Rheum revision

Question 1

Rheum in paces

Answer 1

Either falls or joints
ask about pain, swelling and inflam
features of vasculitidies
fhx
impact on pt life

need to be able to examine joints, spine, GALS

Question 2

Joint pain ddx

Answer 2

Oestoarthritis
Crystal arthiritis
Rheum
Spondyloarthititis (Reactive, Psoriatic,

Question 3

OA exam

Answer 3

Herberdens at DIP, Bouchards at PIP,
squaring of thumb
not involved of MCP
small joint or big joints

xray-
joint space narrowing, chondrosis, Osteophytes and sclerosis
erosion if hand OA

mx-
Pain management
Physio
Help- crutches, aids for ADL
Injection and surgery

Question 4

Crystal arthropathy

Answer 4

gout-foot-nsaid/colchicine OR steroids then allopurinol

Question 5

Ankylosing spondylitis

Answer 5

sacro-illitis
inflam back pain (SX)+ xray signs–now do MRI for faster diagnosis
HLA B27 assox
Assox with joint arthiritis, Uveitis, enthethitis (achilles tendon), Dactylitis (finger)

Mx- not use long term steroidss, cant use conventional DMARD
use biologics- TNFa-influximab, IL17 block

Question 6

Psoritatic arthrititis

Answer 6

DIP involve, sausage finger
xray–

mx-
not use long term steroidss,
conventional DMARD-methotrexate
use biologics- TNFa-influximab, IL17 block
JAK inhib

Question 7

RA mx

Answer 7

Methotrexate
TNFa inhbib
JAK inhib

Question 8

Reactive arthiritis

Answer 8

Mainly after chlamydia or GI (Salmonella, shigella, other)
HLAb27

ix- exclude other forms of arhtiritis

refer to GUM if needed
mx- Pain killers,
Steroids can be -injected in joints
30% dont get better for life–DMARDs are the way

Question 9

SJorgens

Answer 9

Parotitis, dry eyes, dry mouth
Anti-Ro/La, Rh+ve

mx

Question 10

Lupus

Answer 10

Mild- rash, gland swelling
Moderate- heart, lungs, bone marrow (pleurisy, neutropenia)
Severe- Glomerulonephritis, CNS

Ix-dsDNA, CRP/ESR
Monitor- dsDNA, ESR, C3/4 levels

Mx-
Prednis will work acutely
Hydroxyquloroquine v good for mild
More active- steroid sparing DMARD-methotrexate
Biologics-Rituximab

Question 11

Scleroderma

Answer 11

Limited-CREST (skin-arms)-CREST sx + pulm HTN

Diffuse- (Skin all around-esp arms, chest)
more severe-Lung disease, GI disease, Renal ischemic disease

Ix- SCL70-diffuse, anti-centromere CREST
then check organ involvement

Mx-very specialised
but reynauds mx- keep warm/ heated gloves
CCB- Nifedipine/Amilodipine
2nd-sildanefil

Question 12

Dermatomyositis

Answer 12

Heloptrope rash around eyes
rash around joints
weakness around proximal joints
(polymyositis is same w/o skin)
assox with CANCER-

Ix- CK up, not specific Abx
MRI scan of the involved muscles- fluid filled
Want to check for malignancy

Mx-

Question 13

GCA

Answer 13

Large vessels-aorta and cranial vessels
gives the temportal pain, jaw cramps,
EYES-vision issues
assox with PMR

Ix- ESR raised, USS scan-
temporal biopsy before the steroids ideally (if doubt on diagnosis)

Mx- 40mg Pred OD-treat before USS
relapse/persistant- metho, other

Question 14

Wergners/GPA

Answer 14

cANCA-
GPA- Kidneys, lung and nose
Ab-cANCA

Question 15

eGPA

Answer 15

pANCA
Saddle nose, Kidney, ashtma

Question 16

Henoch-Schonlein

Answer 16

Small vessel vasculitis-IgA vasculitis-
ddx-infection, platelet drop

See- Purpuric rash, Kidney blood, Arthiritis but well

Question 17

Osteoporosis Mx

Answer 17

t score< -2.5-(SD from the average for age)—>osteoporosis
normal progressive disease

advice-dietary (vit D calc), Smoking, Steroids, RA

mx-bisphosphonate
desonumab/rankL inhib