rheum Flashcards
signs of rheumatoid arthritis
swan-neck deformity (DIP flexion + PIP extension)
boutonierre deformity (DIP hyperextension + PIP flexion)
Z-shaped thumb
ulnar deviation at MCP joint
radial deviation at wrist
subcutaneous nodules (elbows)
rheumatoid arthritis investigations
bloods: FBC, CRP / ESR
autoimmune screen: anti-CCP, RF, ANA
X-ray
DAS28 score
X-ray findings rheumatoid arthritis
LOSE: loss of joint space osteopenia soft tissue swelling erosions
rheumatoid arthritis management
conservative: physiotherapy, occupational therapist, exercise, monitor disease w das28 scoring
medical:
1. NSAIDs e.g. ibuprofen (+PPI)
2. DMARDs e.g. methotrexate, hydroxychloroquine, sulfasalazine, leflunomide
3. steroids (oral / IM / intra-articular injection)
4. biologics e.g. anti-TNF (etanercept, infliximab)
Felty’s syndrome
splenomegaly arthritis (rheumatoid) neutropenia thrombocytopenia anaemia
Boutonnierre deformity vs swan neck
Boutonnierre: DIP hyperextension + PIP flexion
swan neck: DIP flexion + PIP hyperextension
features systemic sclerosis
CREST features: calcinosis, raynaud’s, oesophageal dysmotility, sclerodactyly, telangiectasia
facial features: beaked nose, microstomia
ILD
GI: dysphagia, bloating, GORD
arrhythmias (cardiac conductive defects)
acute hypertensive crisis
features SLE
SOAP BRAIN MD
serositis: pleuritis, endocarditis, pericarditis
oral ulcers
arthritis
photosensitivity
blood: anaemia, thrombocytopenia, leukopenia
renal: lupus nephritis (proteinuria, haematuria)
ANA positive
immunological: anti-dsDNA, anti-Sm, anti-phospholipid
neurological: psychosis, seizures
malar rash
discoid rash
Ab limited vs diffuse systemic sclerosis
limited: anti-centromere
diffuse: anti-topoisomerase (Scl70)
complications of systemic sclerosis
diffuse →
pulmonary HTN / fibrosis
features dermatomyositis
proximal muscle weakness + wasting (insidious onset, symmetrical)
Gottren’s papules: discrete erythematous papules over MCP and IP joints
heliotrope / iliac rash
shawl sign
mechanics hands (cracking over fingertips)
periungual telangiectasia
ILD
respiratory muscle weakness
dysphagia, dysphonia
signs giant cell arteritis
temporal artery: tender, pulsatile, palpable, headache
ophthalmic artery: visual disturbance
facial artery: jaw claudication (pain on chewing)
signs of polymyalgia rheumatica: morning / evening proximal muscle aching + stiffness
gout vs pseudogout
gout: monosodium urate (needle)
pseudogout: calcium pyrophosphate (rhomboid)
+ve birefringence w polarised light
causes of raynaud’s
primary: raynaud’s disease (no specific cause)
secondary:
autoimmune: SLE, RA, systemic sclerosis
drugs: OCP, ergotamine
haematological: leukaemia, polycythaemia
management raynaud’s
- CCBs e.g. nifedipine
2. IV prostacylin (epoprostenol) infusion
symptoms ankylosing spondylitis
morning stiffness better w activity lower back pain eyes: iritis / conjunctivitis enthesitis: inflammation at sites of insertion of ligaments & tendons into bone (e.g. Achilles tendonitis) peripheral arthritis
management ankylosing spondylitis
cons: regular exercise / physio
med: NSAIDs (1st line)
biologics: anti-TNF e.g. etanercept
DMARDs (like in RA) only if peripheral arthritis
investigations ankylosing spondylitis
bloods: raised ESR / CRP, HLA-B27
imaging: X-ray (MRI if -ve XR)
CXR → apical fibrosis
lung function testing
BASDAI score (disease activity index)
ankylosing spondylitis
associated conditions
8As: apical fibrosis arthritis (peripheral) aortic regurgitation achilles tendonitis amyloidosis atlanto-axial subluxation anterior uveitis AV node block
x-ray findings for ankylosing spondylitis
sacroiliitis: subchondral erosions, sclerosis
squaring of lumbar vertebrae
syndesmophytes: ossification of outer fibers of annulus fibrosus
drugs causes of SLE
procainamide, hydralazine
isoniazid, phenytoin
carbamazepine, sulfasalazine
RFs for pseudogout
hyperparathyroidism low magnesium / phosphate Wilson's disease haemochromatosis acromegaly
management of gout
acute: oral NSAIDs / colchicine (1st) oral prednisolone (2nd)
chronic:
cons: weight loss, reduce alcohol: low purine diet (reduce liver, kidneys, seafood, oily fish, yeast products)
med: allopurinol (1st), febuxostat (2nd), probenecid
Ab for SLE
ANA: most sensitive
anti-dsDNA: most specific (can be used for disease monitoring if present)
rheumatoid factor (25%)
anti-smith: also highly specific
features takayasu arteritis
large vessel vasculitis FLAWS + syncope weak / absent pulses, claudication unequal L + R BP renal artery stenosis arthralgia aortic regurgitation, carotid bruit transient visual disturbance TIAs, CVAs
features granulomatosis w polyangiitis
Wegener's (small vessel vasculitis) upper airway: saddle nose, sinusitis, nasal ulcers, epistaxis lower airway: cough, haemoptysis glomuerulonephritis cANCA (PR3 Ig) +ve
features eosinophilic granulomatosis w polyangiitis
Churg-Strauss (small vessel vasculitis) Hx of atopic disease (→ nasal polyps) eosinophilia haemoptysis rash renal damage focal neurology pANCA (MPO Ig) +ve
