Rheum / MSK Flashcards
Osteoporosis risk factors
SHATTERED Family
Steroid use >5mg/day prednisolone
Hyperthyroidism; hyperparathyroidism, hypercalciuria
Alcohol and tobacco use
Thin (BMI <22)
Testosterone low (e.g. anti androgen in cancer of prostate)
Early menopause
Renal or liver failure
Erosive/inflammatory bone disease (e.g. RA or myeloma)
Dietary Ca low/malabsorption or Diabetes mellitus type 1
Family history
Back pain history
SOCRATES
Early morning
Red flags
- Feel when wiping
- Urinary retention / incontinence
- Bowel incontinence
- Pain + weakness in legs
Weight loss
Bowel habit
Trauma - even minor falls
OP risk factors
Band like pain round chest or abdo
Infective - Fevers / Night sweats
Social
Alcohol
Smoking
IVDU
PMH
HIV
Immunosupression
Diabetes
Previous back surgery
DH
- Steroids
- Immunosupressives
- Any NSAIDs - important for Ank spond
FH
IBD
Psoriatis
Social
How affecting function and work
Smoking - especially for inflam back pains
Ank spond additional features to ask about
All the other seroneg arthritis
Skin rash - psoriasis
IBD / bowel symptoms
Recent infection / STI
Anterior uveitis
Enthesitis - Achillies / golfers / tennis elbow / plantar fasciitis
SOBOE
Pain ful red eyes
Frothy urine
pain achilies
AAAAAAs of ank spond
- Aortic regurg
- AV block
- Anterior uveitis
- AA Amyloidosis - Nephrotic syndrome
- Achilles tendonitis
- Apical pulm fibrosis
Which are the segregative arthritis
HLA B27
Psoriatic arthritis
Enteropathic - IBD
Ank spond
Reactive arthritis
Score for symotoms in Ank Spond
BASDI score
Bath Ank Spond disability index score
Main breathing issue in Ank Spond
Restrictive breathing defect
Exam of inflam back pain eg ankle
Hands nail pitting
Squeeze of joints
Spinal movements
Forward / back / side / twist
Schobers test
Spinal palpation
Precuss spine
Listen to heart and lungs
Chest expansion
Hip flexion / extension
How do you do schobers test
Draw a line between dimples
Draw line 10cm above and 5cm below
then bend foward and measure lumbar spine movement
Should be >10cm
If <5 likely pathological;
5-10cm intermediate
Ank spond Ix
ECG - AV block
Renal dip - protein -> ACR
CXR - fibrosis / failure
FBC / CRP evidence of infection
Consider HLAB27
If peripheral arthopathy
CCP / ANA / RF
Imaging
- XR sacroiliac joints
- MRI more sensitive but less specific
Management of Ank spond
Physio stretching
Education
NSAIDS x2 -> Anti-TNFa
If peripheral disease - DMARDS eg methotrexate / sulphasalazine
Discitis key risks
IVDU
Immunosuppressed
TB - ever treatment or from endemic area
Brucella - Mild / unpasterised cheese
- Farmers / vets (vets as aerosol from placenta high risk)
