspirin:
Leflunomide SE
what needs to be monitored
gastrointestinal, especially diarrhoea
hypertension
weight loss/anorexia
peripheral neuropathy
myelosuppression
pneumonitis
Monitor BP, LFTs FBC
Anti-U1 RNP
mixed connective tissue disease
arthralgia, myositis and Raynaud’s
pain & tenderness localised to the lateral epicondyle
pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended
Lateral epicondylitis
tennis elbow
hurts to straighten your fingers, bend your wrist back you may have tennis elbow.
Tennis, Lateral and outside all have T‘s,
tenderness over the medial epicondyle of the humerus.
Pain is usually elicited by resisted wrist flexion with pronation while keeping the elbow flexed 90 degrees or
resisted forearm pronation w/ the elbow extended.
Medial epicondylitis, or golfer’s elbow
hurts to close your hand in a grip, you may have golfer’s elbow
affects the inside of the elbow
numbness, tingling, and pain in the thumb, index finger, middle finger, and half of the ring finger.
nocturnal sx relieved by shaking hands.
carpal tunnel syndrome
Methotrexate MOA
SE
- folic acid analog = decreased levels of THF
- Inhibits purine snx= halts DNA production (S phase )
Pneumonitis
bone marrow suppression
Megaloblastic anaemia
oral ulcers, gum bleeding, peptic ulcers, and hemorrhagic enteritis
Liver cirrhosis
teratogenic,
Leflunomide mao & se
arresting the cell in the G1 phase of growth. = the proliferation of T-cells suppressed
Liver impairment
Interstitial lung disease
Hypertension
teratogenic
MOA & SE Hydroxychloroquine
Takes 3-6 mo before effective
Inbitits TNF A & IL 1
Retinopathy
Corneal deposits
ventricular arrhythmias.
Use: RA and lupus
Safe in pregnancy
MOA & SE
Sulfasalazine
safe in both pregnancy and breastfeeding take w/ folic acid
Inbitits TNF A & IL 1 by macrophages
Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease
Low level intermitted PTH
= anabolic level= bone formation
Chronic High level PTH =
Catabolic effect = bone reabsorption
RX osteoporosis
1st line Alendronate if can tolerate offered risedronate or etidronate
2nd line Raloxifene and strontium ranelate
Indications for bisphosphonates
Indications:
paget’s,
Osteogenesis imperfecta, osteoporosis,
metastatic disease, hypercalcaemia
MOA bisphosphonates
Death to osteoclasts
Denosumab moa & SE
prevents the maturation of osteoclasts by inhibiting RANKL.Given 2 yearly
good in CKD
Subcutaneous
SE: Dyspnoea and diarrhoea, hypoca, hypoMg
MOA Calcitonin
Direct inhibition of osteoclast & stim osteoblasts
Increase secretion of phosphate & Ca2 in the urine
Indications: Post-men osteoporosis, steroid induced osteoporosis, hyperCa, & Pagets
Teriparatide moa & SE
Recombinant PTH = prevent osteoblast death
administered in pulse like fashion = stim osteo blast
SE: osteosarcoma, transient HYPRca2
Limited to 2 year use
MAO & SE SERM (Raloxifene & Tamoxifen)
oestrogen receptor antagonist and partial agonist.
Inhibit bone reabsorption
Reduces risk of breast ca – not for pre menopausal wmn (it induces menopause via estrogen)
* may worsen menopausal symptoms
* increased risk of thromboembolic events
* may decrease risk of breast cancer
* endometrial cancer
* menstrual disturbance: vaginal bleeding, amenorrhoea
