RHEUM 3 Flashcards
reactive arthritis is why cause symptoms ix treatment
occurs in response to an infection in another part of the body. 1-4 weeks post infection
urogenital. enterogenic. camp. shigella. salmonella
urethritis, arthritis, conjuncitivitis. fatigue, fever, malaise, asymp mono or oligo arthritis, mild renal disease, keratema blenorrhagia, painless oral ulcers, hyperkeratotic nails
inflam markers. blood/urine cultures. joint fluid analysis. XR of affected joints
self limiting. NSAIDs. intraarticular steroids once sepsis ruled out. oral steroids. steroid eye drops. ABs. 15-20% - chronic - DMARDs
physio/ot
enteropathic arthritis is what worsening of symp when symptoms ix rx
inflammatory arthritis involving peripheral joints and spine. IBD. large joint assym oligoarthritis
during flare up of IBD
arthritis in several joints - knees ankle elbow wrist spine shoulder hip
GI - loose watery stools, mucous, blood
decreased weight, low grade fever, uveitis, pyoderma gangresum, enthesitis, oral pathos ulcers
endoscopy, joint aspirate, increased inflam markers, HLA B27, XR/MRI - sacroilitis, US - synovitis/tendosynovitis
treat IBD NSAIDs aggravate IBD
analgesia, steroids, DMARDs, anti TNF
ankylosing spondylitis in who
1.2.3.4.5.
dx
M>F. 20-40s. hallmark - sacroilitis. peripheral arthritis uncommon (F>M)
- limited lumbar motion
- lower back pain for 3m improves w exercise
- decreased chest expansion
- bilateral grade 2-4 sacroilitos on XR
- unilateral grade 3-4
1, 2 or 3 plus either 4 or 5
symptoms of AS
A disease
back pain and stiffness which improves with exercise, enthesisits, loss of spinal movement and development t of ? with loss of lumbar lordosis and increase in thoracic kyphosis. ant uveitis. lungs. asymp enteric mucosal inflam. near. amyloidosis.
AVN block, axial arthritis, anterior uveitis, aortic regurgitation, apical fibrosis, amyloidosis/IgA nephropathy, achilles tendonitis/plantal fascitis, caudal equina
ix of AS
tragus/occiput to wall. decreased chest expansion. modified schobers test. increased CPR/ESR. HLA-B27. CXR - apical fibrosis.
XR changes after a long period or time - sacroilitos, shiny corners, fusion, bamboo spine, syndermorphytes
treatment of AS
exercise like swimming. physio. OT
NSAIDs. DMARDs if peripheral joint involvement .anti TNF for aggressive disease. surgery - rare
prostatic arthritis in relation to skin
extra stuffs
1, 2, 3, 4, 5
precedes skin lesions
10-15% don’t have psoriasis. no rheumatoid nodules RF neg
- confined to DIPs
- symm polyarthritis >5
- spine involvement with or without peripheral joints
- assym oligo <4 with dactylitis
- arthritic mutilans - v aggressive and destructive form telescoping fingers
symptoms of AS
ix
treatment, treat as what
sacroiltiis, nails (pitting, oncholysis), dactolysis, achilles tendonitis, plantar fasciitis, eye disease
HLA B27, increased inflam markers, RF neg
XR: marginal erosions and whacking, pencil in cup, enthesitis
physio, OT, orthotics. NSAIDs. steroid joint injections. DMARDs, anti TNF. large joints - replace
treat as RA
PMR is what
symptoms
ix
rx
common chronic inflam
lethargy, depression, low grade fever, anorexia, night sweats, ache in shoulder, ache in hip girdle, decreased ROM of shoulder, neck and hips, muscle strength is normal
symp prove as day goes on and with movement
increased inflam markers. CK and EMG normal. decreased CD8
responds dramatically to low dose steroids - Red 15mg OD, decrease over 18 months
giant cell arteritis is what
symptoms
ix
rx
granulamoutiss arteritis of large vessel wall thinking - distal ischaemia
visual distortion - headaches and tenderr and jaw claudication - tender enlarged non pulsatile temporal arteritis
increased inflam markers. biopsy - skip lesions
high dose pre. decrease dose over 2 years
soft tissue rheumatica
pain caused by inflammation/damage to ligaments, tendon, muscle or nerve a joint
pain confined to a specific site
polydermatomyositis is what symptoms derm symptoms ix risk of what treatments
idiopathic inflam myopathy which is symm
prox muscle weakness, insidious onset, difficulty bursting hair, climbing stairs. ILD, resp muscle weakness, dysphagia, myocarditis, fever, weight loss, raynauds, non erosive, polyarthritis
derm: v shaped on chest, gottrons papules, héliotrope rash, photosensitive, nail fold capillary dilatation
test power, isotonic testing - 30 seconds to stand and sit
increased inflam markers. exclude other causes: electrolyte, calcium, MRI, TSH
ANA, anti Jo1, anti SRP
EMG. muscle biopsy
risk of underlying malignancy in men and D>P
ovarian, breast, stomach, lungs, bladder or colon
Pre 40mg and immunosup
IV immunoglobulin
fibromyalgia is what cause symptoms ix rx
commonest cause of MSK chronic pain. not assoc w inflam. females 22-50
primary. 25% have RA. 50% - SLE
persistent widespread pain, diffuse and chronic, varies intensity, trigger points 11/18, symp worse with exertion, fatigue, stress, bad sleep, IBS, headaches, depression
rule out other causes
education - graded exercise programme, anti dep, analgesia
inclusion body myositis can be mis dx as what who symptoms ix treatment
can be misdx as PM. >50s M>F
more insidious onset. distal muscle weakness. wrist and finger flexors quads and anterior tibial muscles. assym.
CK levels lower than in DM/PM
muscle biopsy - inclusion bodies
responds poorly to therapy
