Rheum Flashcards
What HLA is associated with ankylosing spondylitis
HLA-B27
Features of ankylosing spondylitis
Young man with low back pain
Insidious onset
Stiffness worse in morning but better with exercise
May have pain at night
Examination findings of ankylosing spondylitis
Reduced lateral flexion
Reduced forward flexion - Schober’s test
Reduced chest expansion
‘A’ features of ankylosing spondylitis
Apical Fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
Xray findings in ankylosing spondylitis
Sacroiliitis
Squaring of lumbar vertebrae
Bamboo spine (late and uncommon)
Syndesmophytes
Apical fibrosis on cxr
Rheumatoid arthritis presentation
Swollen painful joints in hands & feet
Stiffness worse in mornings
Gradually gets worse with larger joints involved
Presentation usually insidious over 6m+
Positive ‘squeeze test’
Swan neck and boutonnière late signs
Rheumatoid arthritis investigations
Rheumatoid factor - positive in 70%
Anti-CCP autoantibodies are highly specific
Ocular manifestations of rheumatoid arthritis
Keratoconjunctivitis - most common
Episcleritis (no pain)
Scleritis (pain)
Corneal ulceration
Keratitis
Steroid induced cataracts
Chloroquine retinopathy
Management of rheumatoid arthritis
Symptom modifying - NSAIDS
Disease modifying - methotrexate
Then infliximab or adalimumab
Causes of osteomalacia
Vitamin D deficiency
CKD
Drug induced - anti convulsants
Inherited
Liver disease. - cirrhosis
Coeliac
Features of osteomalacia
Bone pain - lower back, hips, ribs, thigh
Bone/muscle tenderness
Fractures - especially femoral neck
Proximal myopathy - may lead to waddling gate
Investigations into osteomalacia
Bloods - low Vit D, low Ca and Po, raised AlkPhos
Xray - translucent bands
Treatment of osteomalacia
Vitamin D supplement
Calcium supplement
Treat any underlying conditions
