Rheum Flashcards
Signs of OA on XR
Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis
Signs of RA on XR
Loss of joint space
Erosions
Softening (osteopenia)
Soft tissue swelling
Signs of RA in hands
Swollen joints
Ulnar deviation
Boutonierre and swan neck deformity
Z deformity of thumb
Extra-articular manifestations of RA
Nodules (elbow, lung, cardiac)
Lungs - ILD
Cardiac - IHD, pericarditis
Eye - episcleritis, scleritis
What triad forms felty syndrome?
Splenomegaly
Neutropenia
RA
Initial Ix in RA
RF
Anti-CCP
XR hands and feet
What score can you use to monitor disease activity in RA?
DAS28
What are the reasons for failure of biologic tx?
Develop Abs towards it
OA develops as well causing pain
Non-adherence
What side effect effects all DMARDS?
Myelosuppression
Outline the uric acid cycle
Purine - (xanthine oxidase) - xanthine - uric acid - monosodium urate crystals
Which foods predispose to gout?
Alcohol
Fructose
Red meat
Sea food
Which crystals cause gout?
Monosodium urate
What finding on joint microscopy indicates gout?
Negatively birefrigent needle shaped crystals under polarozed light
When should you measure serum urate in an acute gout attack?
6-8 weeks after (down in acute)
What are the conditions for starting allopurinol?
More than one attack in last 12 months
What drug is an alternative to allopurinol?
Febuxostat
Which drug is used to tx tumour lysis syndrome?
Rasburicase or allopurinol
Which crystals cause pseudogout?
Calcium pyrophosphate
What do the crystals look like in pseudogout?
Positively birefrigent RHOMBOID crystals
Mx for acute pseudogout
Ice, rest
Consider intra-articular steroids
Which auto Abs are most strongly associated with SLE?
ANA
Anti-dsDNA
How is SLE managed?
Avoid sunlight exposure
Which Ab is raised in antiphospholipid syndrome?
Anticardiolipin lupus anticoagulant
Ix for sjogrens syndrome
Schirmer tear test
Rose-Bengal staining (may show keratitis)
Anti Ro and Anti La
Tx for sjogrens syndrome
Artificial tears
Artificial saliva
Features of CREST syndrome
Calcinosis Raynauds phenomenon Esophageal dysfunction Sclerodactyly Telangiectasia
Which Abs are associated with limited cutaneous sclerosis?
Anti-centromere
ANA (90% positive)
Which Abs are raised in diffuse systemic sclerosis?
Scl-70
anti-RNA polymerase
Which Ix are required annually in diffuse systemic sclerosis?
Echocardiogram
Spirometry
What is the leading cause of death in limited cutaneous sclerosis?
Pulmonary htn
How can raynauds phenomenon be treated?
Keep hands warm
Nifedipine
What is important to rule out in a patient presenting with polymyositis?
Neoplasm
What signs are suggestivee of dermatomyositis?
Heliotrope rash
Periorbital oedema
Purplish Gottron papules over knuckles
Ix for dermatomyositis
Anti - Jo1 Increased CK Muscle biopsy EMG Screen systematically for malignancy
Mx for polymyositis
Prednisolone
What conditions are associated with Ehler danos syndrome?
Mitral valve prolapse
Anuerysms
Aortic root dilation
Extra-articular manifestations of seronegative arthropathy?
Enthesitis
Dactylitis
Anterior uveitis
IBD
What area is inflamed in the joints of rheumatoid arthritis?
Synovial membrane
What conditions is marfan syndrome assoc with?
AORTIC DISSECTION/DILATATION
Lens dislocation
Dural actasia
Which Ix are done regularly in marfans?
Echo - aortic root width
MRI of spinal column
What are seronegative arthropathies associated with?
HLA B27
Increased risk sacroiliitis
Mx for fibromyalgia
exercise programmes
CBT
low dose amitriptiline
