Rheum/Msk

Question 1

Rheum Summary?

Answer 1

Evidence of rheumatological disease

* Acute/chronic/acute on chronic 
* Mono/polyarthropathy 
* Symmetrical/asymmetrical 
* Small/medium/large joints 
* With/without systemic features
* Active disease/in remission
* Complications: 
* Mobility 
* Functional 
* Skin, eyes, mucosa, serositis 
* Growth 
* Complications of treatment - Cushingoid 

Main DDx is…

Question 2

Rheum/Msk Ix and Mx?

Answer 2

Ix
* Urine MCS, Echo
* Pathology - FBE CRP ESR UEC LFT
* ANA RF C3 C4 dsDNA ENA
* Special - slit lamp - uveitis, Echo pericarditis, renal Bx nephritis

Mx
* Analgesia - NSAID, PPI, physio
* Intra-articular steroid - mono/oligoarthropathy
* Systemic steroid
Disease modifying - Methotrexate, Biologics

Question 3

Juvenile dermatomyositis - key signs and Mx?

Answer 3

• Proximal weakness/myopathy - 90-100% + muscle pain and tenderness 30-83%
  
  • Malar rash, heliotropic rash and peri-orbital edema
  • Gottron papules over fingers 57-91
  • Calcinosis
  • Peringual capillary changes
  • Dysphagia and dysphonia 13-40%
    Mx - steroid, MTX, hydrochloroquinine

Question 4

SLE - signs, Ix, Mx?

Answer 4

Features:
Most common
* Fever
* Fatigue
* Haematological
* Arthritis
* Nephritis

* D - Discoid rash (rings) 
* O- Oral ulcers
* P - Photosensitivity 
* A - Arthritis - 2 or more joints, knees, carpal, fingers PIP
* M - malar rash - butterfly distribution, spares nose
* I - Immune markers
* N - Neurological - psychosis, seizures
* E - ESR 

* R - Renal - nephritis
* A - ANA 
* S - Serositis - pericarditis, pleuritis, peritonitis
* H - Haematological - cytopenias, haemolytic anaemia

Ix
* FBE - cytopenias
* Inflammatory markers
* Coags
* Renal Ix
* Thyroid

SLE antibodies
* ANA, anti dsDNA, ENA, anti-Ro, anti-La, C3/C4

Mx
* Hydroxychloroquine (retinal pigmentation, colour vision, 6/12 opthal
* Steroids
* Immunosuppressives - MTX, leflunomide, AZA, MMF (mycophenolate), cyclophosphamide
* Severe - PO/IV cyclophosphamide
Belimumab