Rheumatology Flashcards
Hot, Swollen, Painful Knee
Septic arthritis
Ix - blood cultures and mc+s of joint aspirate
Rheumatoid nodules
Indicate severe disease - necrotising granuloma
A 21 year old man had an attack of urethritis 7 days ago. He now has a swollen left ankle and a painful right knee. He also has bilateral conjunctivitis
Reactive arthritis - likely to resolve within 6 months
Ankylosing spondylitis presentation
Pain and stiffness at night and first thing in the morning
Mx - anti TNF
Most common cause of dactylitis
Swelling of whole digit
Psoriatic arthritis
Allopurinol use
Titrate to achieve a serum urate level below lower limit of normal range
Methotrexate side effect
Nausea
Teratogenic
Side effect of alendronic acid
Indigestion and epigastric pain
A 27 year-old lady reports fatigue and frequent mouth ulcers.
She has developed a rash to her cheeks worse in sunlight - which ab is most likely to be present
SLE - ANA
A 63 year old man presents with a 4 day history of severe headache of sudden onset.
He has also had transient visual loss to his left eye. He reports jaw cramping when chewing and has been feeling unwell for about 3 weeks - diagnostic test
Giant cell arteritis
- CRP
- USS and biopsy
Which anti-hypertensives should be avoided in Raynaud’s phenomenon
Bisporolol
61 year old man presents with 6 weeks of pain to his shoulder and hip girdles that came on suddenly. There is marked morning stiffness but no weakness. Shoulder movements are globally restricted due to pain - blood results
Polymyalgia rheumatica
Bloods:
- normal creatine kinase and raised CRP
When is a urine dipstick considered essential in assessing disease activity
SLE
Lady has gritty eyes, Raynaud’s phenomenon and her oral mucosa appears dry.
What is the most likely diagnosis?
Sjogren’s
Septic arthritis risk factors
Immunosuppression Diabetes IV drug abuse Pre-existing joint disease Extremes of age
Pathophysiology of septic arthritis
Haematogenous spread - bacteraemia
Bacteria settle in synovium leading to rapid cartilage breakdown
Can get direct infection due to orthopaedic surgery or penetrating injury
Reactive arthritis associated conditions
Psoriasis
Enthesitis - Achilles tendinitis
Ankylosing spondylitis
Baseline tests required for methotrexate use
U+E
LFT
What needs to be addressed before taking methotrexate
Alcohol consumption Plans to have children Need for contraception Avoidance of breast feeding Ability to attend for regular blood test monitoring
SLE blood results
Low WCC
Low platelet count
Raised plasma viscosity relative to CRP
SLE urine analysis
Blood and/or protein
Polymyalgia rheumatica progression
Resolution within an average of 2 years
No long lasting damage to muscles or joints
Symptoms likely to improve rapidly with corticosteroids
Mx of PMR
Prednisolone
Calcium and vitamin D
Alendronic acid
Asymmetrical
Reactive arthritis
Psoriatic arthritis
