Rheumatological Red Flags Flashcards
Which vessels are typically effected in GCA?
Typically the proximal branches of the aorta
What is the cause of pseudogout?
Calcium pyrophosphate crystals
When do you suspect giant cell arteritis?
Caucasian men and women >55
New headache
Jaw claudication
Unexplained fever
Polymyalgia rheumatica type symptoms
What are some clinical features sugestive of systemic inflammation?
Fatigue
Lethargy
Insidious onset
What is the target of rituximab?
B cells
Pathologically, how does GCA appear on biopsy?
Patchy
Giant cells
Destruction of elastic intima
What are some causes of a severe monoarthritis?
Septic arthritis
Crystal arthritis
Subchondral bone lesion
Haemarthrosis
(palindromic rheumatism)
What are the large vessel vasculitidies?
GCA
Takayasu
What are the medium vessel vasculitidies?
Kawasaki’s
Polyarteritis nodosa
What are the small vessel vasculitidies?
ANCA associated
- Wegener’s
- Microscopic polyangiitis
- Churg-Strauss
Immune Complex Associated
- Cryoglobulinaemia
- IgA
- Hypocomplementemic Urticarial Vasculitis (HUV)
- Anti-GBM (Good Pastures)
What is Behcet’s? What are it’s characteristic manifestations?
Multisystem, variable size vasculitis
Aphthous ulcers, genital ulceration, and uvitis
What is polymyalgia rheumatica? What is it associated with?
A chronic inflammatory disease of the elderly characterised by proximal myalgia’s, particularly of the shoulder girdle
Giant cell arteritis
Malignancy (paraneoplastic effect)
What are some complications of GCA?
Ophthalmic artery - Blindness
Subclavian - Arm claudication
Coronary - Angina, infarction
Carotid - Stroke, TIA
Aorta - aneursym
Iliac - leg claudication
Renal - renovascular hypertension
Mesenteric - Bowel infarction
What must be done in response to a GCA diagnosis?
Commense prednisolone 40-80mg
Temporal artery biopsy
When should methotrexate be considered as an alternative therapy in GCA? What dose?
When long term, high dose (5-10mg) steroids are required and the risk of steroid side effects are high
7.5mg up to 20mg weekly
What is the typical pattern of joint involvement in septic arthritis?
Single, large joints
What are some important Ix for septic arthritis?
Joint effusion
Plain xray
MRI
FBE/Blood cultures
CRP
What should be considered when managing septic arthritis?
Possible infective endocarditis
Deep abscess
What is the impirical therapy for septic artheritis (prior to culture results)?
2g of Flucloxacillin 6 hourly IV
Arthroscopic Joint wash out
With what signs and symptoms can small vessel vasculitidies present?
Fever, malaise, weight loss
Rash (palpable purpura)
Mylalgias, arthralgia
Nail fold infarct
Mononeuropathy multiplex (eg foot drop)
Haematuria, proteinuria
Diffuse alveolar haemorrhage
Upper respiratory tract infection
What are some DDx for small vessel vasculitis?
Meningococcal
Straphylococcus endocarditis
Subacute infective endocarditis
Thrombocytopenic purpura
Arterial thrombosis
What is Henoch-Schonlein purpura?
An IgA mediated, small vessel vasculitis that presents with palpable purpura in the lower limb
What is cryoglobulinaemia? How are they classified?
Single or mixed immunoglobulins that undergo reversible precipitation at low temperatures
Essential, idiopathic
Secondary to another disease
In which patient cohort might you suspect that a acute polyarthritis is attributable to infection?
Young person with multiple/new sexual partner - disseminated N. gonorrhea
What are the typical agents of septic arthrits?
Staph aureas
Streptococcus pyogenes
N. gonorrhea
E. coli
What are some DDx for a palpable purpritic rash?
Meningococcal meningitis
Staphylococcal bacteraemia
Subacute bacterial endocarditis
Drug reaction - OCP or Abx
Henoch-Schonlein purpura
TTP
Arterial thromboembolism
How does Henoch Schonlein purpura present?
Fever
Anorexia
Headache
Purpura
Abdo pain and vomiting
Joint pain
