Rheumatology Flashcards
Gout
Common in older men, big toe most likely
Swelling, joint pain +++, tophi
Blood: Uric acid++
Joint aspiration: needle shaped, negative birefrigent
Acute attack: 1st NSAIDS/Colchicine (diarrhoea), 2ng oral pred/intraarticular steroid
Prevent attack: START urate lowering therapy after first attack of gout(delay until after acute attack) with -1st allopurinol with colchicine/NSAIDS cover 2nd febuxostat
Lifestyle: no alcohol, lose weight and no purine food
Rheumatoid arthritis
Twice as common in women
Peak age 40-50
HLA DR1 &4
Px: painful swollen hands and feet joints, positive “squeeze test”(pain on squeezing the MC or MT joints)
Swan neck and boutonnière deformity (DIP and PIP)
Z-deformity (this is hyperextension of IP joints but fixed flexion of MCP joint, unlike the above)
Extra articular nodules
Resp: pulmonary fibrosis, pulmonary nodules
Ocular:ketoconjunctivitis sicca (this also presents in Sjogren’s syndrome)
Ix: rheumatoid factor (sensitive but not specific), anti CCP(v specific)
X-ray needed for all hands and feet(NICE): LESS( loss of joint space, erosions, soft tissue swelling, subluxation
Tx: start DMARD( 1st: methotrexate (myelosuppresion, liver cirrhosis, pneumonitis)
2nd sulfasalazine(oligospermia so safe in pregnancy as no sperm needed 😀)/ hydroxycholoroquine(eye damage)
)
Then combine then TNF-inhibitor - etanercept/adalimumab: reactivation of TB
Bad prognosis if these: RF(IgM)/Anti ccp +ve, HLA DR4 +ve, extra articular features
Polymyalgia rheumatica
Elderly women with bilateral pain and morning stiffness in shoulder, neck and hip muscles
Dx: clinical, ESR raised(>40)
Tx: prednisolone 15 mg OD and see in a week-if no improvement then it is not PMR
If eye symptoms(GCA) then needs same day referral for IV methylpred
SLE
SOAP BRAIN MD serositis (pleuritis, pericarditis) Oral ulcer Arthritis Photosensitivity Bloods(all low, Hb, Platelet, WCC) Renal(lupus nephritis- protenuria) ANA Immunology(DS DNA) Neurological(seizure)
Malar rash
Discoid rash
