Rheum 2 Flashcards
OA is what
symptoms
XR
treatment
non -inflam. degen. wear and tear
pain and worse on activity. relieved by rest. morning stiffness <30 mins
LOSS
physio. weight loss. analgesia. NSAIDs
RA is what
where is it not
symp
inflam seropositive. synovium (pannus)
Not in DIPs
stiffness and swelling, pain, morning stiffness >30 mins
RA treatment
NSAIDs and analgesia short term for immediate relief and to cover the lag phase of DMARDS
1st line methotrexate, sulfasalzine, hydro
biologics - if two DMARDs tried in comb
influximab and metho
other anti TNFs - toclizumab, rituximab
large vessel vasculitis takayas A who
symptoms /signs
young women, asian, 20-30s
claudication, vascular stenosis and aneurysms, carotid bruits
large vessel vasculitis GCA symptoms
investigation
treatment
claudication of jaw, low of vision
temporal artery biopsy - skip lesions
40mg pred 60mg if loss of vision
metho/azithro
kwaasaki disease is what
who
what can occur
vasculitis of medium vessels
children under 5
coronary artery aneurysms
GPA (wegners) is what
signs
treatment
ANCA pos, CANCA, PR3
sinusitis, rhinitis, saddle nose
IV steroids and cyclophosphamide
ECGPA charge strauss
symp
treatment
pANCA, ANCA pos
same as GPA with late onset asthma and high esosinophil count
IV steroids and cyclophosphamide
HSP is what who symp/signs ix rx
acute IgA mediated disorder
children aged 2-11
<75% have had URTI, pharangyeal infection, GI infection
purpuric rash over buttocks and lower limbs, abdom pain, joint pain, vom, bloody diarrhoea
urinalysis - 50% have renal impairment
self listing within 8 weeks - relapses may occur
gout is what
settles how
ix
rx
hot painful swollen joint
settles in 7-10 days without treatment
serum urate may be be raised in an acute attack
needle shaped negative birefringent
NSAIDs (colchaamen), analgesics, steroids
chronic gout treatment
allopurinol (febixstat)
start 2-4 hours after acute attack - cover with NSAIDs
pseudo gout
what is it and what does it affect
ix
rx
calcium pyrophosphate crystals
affectes fibrocartilage
rhomboid positive birefringent crystals
NSAIDs (colchicine), steroids, rehydration
hydroxy patite what is another name for it what is it what is released who treatment
milwouke shoulder
hydroxylate crystals deposition around a joint
release of collagenous, IL1, serum phosphate
F>M 50-60s
NSAIDs, intra articular steroid injection
reactive arthrirtis triad
when
treatment
ureters triad - urethritis, arthritis, conductivititis
1-3 weeks after infection in another part of the body
self limiting
if chronic - NSAIDs, intra articular steroid, oral steroids, ABs, DMARDs
enteropathic arthritis is what
ix
treatment
worsening of symptoms during flare up of IBD
HLA-B27, increased CRP, increased ESR, XR/MRI - sacroilitis
treat IBD, no steroids - can exacerbate IBD, analgesia, steroids, DMARDs, anti TNF
psoriatic arthritis do all the px have psoriasis ix XR treatment
10-15% of px don’t have psoriasis
HLBA27, increased ESR, increased inflam markers
XR - marginal erosions and whisking, pencil in cup
physio, OT, orthotics, NSAIDs, steroid injections, DMARDs, anti - TNF
DIP fusion for stage 1 where disease confined to just DIPs
ankolysing spondolysis hallmark symp A disease ix rx
sacroilitis
back pain improved with exercise not relieved by rest, decreased chest expansion
ant uveitis, aortic regurg, apical fibrosis, amyloidosis/IgA nephropathy, achilles tendonitis/plantar fasciitis
HLAB27, XR - bamboo spine
physio, OT, NSAIDs, DMARDs if peripheral joint involvement
polymyalgia rheumatica
symp
dx and treatment
assoc with what
ache in shoulders and hip girdle. symp improve as day goes on and with movement
dx test 15 md pred daily - decrease dose over 18m
assoc with temporal arteritis/GCA
GCA symp
ix
treatment
headache in temples. jaw claudication - pain comes on from muscle use. tender enlarged non pulsatile temporal arteries
TAB - skip lesions
40mg pred 60 is visual impairment
reduce dose over 2 years
soft tissue rheumatica is what
pain caused by inflammation/damage to ligaments, tendons, muscles of nerves near a joint
poly/dermatomyositis
symp
treatment
symm proximal weakness, difficulty brushing hair/going up stairs
derm - v shaped rash on chest, hallitrope rash
pred 40mg and immunosuppression
IV Immunglobulin if no response
fibromyalgia
trigger points
inclusion body myositis symp
ix
rx
distal assym muscle weakness
biopsy - inclusion bodies
poor response to treatment
systemic sclerosis is what
limited
diffuse
treatment
excessive deposition of collagen in skin and internal organs. AI
limited - anti centromere hands, face, for arms, feet
diffuse - anti SC 70, can involve trunk, early organ involvement
raynauds - CCB, GI - PPS, Renal - ACEI, ILD - cyclophosphamide
sjorgens is what
symp
ix
rx
lymphocyte infiltration in exocrine organs
ocular dryness - Schirmes test for it
dry mouth. salivary gland involvement
anti La/Ro, biopsy - lymphocytic infiltrate
eye drops, steroids, immune suppressants, saliva replacement, pilocarpine
anti phospholipid syndrome is what
ix
rx
1-5% what have what
recurrent venous thrombosis or arterial thrombosis, fetal loss in young women
anti cardiolupin ABs, anti coag antibodies, anti beta 2 glycoproteins
life long anti coag
of healthy population have anti card ABs
SLE is what
ix
moniter
defect in apoptosis - increased cell death - loss of immune regulation
ANA (not specific) A ds DNA (specific) decreased complement levels C3 C4. Anti SM (specific but low sensitivity), Anti La anti Ro
Anti ds DNA, comp levels (low means active disease), urinalysis, CVS risk - bp, cholesterol, FBC
