Rheum II Flashcards
PMR demographics
It usually affects old adults (above 50 years)
More common in women
More common in caucasians
Core features of PMR
Bilateral shoulder pain that may radiate to the elbow
Bilateral pelvic girdle pain
Worse with movement
Interferes with sleep
Stiffness for at least 45 minutes in the morning
Other features of PMR
Systemic symptoms such as weight loss, fatigue, low grade fever and low mood
Upper arm tenderness
Carpel tunnel syndrome
Pitting oedema
Diagnosis of PMR
Clinical presentation and response to steroids
Inflammatory markers (ESR, plasma viscosity and CRP) are usually raised however normal inflammatory markers do not exclude PMR.
Treatment of PMR
15mg of prednisolone per day.
Symptoms of GCA
Severe unilateral headache typically around temple and forehead
Scalp tenderness my be noticed when brushing hair
Jaw claudication
Blurred or double vision
Irreversible painless complete sight loss can occur rapidly
Diagnosis of GCA
Clinical presentation
Raised ESR: usually 50 mm/hour or more
Temporal artery biopsy findings
Temporal artery biopsy findings in temporal artery biopsy
: Multinucleated giant cells
FBC in GCA
normocytic anaemia and thrombocytosis
Mx of GCA
Steroids
Aspirin
PPI
Refer to vascular, rheum, ophthalmologist
Late complications of GCA
Relapses of the condition are common
Steroid related side effects and complications
Cerebrovascular accident (stroke)
Aortitis leading to aortic aneurysm and aortic dissection
Key ix for diagnosis of myositis
CK blood test
Causes of raised CK
Rhabdomyolysis Acute kidney injury Myocardial infarction Statins Strenuous exercise
What can polymyositis or dermatomyositis be caused by
Underlying malignancy. This makes them paraneoplastic syndromes. The most common associated cancers are:
Lung
Breast
Ovarian
Gastric
Presentation of dermatomyositis/polymyositis
Muscle pain, fatigue and weakness
Occurs bilaterally and typically affects the proximal muscles
Mostly affects the shoulder and pelvic girdle
Develops over weeks
Dermatomyositis skin features
Gottron lesions (scaly erythematous patches) on the knuckles, elbows and knees
Photosensitive erythematous rash on the back, shoulders and neck
Purple rash on the face and eyelids
Periorbital oedema (swelling around the eyes)
Subcutaneous calcinosis (calcium deposits in the subcutaneous tissue)
Auto-antibodies present in dermatomyositis
Anti-Jo-1 antibodies: polymyositis (but often present in dermatomyositis)
Anti-Mi-2 antibodies: dermatomyositis.
Anti-nuclear antibodies: dermatomyositis.
Definitive diagnosis of dermatomyositis
Muscle biopsy
Mx of dermatomyositis/polymyositis
Rheum referral
Corticosteroids
Rule out cancer
Immunosuppressants (such as azathioprine)
IV immunoglobulins
Biological therapy (such as infliximab or etanercept)
Autoantibodies associated with antiphospholipid syndrome
Lupus anticoagulant
Anticardiolipin antibodies
Anti-beta-2 glycoprotein I antibodies
Mx of antiphospholipid syndrome
Long term warfarin with an INR range of 2-3 is used to prevent thrombosis (3-4 may be used with recurrent thrombosis).
Pregnant women are started on low molecular weight heparin (e.g. enoxaparin) plus aspirin to reduce the risk of pregnancy complications. Warfarin is contraindicated in pregnancy.
What is sjogren’s syndrome
This is an autoimmune condition that affects the exocrine glands. It leads to the symptoms of dry mucous membranes, such as dry mouth, dry eyes and dry vagina.
Auto-antibodies associated with sjogren’s syndrome
anti-Ro and anti-La antibodies
Test used to diagnose sjogren’s syndrome
Schirmer test
Mx of sjogren’s syndrome
Artificial tears
Artificial saliva
Vaginal lubricants
Hydroxychloroquine is used to halt the progression of the disease.
Complications of sjogren’s syndrome
Eye infections such as conjunctivitis and corneal ulcers
Oral problems such as dental cavities and candida infections
Vaginal problems such as candidiasis and sexual dysfunction
General features of all forms of vasculitis
Purpura. These are purple-coloured non-blanching spots caused by blood leaking from the vessels under the skin.
Joint and muscle pain
Peripheral neuropathy
Renal impairment
Gastrointestinal disturbance (diarrhoea, abdominal pain and bleeding)
Anterior uveitis and scleritis
Hypertension
What is polyarteritis nodosa
medium vessel vasculitis. It is most associated with hepatitis B but can also occur without a clear cause or with hepatitis C and HIV.
Rash associated with polyarteritis nodosa
It is associated with a rash called livedo reticularis. This is a mottled, purplish, lace like rash.
What is takayasu’s arteritis
Takayasu’s arteritis is a form of large vessel vasculitis. It mainly affects the aorta and it’s branches. It also affect the pulmonary arteries. These large vessels and their branches can swell and form aneurysms or become narrowed and blocked
Presentation of takayasu’s arteritis
It usually presents before the age of 40 years with non-specific systemic symptoms, such as fever, malaise and muscle aches, or with more specific symptoms of arm claudication or syncope
