Rheumatology Flashcards
1
Q
What is osteoarthritis
A
Wear and tear of the joint
Not an inflammatory condition
Occurs in synovial joints
Due to: genetic factors, overuse, injury
2
Q
What are the risk factors for osteoarthritis
A
Obesity
Age
Occupation
Trauma
Female
Family history
3
Q
What X-ray changes would be seen in osteoarthritis
A
Loss of joint space
Osteophytes
Subarticular sclerosis (increased density along joint line)
Subchondral cysts
Do not always correlate with symptoms
4
Q
How might osteoarthritis present
A
Joint pain
Joint stiffness
Worsens with activity
Leads to: deformity, instability, reduced function
5
Q
Which joints are commonly affected by osteoarthritis
A
Hip
Knee
Sacro-iliac
Distal-interphalangeal
Metacarpal-phalangeal (base of thumb)
Wrist
Cervical spine
6
Q
What are the signs of osteoarthritis in the hands
A
Herbeden’s nodes (in DIP joints)
Bouchard’s nodes (in PIP joints)
Squaring at base of thumb
Weak grip
Reduced range of motion
7
Q
What are the NICE guidelines for osteoarthritis diagnosis
A
Can be diagnosed without investigations in > 45s with:
- Activity related pain
- No morning stiffness
- Stiffness lasting < 30 mins
8
Q
What is the management for osteoarthritis
A
Patient education
Lifestyle modification
Physiotherapy
Analgesia
Intra-articular steroid injections (temporarily reduce inflammation)
Joint replacement
9
Q
What is rheumatoid arthritis
A
Chronic inflammation of synovial lining of joints, tendon sheaths, and bursa
Inflammatory arthritis
‘Boggy’ joint swelling
Symmetrical
Affects multiple joints
F>M
Associated with HLA-DR4 and HLA-DR1
10
Q
Which autoantibodies are associated with rheumatoid arthritis
A
Rheumatoid factor (70% patients, target Fc portion of IgG)
Cyclic citrullinated peptide antibodies (more sensitive than RF)
11
Q
How might rheumatoid arthritis present
A
Symmetrical distal polyarthropathy
Can be rapid, or gradual onset
Systemic symptoms (fatigue, weight loss, flu like illness, muscle aches and weakness)
Most have > 6 weeks for diagnosis
Morning stiffness lasting > 30 mins
12
Q
What is palindromic rheumatism
A
Self limiting, short episodes of inflammatory arthritis
Episodes last 1-2 days
13
Q
Which joints are commonly affected by rheumatoid arthritis
A
Proximal interphalangeal
Metacarpophalangeal
Wrist
Ankle
Metatarsophalangeal
Cervical spine
Knee
Hip
Shoulder
14
Q
What are signs of rheumatoid arthritis in the hands
A
Z-shaped deformity of thumb
Swan neck deformity (hyperextended PIPs, flexion of DIPs)
Boutonniere’s deformity (hyperextended DIPs, flexed PIPs)
Ulnar deviation of fingers
15
Q
What are the extra-articular manifestations of rheumatoid arthritis
A
Pulmonary fibrosis
Bronchiolitis obliterans
Felty’s syndrome
Secondary Sjogren’s syndrome
Anaemia of chronic disease
Cardiovascular disease
Episcleritis/scleritis
Rheumatoid nodules
Lymphadenopathy
Carpal tunnel syndrome
Amyloidosis
16
Q
What investigations are needed for rheumatoid arthritis
A
Clinical diagnosis if symptomatic
Rheumatoid factor
Anti-CCP
Inflammatory markers
Routine bloods
X-ray hands and feet
Ultrasound (confirm synovitis)
17
Q
What X-ray changes are seen in rheumatoid arthritis
A
Joint destruction and deformity
Soft tissue swelling
Periarticular osteopenia
Bony erosions
18
Q
What are the NICE guidelines for referral for rheumatoid arthritis
A
Any adult who has persistent synovitis (even if autoantibodies negative)
Urgent if: involves small joints of hands or feet, involves multiple joints, symptoms for > 3 months
19
Q
How is rheumatoid arthritis diagnosed
A
Scored based on: joint involvement (number), serology, inflammatory markers, duration
Score > 6 means rheumatoid arthritis
20
Q
What is the DAS28 score
A
Disease activity score for rheumatoid arthritis
Based on 28 joints
Points given for: swelling, tenderness, ESR/CRP
21
Q
What factors lead to a poor prognosis in rheumatoid arthritis
A
Young onset
Male
More joints affected
Autoantibodies present
Erosion seen on X-ray
22
Q
What is the management for rheumatoid arthritis
A
First presentation and flare ups: NSAIDs (+PPI), aim to induce remission
NICE first line: methotrexate, leflunomide, sulfasalazine, hydroxychloroquine
NICE second line: 2 drugs in combination
NICE third line: methotrexate plus a biological agent
NICE fourth line: rituximab
Physiotherapy
Surgery
23
Q
What is psoriatic arthritis
A
Inflammatory arthritis associated with psoriasis
Varies in severity
24
Q
What are the different patterns of psoriatic arthritis
A
Symmetrical polyarthritis: similar to RA, F>M, MCPs not affected
Asymmetrical pauciarthritis: affects digits and feet
Spondylitic: M>F, back stiffness, sacroiliitis, atlanto-axial involvement
25
What are the signs of psoriatic arthritis
Plaques of psoriasis on skin
Pitting of nails
Onycholysis (separation of nail from bed)
Dactylitis (inflammation of whole finger)
Enthesitis (inflammation of point of insertion of tendon to bone)
26
What other features are associated with psoriatic arthritis
Eye disease (conjunctivitis, anterior uveitis)
Aortitis
Amyloidosis
27
What screening tool is used for psoriatic arthritis
Psoriasis epidemiological screening tool (PEST)
Based on: joint pain, swelling, history, nail pitting
28
What X-ray changes are seen in psoriatic arthritis
Periostitis (inflammation of periosteum)
Ankylosis (bones fuse together)
Osteolysis
Dactylitis (inflammation of whole digit)
Pencil in cup appearance (central erosion of bone)
29
What is arthritis mutilans
Most severe form of psoriatic arthritis
Often in phalanxes
Osteolysis of bone around joints
Get progressively shortening digits (telescopic finger)
30
What is the management for psoriatic arthritis
NSAIDs
DMARDs (methotrexate, lefunomide, sulfasalazine)
Anti-TNF inhibitors (infliximab)
Ustekinumab (last line)
31
What is reactive arthritis
Synovitis in joints due to recent infective trigger
Usually acute monoarthritis
Joint warm, swollen, painful
Common triggers: gastroenteritis, STIs
Linked to HLA-B27
32
What is reactive arthritis associated with
Bilateral conjunctivitis
Anterior uveitis
Circinate balanitis (dermatitis of head of penis)
33
What investigations are needed for reactive arthritis
Serology
Inflammatory markers
Joint aspiration (rule out septic/crystal arthritis)
34
What is the management for reactive arthritis
Antibiotics
Aspiration (send for gram stain and crystal examination)
Once septic arthritis rules out: NSAIDs, steroid injections, systemic steroids
Most recover in 6 months
If have recurrence: DMARDs, anti-TNFs
35
What is ankylosing spondylitis
Inflammatory condition mainly affecting spine
Progressive stiffness and pain
Related to HLA-B27
Key joints: sacroiliac, vertebral column
Can get fusion of joints (bamboo spine)
36
How might ankylosing spondylitis present
M = F
> 3 months
Lower back pain and stiffness
Sacroiliac pain in buttocks
Worse on rest (improves with movement)
Worse at night and in morning
May wake from sleep
Takes > 30 mins for stiffness to improve
Get flare ups
Can get vertebral fractures
37
What is ankylosing spondylitis associated with
Systemic symptoms (weight loss, fatigue)
Chest pain (costovertebral and costosternal joints)
Enthesitis
Dactylitis
Anaemia
Anterior uveitis
Aortitis
Heart blocks
Reactive lung disease
Pulmonary fibrosis
Inflammatory bowel disease
38
What is Schober's test
For ankylosing spondylitis
Stand, mark 10 cm above and 5cm below L5, lean forwards. If < 20cm, suggests restricted lumbar movement
39
What investigations are needed for ankylosing spondylitis
Inflammatory markers
HLA-B27 test
X-ray spine and sacrum
MRI spine (see bone marrow oedema before X-ray changes)
40
What are the X-ray changes associated with ankylosing spondylitis
Bamboo spine
Squaring of vertebral bodies
Subchondral sclerosis and erosions
Syndesmophytes (bone growth where ligaments insert into bone)
Ossification
Fusion of facet. sacroiliac and costovertebral joints
41
What is the management for ankylosing spondylitis
NSAIDs
Steroids (for flare ups)
Anti-TNF medications
Secukinumab (monoclonal antibody against IL 17)
Physio
Exercise
Smoking cessation
Bisphosphonates
Treat complications
Surgery
42
What is systemic lupus erythematosus
Inflammatory autoimmune connective tissue disease
Affects multiple organs and systems
More common in asian women
Young - middle age
Remitting and relapsing course
Shortened life expectancy
43
How might systemic lupus erythematosus present
Fatigue
Weight loss
Arthralgia
Non-erosive arthritis
Myalgia
Fever
Photosensitive malar rash
Lymphadenopathy
Splenomegaly
Shortness of breath
Pleuritic chest pain
Mouth ulcers
Hair loss
Raynaud's phenomenon
44
What are the investigations for systemic lupus erythematosus
Antinuclear antibodies
Anti-double stranded DNA (anti-dsDNA, specific to SLE)
Antiphospholipid antibodies
FBC (normocytic anaemia of chronic disease)
C3 and C4 (decreased activity)
Inflammatory markers
Immunoglobulins
Urinalysis
Urine protein:creatinine ratio
Renal biopsy (investigate lupus nephritis)
45
How is systemic lupus erythematosus diagnosed
SLICC criteria
ACR criteria
Suggestive clinical features and bloods
46
What are the complications of systemic lupus erythematosus
Cardiovascular disease
Infection
Anaemia of chronic disease
Pericarditis
Pleuritis
Interstitial lung disease
Lung nephritis
Neuropsychiatric SLE (optic neuritis, transverse myelitis, psychosis)
Recurrent miscarriage
VTE
47
What is the management for systemic lupus erythematosus
No cure
First line: NSAIDS, steroids (for flare ups), hydroxychloroquine (first line if mild), suncream
Immunosuppressants (if first line not working): methotrexate, azathioprine, tacrolimus, ciclosporin
Biological therapies: rituximab, belimumab
48
What is discoid lupus erythematosus
Non-cancerous chronic skin condition
F>M
20-40s
More common in darker skin
Associated with smoking
Can progress to SCC
49
How might discoid lupus erythematosus present
Lesions on face, ears, scalp
Photosensitive
Scarring alopecia
Hyper/hypopigmentation
Lesions: inflamed, dry, erythematous, patchy, crusty, scaling
50
What is the management for discoid lupus erythematosus
Skin biopsy (confirm)
Sun protection
Topical steroids
Intralesional steroid injections
Hydroxychloroquine
51
What is systemic sclerosis
Autoimmune inflammatory and fibrotic connective tissue disease
Affects skin and internal organs
Patterns: limited, diffuse (cardiovascular/lung/kidney issues)
52
What are the features of systemic sclerosis
Scleroderma (hardening of skin)
Sclerodactyly (skin changes in hands)
Telangiectasis (dilated blood vessels)
Calcinosis (calcium deposits under skin)
Raynaud's phenomenon
Oesophageal dysmotility
Systemic and pulmonary hypertension
Pulmonary fibrosis
Scleroderma renal crisis
53
What are the autoantibodies associated with systemic sclerosis
Antinuclear antibodies
Anti-centromere antibodies
Anti-Scl-70 antibodies
54
How is systemic sclerosis diagnosed
Based on ACR or EULAR criteria
Clinical features
Autoantibodies
Nailfold capillaroscopy
55
What is the management for systemic sclerosis
Steroids and immunosuppressants for diffuse disease
Smoking cessation
Gentle stretching of skin
Emollients
Physio
Nifedipine (for Raynaud's)
PPIs and pro-motility medications (for GI issues)
Analgesia
Antibiotics (for skin infections)
Antihypertensives
Supportive management (for pulmonary fibrosis)
56
What is polymyalgia rheumatica
Inflammatory condition causing pain and stiffness in shoulders, pelvic girdle, and neck
Strong association with giant cell arteritis
> 50s
F>M
More common in Caucasians
57
What are the core features of polymyalgia rheumatica
At least 2 weeks
Bilateral shoulder pain
Bilateral pelvic girdle pain
Worse on movement
Interferes with sleep
Stiff for > 45 mins in morning
Reduced range of movement
Muscle strength normal
Muscle tenderness
58
What are the additional symptoms of polymyalgia rheumatica
Systemic symptoms (weight loss, fatigue, low grade fever, low mood)
Upper arm tenderness
Carpal tunnel syndrome
Pitting oedema
59
What are the differentials for polymyalgia rheumatica
Osteoarthritis
Rheumatoid arthritis
CLE
Myositis
Cervical spondylitis
Adhesive capsulitis
Thyroid dysfunction
Osteomalacia
Fibromyalgia
60
What investigations are needed for polymyalgia rheumatica
Based on clinical presentation and response to steroids
Raised inflammatory markers
61
What is the management for polymyalgia rheumatica
Steroids (assess at 3-4 weeks, if good response, start reducing dose, can increase again if symptoms recur)
Methotrexate (if repeatedly relapsing)
62
What is giant cell arteritis
Systemic vasculitis of medium and large arteries
Presents with temporal arteritis
Strongly linked to polymyalgia rheumatica
> 50s
F>M
63
What are the risk factors for giant cell arteritis
> 50
F>M
White
64
What might giant cell arteritis present
Headache (severe, unilateral)
Scalp tenderness
Jaw claudication
Blurred/double vision
Irreversible, painless sight loss
Systemic symptoms
65
How is giant cell arteritis diagnosed
> 50s need 2+ of: high inflammatory markers, new onset localised headache, tenderness over scalp arteries, new visual symptoms, biopsy shows necrotising arteritis
Duplex ultrasound (hypoechoic halo sign of temporal arteries)
66
What is the management for giant cell arteritis
Steroids (start before confirming diagnosis) + PPI
67
What are the complications of giant cell arteritis
Early: vision loss, cerebrovascular accident
Late: relapse of condition, cerebrovascular accident, aortitis leading to aortic aneurysm/aortic dissection
68
What are polymyositis and dermatomyositis
Autoimmune conditions causing inflammation of striated muscle
69
What is the key investigation for diagnosing myositis
Creatine kinase
70
How might polymyositis and dermatomyositis present
Muscle pain
Fatigue
Weakness
Bilateral
Usually affects proximal muscles
71
What autoantibodies are associated with polymyositis and dermatomyositis
Anti-Jo-1
Anti-Mi-2
ANA
72
What investigations are needed for polymyositis and dermatomyositis
Elevated creatine kinase
Autoantibodies
EMG
Muscle biopsy
73
What is the management for polymyositis and dermatomyositis
Physio
Corticosteroids
Immunosuppressants
IV immunoglobulins
Biological therapies
74
What is antiphospholipid syndrome
Associated with antiphospholipid antibodies
Causes hyper-coagulable state
Associated with: thrombosis, complications in pregnancy (recurrent miscarriages, stillbirth)
Can be secondary to SLE
75
How is antiphospholipid syndrome diagnosed
History of thrombosis or pregnancy complications
Plus persistent antibodies (lupus anticoagulant, anticardiolipin, anti-beta 2 glycoprotein I)
76
What is the management for antiphospholipid syndrome
Long term warfarin (target INR 2-3)
Pregnant women: LMWH and aspirin
77
What is Sjogren's syndrome
Autoimmune condition affecting exocrine glands
Get symptoms of dry mucous membranes
Can be secondary to SLE or rheumatoid arthritis
Schirmer test: filter paper under eyelid, see how far moisture travels
78
Which antibodies are associated with Sjogren's syndrome
Anti-Ro
Anti-La
79
What is the management for Sjogren's syndrome
Artificial tears
Artificial saliva
Vaginal lubricants
Hydroxychloroquine (halts disease progression)
80
What are the complications of Sjogren's syndrome
Eye infections (conjunctivitis, corneal ulcers)
Oral problems (dental cavities, candida infections)
Vaginal problems (candidiasis, sexual dysfunction)
Pneumonia
Non-Hodgkin's lymphoma
Peripheral neuropathy
Vasculitis
Renal impairment
81
Which types of vasculitis affect small vessels
Henoch-Schonlein purpura
Eosinophilic granulomatosis with polyangiitis
Microscopic polyangiitis
Granulomatosis with polyangiitis
82
Which types of vasculitis affect medium vessels
Polyarteritis nodosa
Eosinophilic granulomatosis with polyangiitis
Kawasaki disease
83
Which types of vasculitis affect large vessels
Giant cell arteritis
Takayasu's arteritis
84
How might vasculitis present
Purpura (purple non-blanching spots due to bleeding from vessels under skin)
Joint and muscle pain
Peripheral neuropathy
Renal impairment
GI disturbance
Anterior uveitis, scleritis
Hypertension
Systemic features (fatigue, fever, weight loss)
85
What investigations are needed for vasculitis
Inflammatory markers
Anti-neutrophil-cytoplasmic antibody (ANCA)
86
What is the management for vasculitis
Refer to specialist
Steroids
Immunosuppressants (cyclophosphamide, methotrexate, azathioprine, rituximab)
87
What is Henoch-Schonlein purpura
IgA vasculitis (IgA deposited in affected organs)
Purpuric rash on lower limb/buttocks in children (mostly < 10s)
Often triggered by infection (tonsillitis, gastroenteritis)
Classical features: purpura, joint pain, abdo pain, renal involvement (IgA nephritis)
Management: analgesia, rest, fluids
Kidney involvement resolves in 4-6 weeks
1/3 get recurrence in 6 months
88
What is eosinophilic granulomatosis with polyangiitis
Churg-Strauss syndrome
Small and medium vessel vasculitis
Associated with lung and skin problems
Presents with severe asthma
Mostly in late teens/adults
Raised eosinophils on FBC
89
What is microscopic polyangiitis
Small vessel vasculitis
Get renal failure
Can affect lungs (SOB, haemoptysis)
90
What is granulomatosis with polyangiitis
Small vessel vasculitis
Affects respiratory tract and kidneys
91
What is polyarteritis nodosa
Medium vessel vasculitis
Associated with Hep B, Hep C, HIV
Affects skin, GI tract, kidneys, heart
Associated with livedo reticularis (mottled, purplish, lace-like rash)
92
What is Kawasaki disease
Medium vessel vasculitis
Young children (<5)
Presentation: persistent high fever (>5 days), erythematous rash, bilateral conjunctivitis, erythema and desquamation of palms and soles, strawberry tongue
Management: aspirin, IV immunoglobulins
Key complication: coronary artery aneurysm
93
What is Takayasu's arteritis
Large vessel vasculitis
Affects aorta and its branches
Affects pulmonary arteries
Large vessels swell to form aneurysms
Presentation: fever, malaise, muscle aches, arm claudication, syncope
Diagnosis: CT, MRI angiography, doppler ultrasound
94
What is Behcet's disease
Complex inflammatory condition
Presents with recurrent oral and genital ulcers
Inflammation in: skin, GI tract, lungs, vessels, MSK system, CNS
Associated with HLA-B51 gene
95
What are the main differentials for mouth ulcers
Simple aphthous ulcers
Inflammatory bowel disease
Coeliac disease
Vitamin deficiency (B12, folate, iron)
Herpes simplex ulcer
Squamous cell carcinoma
96
What are the clinical features of Behcet's disease
Mouth ulcers
Genital ulcers
Easily inflamed skin
Eye problems (uveitis, retinal vasculitis, retinal haemorrhage)
Arthralgia
GI inflammation and ulceration
Memory impairment, headaches
Thrombosis
Pulmonary artery aneurysms
97
What are the investigations for Behcet's disease
Clinical diagnosis
Pathergy test (cause abrasion with sterile needed, review in 48 hrs, look for wheal)
98
What is the management for Behcet's disease
Topical steroids (mouth)
Systemic steroids
Colchicine (anti-inflammatory)
Topical anaesthetic (genital ulcers)
Immunosuppressants
Biological therapy
99
What is the prognosis for Behcet's disease
Remitting and relapsing course
Increased mortality of have haemoptysis or neurological involvement
100
What is gout
A crystal arthropathy
Chronically high blood uric acid levels
Urate crystals deposited in joints
Joints hot, swollen, painful
Gouty tophi: subcutaneous deposits of uric acid, affects small joints and connective tissue
101
What are the risk factors for gout
M>F
Obesity
High purine diet (meat, seafood)
Alcohol
Diuretics
Existing cardiovascular or kidney disease
Family history
102
Which joints are typically affected by gout
Metatarcophalangeal joint (base of big tow)
Wrist
Carpometacarpal joint (base of thumb)
Can affect large joints)
103
How is gout diagnosed
Aspirate fluid: no bacterial growth, needle shaped crystals, negative birefringent of polarised light, monosodium urate crystals
Joint X-ray: joint space maintained, lytic lesions in bone, 'punched out' erosions
104
What is the management for gout
Acute phase: NSAIDs, colchicine, steroids
Prophylaxis: allopurinol (xanthine oxidase inhibitor, reduces uric acid levels), lifestyle changes (diet, alcohol...)
105
What is pseudogout
Crystal arthropathy
Caused by calcium pyrophosphate crystals
Mostly in older adults
106
How might pseudogout present
Hot, swollen, stiff, painful joint
Knee, shoulder, wrist, hip
107
How is pseudogout diagnosed
Aspirate fluid: no bacterial growth, calcium pyrophosphate crystals, rhomboid shaped crystals, positive birefrengent of polarised light
X-ray: chondrosclerosis (white line in joint space), loss of joint space, osteophytes, subarticular sclerosis, subchondral cysts
108
What is the management for pseudogout
Usually resolves spontaneously in a few weeks
NSAIDs
Colchicine
Joint aspiration
Steroid injections
Oral steroids
Joint washout (in severe cases)
109
What is osteoporosis
Reduced density of bone
Bones weaker, more prone to fracture
110
What are the risk factors for osteoporosis
Older age
F>M
Reduced mobility and activity
Low BMI
Rheumatoid arthritis
Alcohol
Smoking
Long term corticosteroids
SSRIs, PPIs, antiemetics, anti-oestrogens
111
What is the FRAX tool
Predicts risk of a fragility fracture in the next 10 years
Measures: age, BMI, co-morbidities, smoking, alcohol, family history
112
What is bone mineral density
Measured by DEXA scan
X-ray measuring how much radiation is being absorbed by bones
Z-score: standard deviations below mean for age
T-score: standard deviations below mean for healthy young people
113
How is osteoporosis assessed for
FRAX tool: F > 65, M > 75, young with significant risk factors
NOGG guidelines
114
How is osteoporosis managed
Lifestyle changes
Calcium and vitamin D supplements
Bisphosphonates (interferes with osteoclast activity, causes GORD)
Denoxumab (monoclonal antibody)
Strontium ranelate (stimulates osteoblasts, blocks osteoclasts)
Raloxifine (selective oestrogen receptor modulator)
HRT
115
What is involved in the follow up of patients with osteoporosis
Low risk: repeat assessment in 5 years
On bisphosphonates: repeat FRAX and DEXA every 3-5 years, consider treatment holiday if no longer at risk
116
What is osteomalacia
Defective bone mineralisation
'Soft' bones
Insufficient vitamin D
If in children before growth plates close, get rickets
117
How might osteomalacia present
Fatigue
Bone pain
Muscle weakness
Pathological/abnormal fractures
118
What investigations are needed for osteomalacia
Serum 25-hydroxyvitamin D (low)
Serum calcium (low)
Serum phosphate (low)
Serum ALP (high)
PTH (high)
X-ray (osteopenia)
DEXA (low mineral density)
119
What is the management for osteomalacia
Vitamin D supplements (high dose colecalciferol for 6-10 weeks, then maintenance dose)
120
What is Paget's disease of bone
Disorder of bone turnover
Excessive bone turnover (increased osteoblast and osteoclast activity, not coordinated)
Enlarged and misshapen bones
Increased risk of pathological fractures
Mostly affects head and spine
Mostly in older adults
121
How might Paget's disease of bone present
Bone pain
Bone deformity
Fractures
Hearing loss (ear bones affected)
122
What investigations are needed for Paget's disease of bone
X-ray: bone enlargement and deformity, osteoporosis circumscripta (well defined osteolytic lesions), cotton wool appearance (poorly defined patches of high and low density), V-shaped deformity (osteolytic lesions in long bones)
ALP high
Calcium normal
Phosphate normal
123
What is the management for Paget's disease of bone
Bisphosphonates (interfere with osteoclast activity)
NSAIDs
Calcium and vitamin D supplements
Monitor
124
How are the complications of Paget's disease of bone
Osteogenic sarcoma
Spinal stenosis
125
What are the features of inflammatory joint problems
Morning stiffness > 1 hour
Better with activity
Worse with rest
Significant fatigue
Have systemic involvement
126
What are the features of mechanical joint problems
Morning stiffness < 30 mins
Worse with activity
Better with rest
Minimal fatigue
No systemic symptoms
127
What is Raynaud's phenomenon
Vasospasm of digits
Colour changes in digits due to cold
F>M
Associated with: scleroderma, SLE, dermatomyositis and polymyositis, Sjogren's syndrome, beta blockers
128
What is the management for Raynaud's phenomenon
Avoid cold
Stop smoking
CCBs (first line)
ARBs, ACE inhibitors, SSRIs
129
What are the complications of Raynaud's phenomenon
Digital ulceration
Severe digital ischaemia
Infection
130
What is hypermobility spectrum disorder
Joints move beyond normal limits
Due to laxity of ligaments, capsules, and tendons
Pain due to microtrauma
F>M
More in asians
131
How might hypermobility spectrum disorder present
Pain around joints
Worse on activity
Fatigue
Soft tissue rheumatism
Marfanoid habitus
Arachnodactyly
Drooping eyelids
Hernias
Uterine/rectal prolapse
132
What is the management for hypermobility spectrum disorder
Physio
Splinting
Paracetamol
Surgery
133
What is fibromyalgia
Chronic widespread pain in all 4 quadrants of body
Induced by deliberate sleep deprivation
F>M
40 - 50s
134
How might fibromyalgia present
Pain
Joint stiffness
Profound fatigue
Unrefreshed sleep
Numbness
Headache
Irritable bowel/bladder
Depression and anxiety
Poor memory
135
What is the management for fibromyalgia
Education
Reassurance
Opiates not recommended
Amityiptyline
CBT
