Rheumatology Flashcards
How do osteo and rheumatoid arthritis compare on
Stiffness
Distribution
Finger joints
Systemic upset
Osteoarthritis // rheumatoid
Worse on movement // better on movement
Unilateral, large joints // Bilateral, smaller joints
DIP, PIP // MCP, PIP
No // Yes
What is this XR of?
Osteoarthritis
Loss of joint space, osteophytes at joint margin
What is this XR showing
Rheumatoid arthritis
Loss oj joint space
Perarticular erosions
Subluxation
How do you treat osteoarthritis?
- Oral paracetamol + topical NSAIDs
- Oral NSAIDs + PPI
- Consider weak opiates (eg codeine)
What are the investigations and scoring cut offs for rheumatoid arthritis?
XR for bone status + anti-RF (do Anti-CCP if -ve as more specific)
DAS >=2.6 OR ELAR >=6.0
What is the treatment ladder for RA?
- HCQ (mild) / MTX / LFM / SFZ
- Combo of 2 above
- MTX + TNFi
- MTX + rituximab
Which DMARDs are safe in pregnancy
SFZ/HCQ
Which DMARD causes
Immunosuppression
HTN + neuropathy
Strange visions (nightmares, blurry)
Reactivates TB
Methotrexate
Leflunomide
Hydroxychlorquine
TNFis
How can you differentiate psoriatic arthritis from rheumatoid
Can be assymetrical and affect DIPs
Potentially have psoriatic lesions following the joint pain
What are the investigations for psoriatic arthritis?
XR: erosion + new bone formation, ‘pencil in cup’
What is the treatment for psoriatic arthritis?
NSAIDs for pain
DMARDs –> anti-TNF –> Ustekinumab
Since they both occur following infection, how can you separate reactive arthitis and septic arthritis?
Perform a joint aspirate
Reactive will have no crystals or pathogens
Also, reactive arthritis has triad of cant see, pee or climb a tree
Reaactive more assoicated with GI and chlamydia while gonorrhea is more septic arthritis
How do you treat septic arthritis
BNF says Fluclox (clindamycin) 4-6 weeks
IVOST after 2 weeks
How do you distinguish ankylosing spondylitis from spinal stenosis?
Ank spond // Spinal stenosis
Back pain, anterior uveutis, other things beginning with A// claducation
Reduced flexion (Schober’s <5cm) // relieved on bending forward
Bamboo/question mark spine on XR // XR/MRI for canal narrowing
What is the treatment algorithm for ankylosing spondylitis?
- NSAIDs
- DMARDs if peripheral joint involvemnet
+ TNFi if resistant
Regarding connective tisssue diseases, which conditions are most associated with the following?
1) Anti-dsDNA
2) Anti-sm
3) Anti-histone
4) Anti-Ro
5) Anti-La
6) Anti-scl70
7) Anti-centromere
8) Anti-Jo, SRP
9) Anti-RNP
1-2) SLE (dsDNA more specific)
3) Drug induced lupus (will be dsDNA -ve)
4-5) Sjogren’s (Ro 70%, la 30%)
6) Diffuse systemic sclerosis
7) Limited systemic sclerosis
8) Polymyositis
9) Mixed connective tissue disease
Joint pain + fatigue + ulcers + photosensitive rash suggests what?
Lupus
For SLE, what do you use for…
Symptoms
Control
NSAIDs, Steroids, suncream
Mild: HCQ
Severe: Immunosuppressants
Resistant: Rituximab, belimumab
How can PMR and myositis be distinuished based on
Features
Lab findings
PMR // myositis
STIFFNESS in hips and shoulders // WEAKNESS in hips and shoulders + skin maniefasations if dermatomyositis
normal CK // raised CK, anti-jo, SRP
How do you treat polymyalgia rheumatica?
Exercise
5mg prednisilone
What is the definitive investigation and treatment steps for myositis?
Muscle biopsy showing immune cell infiltration
40mg prednisilone
Immunosuppressants/IGs/Biologics if that does not work
How does systemic sclerosis and polymyositis differ in terms of
Features
Antibodies
polymyositis // Systemic sclerosis
Both have fibrosis and dysmotility
Proximal muscle weakness // CREST
Anti-Jo, anti-synthase // Anti-centromere (central =limited), Anti-scl70 (Scl=Systemic)
Following a diagnosis of polymyositis, what do you need to check for?
Malignancy
Dry eyes + mucosa + joint pain indicates what?
How do you investigate this?
How do you treat this?
Sjogren’s syndrome
Antibodies: ANA, RF, Ro and La
Schirmer’s to measure tear formation
Artificial tears and pilocarpine for saliva
What is a complication of Sjogren’s?
Increase in lymphoid malignancy
Differntiate temporal arteritis and takayasu
Temporal // takayasu
>50s, rapid onset of headache and jaw claudication; PMR symptoms // <50s asian women; renal artery stenosis
How do you investigate and treat temporal arteritis?
Temporal artery biopsy shows skip lesions
High dose pred OR IV dex if visual loss
Taper steroids down after that
As both have sinusitis and breathlessness how do you differentiate eGPA and GPA?
eGPA: Asthma, pANCA, eosinophils
GPA: Nosebleeds, cANCA
