Rheumatology Flashcards
In drug induced SLE what antibody can be present?
Anti - Histone
First line investigation in Ankylosing Spondylitis
Lower Spine X - Ray
if negative but strong suspicion - use MRI to determine if early signs
Fluctuating fever - spiking in the evening Salmon pink rash Arthralgia Increased ferritin Lymphadenopathy
Stills Disease
Stills Disease Diagnosis
Increased Ferritin
RF and ANA -ve
Stills disease - Management
NSAIDs - 1 week
Steroids + NSAIDs
Methotrexate
IL-1 or anti TNF
Commonest cardiac complication of SLE
Pericarditis
Causes of drug induced lupus
Procainamide
Hydralzine
Isoniazide
Phenytoin
Management of drug induced lupus
Stop offending agent
Management of Psoriatic arthritis
NSAIDs -> Intrarticular corticosteroid injections -> Methotrexate
AVOID oral steroids as can cause psoriasis flairs
Arthritis
Uveitis
Urethritis
Yellow waxy rash on soles of feet = keratoderma Blennorrhagica
Reactive Arthritis
Chlamydia
Shigella, Campylobacter, salmonella
Reactive arthritis diagnosis and management
Joint aspirate shows elevated WCC but no culture or gram stain
Chlamydia - STI
Campylobacter or salmonella if diarrhoea prodrome
NSAID + interarticular steroid
Methotrexate or sulfasalazine for persistent
Commonest Juvenile Idiopathic Arthritis
Pauciauricular or oligoarticular
Child + systemically well Tired Arthritis affecting medium sized joints - knee ankle etc Limp ANA +ve Duration over 6 weeks
Oligoarticular Juvenile Idiopathic Arthritis
Child Pyrexia Salmon Patches Lymphandenopathy Uveitis Arthritis Weight loss
Systemic Juvenile Idiopathic Arthritis
juvenile idiopathic arthritis management
NSAIDs
DMARDS
Intrarticular corticosteroids
Ensure physical activity is continued
Fuzzy brain
Poor sleep
Generalised pain -> focal very painful areas
Fibromyalgia
Explain diagnosis -> aerobic exercise -> CBT -> pregablin duloxetine
In gout what should be started alongside allopurinol?
6 months cover of colchicine should be given. Even if no current flair up.
Anti dsDNA vs ANA - SLE
Anti dsDNA - very specific not very sensitive
ANA - Very sensitive but not very specific
Shobers test
Distance should increase by more than 5 cm
Find L5 - find and mark 10cm above and 5cm below this.
- ask patient to bend forward. The distance should increase by >5cm
What pulmonary involvement is linked to Limited systemic Sclerosis
Pulmonary Hyertension
What pulmonary involvement is linked to Diffuse Systemic Sclerosis
Pulmonary fibrosis
In Polymyalgia Rheumatica with no GCA signs what is the management.
Prior to starting steroids screen for issues that can be compounded by long term steroid use.
Random Blood glucose and a HbA1c
DEXA scan if FRAX score is high
What is used if there is ophthalmic artery involvement in GCA?
IV methyprednisilone
1st line management of raynauds phenomenon
Nifedipine
HSP management
NSAIDs and antihypertensives if required
Regular urine dip for 12 months post episode
Management of SLE
NSAID + Hydroxychloroquine +/- steroid for flair up
Neuro/renal/haem involvement = cyclophosphamide + high dose steroid
Rheumatoid Arthritis management
DMARD usually methotrexate + bridging steroid
Inadequate response to two DMARDs = Etanercept or Infliximab
How is disease activity monitored in Rheumatoid Arthritis
DAS28 and CRP
Small and medium vessel arteritis linked to hepatitis B
Polyarteritis Nodosa
What vessels aren’t affected in polyarteritis nodosa?
Pulmonary
Management of polyarteritis nodosa
Steroids + cyclophosphamide
10-40 year old asian female
Absent limb pulses
Fatigue
Takayasu Arteritis - Large vessel arteritis
Steroids is mainstay of management
Which DMARD can be used to manage a severe unremitting relapse of Rheumatoid arthritis in pregnancy?
Hydroxychloroquine
Sulfasalazine
Mild psoriatic arthritis can be managed how?
NSAIDs
Management of Sjogrens
Arthritis - hydroxychloroquine + NSAID
Rest is symptomatic - lubrication artificial tears etc
What antibody has the highest specificity for Rheumatoid Arthritis?
Anti CCP
Rheumatoid Factor - as specific but not as sensitive as occurs more often in general population
