Rheum Flashcards
what hand joints are affected in osteoarthritis
DIP
carpometacarpal joint at base of thumb
x ray changes osteoarthritis
loss of joint space
osteophytes
subchondral cysts
subarticular sclerosis
signs of osteoarthritis on examination
crepitus on movement
effusions
enlargement of the joint
restricted ROM
herberdens nodes
bouchards nodes
squaring of base of thumb
weak grip
in osteoarthritis when do you get creptius
on movement
what is the typical pattern of bone pain in osteoarthritis
worse with movement and at the end of the day
how is osteoarthritis diagnosed
clinically
over 45 with pain worse with movement and no morning stiffness
osteoarthritis mx
conservative= weight loss, exercise, occupational therapy (walking aids etc)
medical= topical nsaids first line, then oral (plus PPI), sometimes intra articular steroids
surgical= joint replacement
how do NSAIDs cause hypertension
they block prostaglandins which are vasodilators
pain relief in osteoarthritis
paracetamol and opiates not recommended
nsaids for short term use
what antibody class is rheumatoid factor
IgM most often but can be others
rheumatoid arthritis antobodies
anti ccp
rheumatoid factor
what is felt on joint examination in rheumatoid arthritis
tenderness
synovial thickening
they feel boggy
boggy joint indicates
rheumatoid arthritis
rheumatoid arthritis hand signs
z thumb
swan neck deformity
boutonniere deformity
ulnar deviation of hands and MCP
swan neck deformity
flexed DIP
hyperextended PIP
boutonnieres deformity
hyperextended DIP
flexed PIP
what spine change can occur in rheumatoid arthritis
what does this mean
atlanto-axial subluxation
patients should have an assessment before general anaesthetic and intubation as it can cause spinal cord compression
extra articular manifestations of rheumatoid arthritis
pulmonary fibrosis
sjogrens syndrome
anaemia of chronic disease
carpal tunnel
eye conditions- scleritis, episcleritis, keratitis
suspected rheumatoid arthritis mx
urgent rheumatology referral (within 3 weeks)
start an nsaid and take bloods while waiting
x ray changes rheumatoid arthritis
periarticular osteopenia
bony erosions
soft tissue swelling
joint destruction
score used to measure functional ability in rheumatoid arthritis
HAQ
score used to monitor disease activity in rheumatoid arthritis
DAS28
mx of rheumatoid arthritis
cMARDs or dMARDs
- monotherapy
- combination therapy
- biologics
mildest dMARD for RA
hydroxychloroquine
safest dMARDs for pregnancy
hydroxychloroquine
sulfasalazine
TNF inihibitor biologic agents
adalimumab
etanercept
infliximab
methotrexate side effects
mouth ulcers
liver toxicity
bone marrow supression
teratogenic
sulfasalazine side effects
orange urine
reversible male infertility
bone marrow supression
leflunomide side effects
hypertension
peripheral neuropathy
hydroxycholorquine side effects
renal toxicity
blue grey skin pigmentation
hair bleaching
anti tnf medications side effects
reactivation of TB
skin cancer
rituximab side effects
night sweats
thrombocytopenia
psoriatic arthritis antibodies
it is seronegative
oligoarthritis number of joints
1-4
polyarthritis number of joints
more than 4
what joints does psoriatic arthritis mainly affect
axial skeleton
DIP
what is arthritis mutilans
in psoriatic arthritis when the whole joint is destroyed
telescoping (shortening) of the digits may be seen
signs of psoriatic arthritis
dactilytis
nail pitting
onycholysis
psoriatic plaques
x ray sign psoriatic arthritis
pencil in cup
seen in arthritis mutilans
mx psoriatic arthritis
nsaids
steroids
dmards
biologics
x ray signs psoriatic arthritis
periostitis
ankylosis
osteolysis
dactylitis
what is reactive arthritis
arthritis triggered by an infection
usually a monoarthritis
how is reactive arthritis different to septic arthritis
there is no infection in the joint
reactive arthritis triad
cant see cant pee cant climb a tree
conjunctivitis
urethritis
arthritis
reactive arthritis mx
treat the triggering infection
nsaids
steroid injection or systemic steroids
ank spond autoantibodies
seronegative
different for an acute swollen joint
reactive arthritis
septic arthritis
gout
pseudogout
joint pain in ank spond
lower back and buttock pain
worse at night and may wake them in morning
morning stiffness lasting 30 mins
pain improves with activity
associated conditions to ank spond pnuemonic
anterior uveitis
aortic regurg
av block
apical lung fibrosis
anaemia of chronic disease
schobers test
mark 10cm above L5 and 5cm below
get them to bend forward and touch toes
distance <20cm= ank spond
x ray changes in ank spond
squaring of vertebral bodies
fusion of joints
subchondral sclerosis
syndesmophytes
ossification of ligaments, discs and joints
ank spond mx
medical
1. nsaids
2. anti tnf agents
3. secukinumab (monoclonal anitbodies)
intra articular steroids
physiotherapy
avoid smoking
exercise and mobilisation
bisphosphonates
SLE symptoms
myalgia
fever
malar rash
lymphadenopathy
splenomegaly
joint pain
hair loss
mouth ulcers
fatigue
weight loss
SOB
pleuritic chest pain
raynauds
oedema
FBC in SLE
anaemia of chronic disease
low WCC and platelets
anti ds dna
SLE
anti centromere
limited cutaneous systemic sclerosis
anti ro and anti la
sjogrens
anti scl-70
systemic sclerosis
anti jo1
dermatomyositis
complications of SLE
cardiovascular disease
pleuritis
pulmonary fibrosis
anaemia
pericarditis
lupus nephritis
SLE mx
1st line
hydroxychloroquine
nsaids
steroids
if more severe
dmards
biologics
dmard examples
mycophenolate mofetil
methotrexate
cyclophosphamide
what is discoid lupus
autoimmune skin condition
photosensitive lesions that are inflamed, dry, erythematous and scaling
they can cause scarring alopecia, hypo or hyper pigmentation
discoid lupus mx
sun protection
topical steroids
hydroxycholorquine
other name for systemic sclerosis
scleroderma
types of systemic sclerosis
limited cutaneous systemic sclerosis
diffuse cutaneous systemic sclerosis- CREST plus internal organ involvement
describe scleroderma
hardening of the skin that makes it look tight and shiny
colour changes in raynauds
white
then blue
then red
raynauds mx
keep hand warm
CCB- nifedipine
what drug worsens raynauds sx
beta blockers
systemic sclerosis antibodies
ANA postive
limited= anti centromere
diffuse= anti scl 70
what additional sx do you get in diffuse cutaneous systemic sclerosis
internal organ involvement
heart= hypertension, CAD
lung= pulmonary htn, pulmonary fibrosis
kidney= scleroderma renal crisis
what condition is PMR associated with
GCA
PMR antibodies
none
pain in PMR
shoulder, neck, pelvic girdle
worse in morning
stiffness lasts 45 mins
pain disrupts sleep
pain somewhat eases with activity
PMR mx
15mg prednisolone daily
follow up in 1 week
continue for 1-2 yrs then wean off in a reducing regime
after how long does steroid dependancy occur
3 weeks
GCA sx
unilateral headache
around temple and forehead
jaw claudication
blurred or double vision
thick and tender temporal artery
what is seen in GCA on temporal artery biopsy
multinucleated giant cells
what is seen in GCA on US
halo sign
stenosis of temporal artery
GCA mx
steroids
40-60mg prednisolone OD if no visual sx or jaw claudication
500-1000mg methylprednisolone OD if visual sx or jaw claudication
start immediately if suspected to avoid vision loss
key complication of GCA
vision loss
complications of steroid use
weight gain
diabetes
osteoporosis
skin changes in dermatomyositis
grotton papules
heliotrope rash affecting eyelids
periorbital oedema
photosensitive rash on back/shoulders/neck
polymyositis and dermatomyositis main sx
proximal muscle weakness
polymyositis/dermatomyositis diagnostic test
raised CK
anti jo1 in polymyositis
polymyositis/dermatolyositis mx
corticosteroids
