Rheumatolog/MSK Flashcards
Indication of Allopurinol in Gout
After the first attack of Gout
(Usually once the patient is not in pain and inflammation has settled) (No longer a 2 week hard wait)
How long should you continue Allopurinol
Until Urate levels are <300micromol/L
5 Other indications when starting allopurinol
1) >2 attacks of Gout in 12 months
2) Prophylaxis when starting cytotoxic drugs (Chemo)
3) Uric acid Renal stones
4) Tophi
5) Renal disease
What is a complication of long term steroid use in PMR that affects the bones
1) Osteoporosis
2) AVN of the long bones i.e femoral head
How would Avascular necrosis present
Progressive pain (Long bones) - I.e femur which affects weiht bearing ability/ROM of the affected side
Four Causes of Avascular necrosis
1) Long term steroid use
2) Trauma
3) Chemotherapy
4) ETOH Excess
Most sensitive investigation to Dx Avascular necrosis
MRI
1st line investigation for AVN
X ray - However, may not pick up early disease
Gold standard - MRI
What are the typical X ray signs of Avascular necrosis
1) Flattening of the vascular head at the acetabular joint- Crescent sign
2) Subchondral fractures
What are the patterns of joint involvement of Psoriatic arthritis
- DIP joints - Symetrical Polyarthritis vs assymetrical oligoarthritis
- Sacroilitis
Signs of Psoriatic arthritis
- Skin - Psoriatic rash (Elbows)
- Nails - Pitting, Oncolysis
- Dactylitis
- Tenosynovitis - Tendons of the flexor compartment of the hand
- Enthesitis - Plantar fascitis, Achiles tendonitis
- X ray - Pencil in cup deformity of the DIP joints
Rx of Psoriatic arthritis
Mild - NSAID
Mod/severe - Methotrexate –> Monoclonals
PDE-5 Inhibitor - Apremilast
What type of athropathy is psoriatic arthritis
Seronegative athropathy part of the HLA-B27 group
How does an ulnar nerve palsy present - Symptoms
1) Tingling/numbness of the MEDIAL 1.5 digits
2) Muscle wasting of the hypothenar eminence
What clinical examination tests can be used to Dx/differentialy Cubital tunnel syndrome
Fromet’s sign
-You ask the patient to grip a piece of paper between the thumb and index finger
- You then pull the paper away - Apply resistnance
- +ve test - Flexion of the thumb at the interphalangeal joint
- WHY - Compensatory effect - as the Ulnar nerve supplies the adductor policis muscle which becomes weak
What is the most common cause of foot drop
Common peroneal nerve palsy
What causes common peroneal nerve palsy
Caused by kneeling, crossing legs for prolonged period to time
Also caused by weight loss/Bakers cyst
Pathophysiology of Common peroneal nerve palsy
Compression of the common peroneal nerve at the level of the neck of the fibula
5 causes of foot drop
Most common - Common peroneal nerve palsy
L5 Radiculopathy - Foot drop + Weakness in Hip flexion
Stroke
Sciatic nerve lesion
When to refer a patient with footdrop to a specialist
Bilateral foot drop
Fasiculations
hypo/hyper reflexia
What is Raynauds phenomenon
Transient vasoconstrictio of distal arterioles resulting in pain/colour change of the digits
How would you characterise Raynaud’s Phenomenon
Primary - Young women aged in their 30’s
Secondary:
What is the most common secondary cause of raynauds phenomenon
Scleroderma
- CREST Syndrome in systemic sclerosis
- Diffuse scleroderma (Affecting organs) - scl-70+ve
What are the secondary causes of Raynauds (6)
Connective tissue disorders:
- Scleroderma
- Rheumatoid
- SLE
Leukaemia
Cervcial rib - Bilateral - constricting the subclavians
Vibrating tool use
Contraceptive pill
