Rheum Mix Flashcards
Methotextrate side effects and toxicity treatment
-Mucositis
-myelosupression
-pneumonitis (non-productive cough, dysponea, malaise and fever)
-pulmonary fibrosis
-liver fibrosis
-folinic acid for toxicity
Osteoarthritis x-ray findings (LOSS)
-Loss of joint space
-Osteophytes
-Subchondral cysts
-Subchondral sclerosis
Reactive arthritis triad
Urethritis + arthritis +/- conjunctivitis = reactive arthritis
Chlamydia trachomatis is the most common cause of reactive a.
Hydroxychloroquine side effects
-Bull’s eye retinopathy (may result in severe and permanent visual loss) for which baseline ophthalmological examination and annual screening is generally recommended
-safe in pregnancy though
Ankylosing spondylitis x-ray findings
-sacro-ilitis on pelvic x-ray (subchondral erosions, sclerosis)
-squaring of lumbar vertebrae
-syndesmophytes
-aytpical fibrosis on cxr
-bamboo spine
Discoid lupus eruthematosus sx + tx
erythematous, raised rash, sometimes scaly, may be photosensitive
more common on face, neck, ears and scalp
Tx: topical steroid, 2nd line oral hydroxychloroquine
Cubital Tunnel syndrome vs carpal tunnel syndrome
Carpal: pain/pins and needles in thumb, index, middle finger
Cubital: Tingling and numbness of the 4th and 5th finger which starts off intermittent and then becomes constant.
Investigations + findings for ankylosing spondylitis
Pelvic X-ray
-sacroiliitis: subchondral erosions, sclerosis
-squaring of lumbar vertebrae
-‘bamboo spine’ (late & uncommon)
-syndesmophytes: due to ossification of outer fibers of annulus fibrosus
-chest x-ray: apical fibrosis
What structure is divided in carpal tunnel surgery
flexor retinaculum- decompress median nerve
Carpal Tunnel tests
-Tinel’s sign: tapping causes paraesthesia
-Phalen’s sign: flexion of wrist causes symptoms
-weakness of thumb abduction (abductor pollicis brevis)
-wasting of thenar eminence (NOT hypothenar)
test for achillies tendon rupture
positive Thompson’s test is pathognomonic for Achilles tendon rupture; the patient lies prone and the calf muscle belly is squeezed. The test is positive if the squeezing of the calf does not cause plantarflexion of the calf.
Knee arthroplasty nerve damage
common peroneal nerve
ANCA associated vasculitis (Wegener’s granulomatosis) or (Churg-Strauss) Sx
-renal impairment
-resp problems (cavitating nodules on CXR)
-joint pain
-sinusitis and epistaxis
Ix: cANCA: wegners
pANCA: churg
Temporal arteritis RF
Polymyalgia rheumtica
Temporal arteritis fundoscopy
Anterior ischemic optic neuropathy: swollen pale disc and blurred margins
Bone disorder lab values
- Osteoporosis: all normal
- Osteomalacia: decreased Ca and Ph, increased ALP + PTH
- Primary hyperparathyroidism: Ca, ALP, PTH increased, Ph decreased
- Secondary hyperparathyroidism: Reduced Ca and Ph, elevated PTH and ALP
- Paget’s: isolated increase in ALP
Retinal vein occlusion fundoscopy
flame haemorrhages, cotton wool spots, optic disc swelling and macular oedema
Reactive arthritis triad
Conjunctivitis, urethritis and arthritis
Tx: NSAID
Gout Mx
Allopurinol (urate lowering) and then colchicine for acute flares (co-prescribe)
SE: diarrhoea
SLE Ix
- ANA postive (+/-anti dsDNA)
Monitoring: Raised CRP may indicate infection, complement levels C3, C4 are low during active disease
RA Mx
DMARD i.e. methotextrate + short course of bridging prednisolone
Flares: IM corticosteroids
Monitor using CRP
Septic arthritis Mx
Fluxloxacillin (clindamycin if allergic) 4-6 weeks
Pseudogout RFs and features
-haemochromatosis
-hyperparathyroidism
-acromegaly
Features: joint aspiration: shows weakly positive birefringent rhomboid shaped crystals
x-ray: chondrocalcinosis
Hip Fracture Mx
Undisplaced: intertrochanteric hip screw
Displaced: hemi or total arthroplasty
Polymyalgia Rheumatica Sx
> 60
Rapid onset
Aching, morning stiffness (NOT weakness)
mya how low mood, night sweats etc.
IX: raised ESR, NORMAL CK and EMG
Tx: prednisolone
Gout Sx
-pain
-swelling
-erythema
70% 1st presentations uasually affect 1st metatarsopharyngeal joints
Gout Ix
-measuring uric acid levels (>360 +ve)
-synovial fluid: needle shaped negatively birefringent monosodium urate crystals under polarised light
Hypocalcaemia Sx
CAT numb
C- convulsions
A- arrhythmias (QT prolongation)
T- tetany
N- numbness in hands, feet, peri-orally
Osteoarthritis Mx
1st line: topical NSAID
2nd line: oral NSAID + PPI
Antiphospholipid Sx, Ix, Mx
CLOT
C: clots
L: livedo reticularis (mottling)
O: obstetric complication (recurrent miscarriages)
T: thrombocytopenia
Ix: antibodies: anticardiolipin, lupus anticoag
-thrombocytopenia
-prolonged APTT
Mx: low-dose aspirin, if VTE, should be given lifelong warfarin (INR 2-3)
Most common site of metatarsal stress fractures?
2nd metatarsal
Immunoglobulin secreted in breast milk
IgA
Rheumatoid Arthritis Ix
-Rheumatoid factor
-Anti-CCP antibodies
-Yellow, turbid aspirate findings
Lumbar spinal stenosis
-Sx mimicking claudication
-Sitting is better than standing
Ix: MRI
Osteochondritis dissecans Sx and vs Osgood Schlatter
Knee pain, swelling, painful ‘clunk’
Osgood Schlatter: localised over tibial tuberosity, non-clunking
Drug induced lupus antibodies
Anti-histone antibodies
Septic arthritis causative agents by demographic
In general: S. Aureus
Young children: S. Pyogenes
Patients has a Prosthetic joint: S. Epidermidis
Sexually-active young adults: N. Gonrrhoeae
optic neuritis sx ix mx
-unilateral decrease in vision
-poor discrimination of colours (red desaturation)
-relative afferent pupillary defect
-central scotoma
Ix: MRI brain and orbits with gadolinium contrast
Mx: high dose steroids
Differentials for vasculitis
Usually infective- more acute representation than vasculitis
-HEP B C
-Infective endocarditis
-Cocaine use (granulomatous changes)
ANCA pathology
Antibodies against neutrophil granule components
cANCA (cytoplasmic)
pANCA (perinuclear)
Vasculitis DDs
- Systemic: infection i.e. endocraditis, neisseria meningitides, hep b & c
- malignancy: metastatic carcinoma, paraneoplastic
- vessel occulsion: embolitic and thrombolitic
- drugs i.e. cocaine can mimic GPA/wegner’s
Temporal arteritis is associated with which PMH
Polymyalgia Rheumitica
Avascular necrosis of femoral head RF and Imaging
RF: long term steroid use, chemotherapy
Imaging: X-ray may be normal, MRI is gold standard
Colchicine/Allopurinol gout guidelines
Lifestyle mods: reduce alcohol, lose weight
1.Colchicine first line (SE diarrhoea)
If on allopurinol continue in acute
- Allopurinol offered for urate-lowering therapy after first attack of gout or +4 attacks + colchicine cover for 6 months
PMR investigations
Raised inflammatory markers e.g. elevated ESR
Normal EMG and creatinine kinase
Anterior shoulder dislocation
Shoulder contour flattened
Small bulge below clavicle
May have sensory loss of badge patch area
Temporal arteritis Ix Tx
Raised ESR/CRP
Temporal artery biopsy (skip lesions)
Tx: high dose oral pred
If visual loss IV methylpred
Methotextrate SEs
mucositis
myelosurpression
pneumonitis
pulmonary fibrosis
liver fibrosis
Colles’ fracture
Fall onto extended outstretched hands
Described as a dinner fork type deformity
Classical Colles’ fractures have the following 3 features:
Features of the injury
1. Transverse fracture of the radius
2. 1 inch proximal to the radio-carpal joint
3. Dorsal displacement and angulation
Polymyositis
Sx: proximal muscle weakness +/- tenderness
Ix: elevated CK
associated with malignancy
High dose corticosteroids
Enteropathic arthritis
associated with HLA-B27
