RHEUM 2 Flashcards
osteoarthritis is what cause primary cause secondary cause localised disease generalised disease RF:
non inflam. F>M
deign wear and tear. imbalance between wear and repair of cartilage of joints
idiopathic
prev surgery/injuries, Ra, genetic, acromegaly, calcium crystal deposition dx
age, occupation, muscle weakness, sports, obesity, prev injuries
symptoms of OA XR features and when is it done knee: hands: hip: spine:
pain worse on activity. relieved by rest. still in morning <30 mins
loss of space, osteophytes, sclerosis, subchondral cysts
clinical diagnosis if features are typical otherwise XR
crepitus, valgus/varus, osteophytes, effusion, decreased ROM, bakers cyst
herband,s bouchards, squaring of thumb
pain may be felt in groin or knee.
osteophytes lead to spinal stenosis
treatment for osteoarthritis
physio. weight loss. walking stick
analgesia. NSAIDs topical if knee/hand
PO NSAIDs/COX2I. opoiods, capsaicin cream, intraarticular steroid
surgery - joint replacement
rheumatoid arthritis is what who cause what complications
inflam. seropos. F>M. 30-50
genetic, enviro, smoking, infective cause
small joints of hands, feet, knee, shoulder, elbows
infection, atlantoaxial/subaxial subluxation, ILD and peripheral neuropathy, increased CDV risk, life expectancy goes down by 10 years
symptoms of RA
hands of RA
felty’s syndrome
joint pain swelling. decreased ROM. morning stiffness >30min. general symptoms like fatigue. extrarticular: dry eyes, scleritis, pulmonary fibrosis, effusion, rheum nodues
volar MCPJ subluxation, ulnar deviation, z shaped thumb, swan neck deformity, boutiners, bouchards nodules
Ra and splenomegaly and decreased WCC
ix for RA
treatment
scoring system 6/10 helps w dx
anti CCP. RF less specific. increased ESR, CRP, PV. inflam markers, anaemia of chronic disease.
USS - synovial inflammation. XR - periarticular osteopenia, soft tissue swelling, loss of joint space, periarticular erosions, subluxation
NSAIDs and analgesia for short term relief to cover up lag phase
DMARDs metho, sulfasaline
biologics tried to comb DMARDs and DAS128>5.1 anti TNF - taclizumab, rituximab
influximab and metho
SLE in who and what is it
cause
clinical criteria
immunological criteria
chronic AI disease. F>M. afrocaribean and asians. any part of the body. 20-40s
enviro and genetic
chronic/acute cutaneous cysts. oral/nasal ulcers. non scarring alopecia. arthritis. renal. near. haemolytic anaemia. leukopenia. thrombocytopenia
ANA, anti dsDNA, anti SM, anti phospho, anti compliment, direct coombs test
symptoms of SLE general skin MSK lung heart kidneys CNS haem
fever malaise poor appetite weight loss fatigue.
photosensitivity, molar rash, discoid lupus, erythematous, subacute lupus, oral/nasal ulcers, raynauds
polyartheritis/polyarthralgia, deforming arthropathy, erosive arthritis, myopathy
pleurisy, infection, fibrosis, ILD, pulmonary htn, pulmonary infarcts
pericarditis, CM, pulmonary htn, endocarditis
proteinuria, urine sedmants, htn, AKI/CRF
depression, cerebral ischaemia, migraines
anaemia, leucopenia, thrombocytopenia
ix for SLE
FBC. renal function tests. CXR. ECHO. ANA not specific. Ads DNA specific and varies w disease activity. decreased C3 and C4. Anti SM specific but low sensitivity. anti Ro anti La anti RNP. increased ESR. RF pos in 20%
counselling, monster, avoid excessive sun
NSAIDs, analgesia, anti malarial, steroids, immunosuppression - hydroxychlorquinine
how to monitor SLE
anti ds DNA complement urinalysis CV risk - BP and proteinuria FBC and blood biochemistry
systemic sclerosis in who what is it limited diffuse other ix
F>M. AI. 25-55s
excessive deposition of collagen in skin and internal organs
limited anti centromere AB
raynauds, face, forearm, feet, late organ development
diffuse anti SCL 70
skin changes develop rapidly. can involve trunk/prox limbs, early organ involvement
ANA 90%
RF 30%
symptoms SS
major cutaneous
minor
other
raynauds
centrally located skin sclerosis that affects arms face neck
atrophy og fingertips and bilateral lung fibrosis
telangiectasia, calcinosis, pulmonary htn, pulmonary fibrosis, renal crisis, dysphasia, malabsorption, inflam arthritis, myositis
treatment of SS
raynauds -CCB GI - PPIs renal - ACEI ILD - immunosuppressive = azithro diffuse - metho, myclophenolate, cyclophosphamide
sjorgens in who what is it cause criteria/symptoms immunology biopsy what other ix
F>M. 45-60s. AI
lymphocytic infiltrates in exocrine organs
primary. secondary - AI disease - thryoid/coeliac/PBC
dry eyes for >3m. fry mouth. ocular symp. ocular symp. salivary gland involvement.
dry eyes/mouth, fatigue, arthralgia, raynauds, salivary swelling, LD, skin and vaginal dryness, ILD, neuropathy, renal and tubular acidosis, neonatal complete heart block
anti Ra and/or Anti La
lymphocytic infiltrate
schirmers test for ocular dryness
sjorgens risk of what
treatment
what risk should monitor
5-10% risk of B cell lymphoma
eye drops. saliva replacement. pilocarpine - saliva production. steroids. immunosuppression-hydroxy
CV
