Rheumatology Flashcards
Rheumatoid arthritis
Autoimmune
Inflammation of synovial joints
RA vs OA morning stiffness
Ra >30min
OA <10min
Sjorgens
Inflammation of lacrimal glands
Dry mouth and eyes. Joint fatigue and pain.
Ro and La antibodies.
Primary vs secondary sjorgens
Primary occurs on own but secondary occurs with rheumatic illness e.g. RA
Hand signs of RA
Swan neck of fingers Ulnar deviation (fingers out to side) Knuckle swelling and subluxation Z thumb Boddy swelling (except Knuckle near finger nail)
Extra articular RA features
Lung - nodule, fibrosis and crackles
Cardiac - Myocarditis, valve Inflammation
Skin- nodules on back of elbow (rheumatoid nodules) and inflamed small BV
Secondary sjorgens
RA blood test
Anaemia
Abnormal platelets
Inflammatory markers (CRP, ESR)
Auto antibodies
Xray early ra signs
Osteopenia around joing
ST swelling
Late RA Xray signs
Erosins
Narrow joint space
Subluxation/dislocation
Ankylosis (fusion)
RA treatment steps
Relief then dmards then biologic
Methotrexate
DMARD Often used in combo with another DMARD Lowers Inflammation Renally excreted and has some lung comps Nausea and mouth ulcers Contraindicated preconception
Stop 2 weeks prior to surgery until 2 weeks later or would heals
Biologic drugs
IV infusion or injection weekly
Decrease inflammation by targeting specific part of immune system
Anti TNF is main (Infliximab)
Stop 2 weeks prior to surgery until 2 weeks later or would heals
Why are biologic drugs sometimes forgotten by pts?
Not on repeat prescription as given as injection or IV infusion
Rheumatoid neck
Erosion of c1/c2.
Can compress SC (drunken walk, pins and needles, hand feet sense change).
Wonky head
Dental chair positioning.
RA OH impact
Hard to hold toothbrush
Immunosuppressive drugs compound caries and gingivitis
Pt often have osteoporosis (bisphosphonates- MRONJ)
Juvenile idiopathic arthritis
<16 years old
Jaw underdevelopment due to altered mandibular growth due to TMJ inflam
Ankylosing spondylitis
Spibe Inflammation
Late teens to early 30s onset
Back pain
Stooped posture that’s fixed
Biologic drugs
Eye condition often in those with ankylosing spondylitis
Anterior uveitis
Osteoarthritis
Degenerative
Cartridge breakdown in joint causing bone on bone
OA risk factors
Age
Occupation - high impact
OA symptoms
Pain
Stiffness
Decreased movement
Joint instability
Bouchard’s and Heberden’s nodes
Bony knuckle enlargement, sign of OA
H=end finger joint
B = mid finger
OA joint xray signs
Loss of joint space
Osteophytes (bone fragments)
Subcontral sclerosis (thickened bone)
OA Tx
Weight loss
Physio
NSAIDS
surgery
Osteoporosis aetiology
Hormonal Nutrition Genetics Age Smoking alcohol Activity
Bisphosphonates
Inhib bone resorption
MRONJ risk
Gout
Urate crystals precipitating out of blood causing neutrophil inflammatory response
Red, swollen, painful
Scleroderma
Autoimmune causing increased collagen
Tight lips
Red lips (telangiectasia) bv close to surface
Often also have raynauds
To CT disorders
NSAIDS
DMARDS
Cytotoxic
Biologic
Osteosarcoma
15 to 30
Metaphysis in knee
Chondrosarcoma
Mid age to old
Ribs, pelvis, proximal of long bones
Ewings sarcoma
Under 20
Diaphysis (long bone shaft)
Undifferentiated sarcoma
Mid age to elderly
Metaphysis (wide part of long bones)
Osteomyelitis
Infection of long bones
At risk if recent fracture
