Rheumatological disorders Flashcards by Naina K

Types of rheumatic disease

Non-inflammatory

Inflammatory

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Types of rheumatic disease
Non-inflammatory

Inflammatory

Osteoarthritis

Rheumatoid arthritis
Systemic Lupus
Vasculitis

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Rheumatoid arthritis

What is it - what kind of disease

Who does it affect?

What does it involve

Disease of synovial joints
Affects 1%
Autoimmune, systemic inflammatory illness
Symmetrical joint inflammation and deformity - sub luxation of the bone
Extra-Articular features

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Rheumatoid arthritis symptoms

Inflammatory

Relieving factors

Pain
Early morning stiffness 
Stiffness after rest 
Ease with use/exercise 
Swelling Flu like symptoms 
Anti-inflammatory drugs e.g NSAIDs may be helpful, heat

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Inflammation signs

Can lead to

Calor, Rubor, Tumor, Dolor

Progressive joint deformity

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Side effects of rheumatology drugs

Infection

Bone Marrow toxicity =

Hepatotoxic = signs

Gastric upset signs =

Skin rashes

All increase risk
Reactivation of TB

Low WBC, low platelets, pancytopenia

Abnormal liver tests

Nausea, diarrhoea, flatulence

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Methotrexate

Don’t co prescribe with…

Lung issues

Contraindicated in

DMARD
1x weekly dose 15-25mg

Never co prescribe with trimethoprim –> severe bone marrow suppress =om

Lung complications
Pneumonia and fibrosis

Renal excretion

Nausea and mouth ulcers

Pre-conception period

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Biological drugs

Stop 2 weeks pro
Greater infection risk 
Reactivation of TB/Hep B and C 
Contraindicated if patient develops cancers
May exacerbate MS if TNF given

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Rheumatoid neck

Erosive change at C1 C2 and lower levels
Subluxation at the atlanto-axial level

Erosion causes changes at pannus articulating point

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Steps for rheumatoid neck

Ask about pain
When positioning check no new pain arises
Pre- inctubation - flexion and extension

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Caries/gingivitis in RA

Poor hand/neck/shoulder fx can impair dental hygiene
Immunsuppresive may compound this
Many have osteoporosis

Gingivitis MAY be a trigger

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Juvenile idiopathic arthritis

Occurring before age of 16 
Many different patterns 
Jaw underdevelopment
- micrognathia, malocclusion 
- pain

TMJ inflammation which as leads to altered mandiublar growth

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Spondyloarthropathy

Ankylosing spondylitis

Psoriatic arthritis
Enteropathic arthritis

Reactive arthritis

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Ankylosing spondylitis

Inflammatory spinal pain
Gradual calcification of vertebrae –> limited movement
Rigid fused neck or atlanto-axial subluxation

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Common feature of spondyloarthropathy

Enthesistis - inflammation of junction between tendon and ligament e.g swelling around achilles

Dactylitis - SAUSAGE finger/toe

Skin psoriasis

Inflammatory eye disease - red painful photophobic eye –> IRITIS/uveitis

Inflammatory bowel disease

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Large joint oligoarthritis

Swelling of knee

Psoriasatic arthritis

Psoriasis of nail bed 
Inflammation of fingers 
Distal arthritis 
Nail pitting
Dactylitis

Osteoarthritis

x ray findings

Degenerative process, exaggerated repair response
Pain, stiffness, deformity, reduced joint movement and instability
Increases with age
Occupation/hobbies increase risk
Footballers, hands and wrists

Loss of joint space
Osteophytes
Sub-chondral sclerosis

Commonest indication for joint replacement surgery

Banding of legs

Gout

What is it

Why

Treatment

Sudden, painful, red, swollen

Urate crystals which precipitate out into the joints from bloodstream
Intense neutrophil led inflammatory response

High serum rate

genetics
renal impairment
diuretics
dehydration
intercurrent illness
high alcohol, fructose, red meat, shellfish
part of a metabolic syndrome

NSAIDS
COLCHICINE
STEROIDS

Rate lowering drugs e.g allopurinol and febuxostat

Severe chronic gout

Chronic polyarticular tophaceous gout

Connective tissue disease

Rare auto immune systemic diseases
Certain common features

Life threatening due to organ involvement

Auto-antibodies

Examples of connective tissue disease

Systemic lupus erythematosus
Scleroderma
Primary Sjogrens
Polymyositis/dermatomyositis

Common features of connective tissue disease

Raynaud’s syndrome –> vasoconstriction of fingers and toes in response to cold (white for constriction, blue for cyanosis then red for hyperaemia)
Mouth ulcers
Cardiorespiratory disease

SLE

Lupus Malar rash Photosensitivity Non-erosive arthritis

Scleroderma / systemic sclerosis

Skin thickening and tightening Severe Raynauds --> digital ulcers, frank tissue necrosis, digital gangrene Can be limited to hands, feet and face --> LIMITED SYSTEMIC SCLEROSIS Widespread - DIFFUSE systemic sclerosis Oral tethering and telangiectasia Tethered digital skin

Sjogren's syndrome What is it Which glands does it affect and names of conditions Mechanism Signs of affected glands

Auto-immune inflammatory disorder Lacrimal, salivary, nasal, laryngeal, tracheal and vaginal Xerostomia and keratoconjunctivitis sicca Marked lymphocytic infiltration destroying gland architecture and fx Swollen, inflamed, tender and later atrophic Glossitis

Polymyositis and dermatomyositis

Associated with muscle inflammation Weakness of arms and thighs painless wasting Both associated with lung fibrosis 1. muscle involvement ONLY 2. inflammation of muscles AND skin - photosensitivity - strong association with internal malignancy

Treatment for connective tissue diseases

NSAIDs steroids DMARDS Cytotoxic drugs Biological drugs

Sjogrens' phases Associated with

Primary - if occurs on its own - dry eyes and mouth - high immunoglobulins - fatigue and joint pain - rare but serious complications - vasculitis, renal involvement, neurological involvement, lymphoma Secondary - if occurs in association with other rheumatoid diseases Histology - intense lymphocytic infiltration --> disruption of normal gland Atrophy of tongue and parotid gland, bilateral parotid enlargement Lymphoma and rheumatoid arthritis Bilateral parotid enlargement, inflammatory arthritis, neuropathy, neuralgia

Xerostomia Occurs due to.. Causes Signs and symptoms

Marked reduction in saliva production Difficulty chewing or swallowing, articulation, increased caries risk Sore tongue, oral mucosa

Keratoconjunctivitis sicca

``` Common symptom complex Dry red itchy sore photophobic eyes Decreased tear secretion --> conjunctival ulcers Painful to blink Eyes feel gritty ```

Further investigations of Sjogren's

Sialometry - rate of saliva production Sialography - anatomy of gland Scintigraphy Labial gland biopsy

Treatment of Sjogren's

``` Control disease Symptomatic control Stimulation of residual salivary gland Attention to dental hygiene Avoid smoking and drugs e.g antidepressants ```

Behcet's disease Symptoms Treatment When else can ulcers be found

Oral and genital apthous ulcers Skin lesions Thrombophlebitis ``` Good OH Review physical trauma Topical barriers Topical steroids Oral colchicine Oral steroids Disease modifying drugs ``` Inflammation of mucous membranes as part of systemic illness

Mouth ulcer tx

Topical steroids | Mouthwashes

Reiter's syndrome Due to

Associated with reactive arthritis post GUI or GI infection Rash of hands and feet Ulceration of the tongue and palate Infection (gut or STI)

Candidiasis Tx

``` Common in rheumatology patients Immunosuppressed Sore red mouth Reduce steroids Nystatin Flucanazole Mouthwashes ```