Rheumatology Flashcards
What are the key presenting features of OA?
Oligo-pauci-arthritis (<5 joints)
-can be asymmetrical
Joint stiffness worsens t/o day
Neuropathic pain
What are the key examination findings of OA?
Oligo-pauci-arthritis (<5 joints)
-can be asymmetrical
Crepitus
Muscle wasting
HerbeDen (DIPJ) and Bouchard (PIPJ) nodes
What are the key risk factors for OA?
Age
Obesity
Trauma
How should OA be treated?
Lifestyle/conservative w/ paracetamol –>
NSAIDs –>
Co-codamol –>
Intra-articular steroids –>
Joint replacement
What are the key risk factors for RA?
Smoking
FHx
What are the key presenting features of RA?
Poly-articular (>5 joints)
-symmetrical
DEFORMING
Early morning stiffness/pain improves w/ use
Constitutional sx
What are the key examination findings of RA?
Poly-articular (>5 joints)
-symmetrical
Boggy joints
Rheumatoid nodules
Joint deformity
What are the different patterns of RA?
Insidious (70%)
Acute (15%)
Constitutional (10%)
Palindromic (5%)
What are the systemic associations of RA?
ILD
Pleural effusion
Atherosclerosis
Anaemia
Mononeuritis multiplex + compression neuropathy
Scleritis & episcleritis
Felty syndrome
Lymphoma
What is Felty syndrome?
Triad of:
-RA
-Splenomegaly
-Neutropenia
Causes recurrent infections
What is a Swan-Neck deformity?
PIPJ hyperextended
DIPJ flexed
What is a Boutonniere deformity?
PIPJ flexed
DIPJ hyperextended
What is a Z-thumb?
MCPJ fixed flexion
PIPJ and DIPJ hyperextended
What is Jaccoud’s arthropathy?
Ulnar subluxation
-non-erosive
What is Vaughan-Jackson syndrome?
Inability to extend 5th finger 2o extensor tendon disruption on ulnar side
-seen in RA
What is arthritis mutilans?
Severe destructive joint disease
-seen in RA/PA
What % of patients w/ RA have a positive RF?
70%
What are the XR signs of arthritis?
Osteopenia
Cartilage loss
Space loss
Erosions
Subluxation
What is the management of RA?
Steroids AND DMARDs
-Methotrexate
-Hydroxychloroquine
How does PA present?
ANY joint pattern
Psoriatic rash
Tendon disease
Nail disease
What tendon problems are common in PA?
Achilles tendinitis
Golfer/tennis elbows
Plantar fasciitis
DACTYLITIS
What nail problems are common in PA?
Pitting
Onycholysis
Subungual hyperkeratosis
Dystrophy
What ix are indicated in PA?
ESR
XR (pencil-in-cup deformity)
SERONEGATIVE
What is the rx for PA?
NSAIDs
Methotrexate
AVOID STEROIDS - psoriatic flare
Sulfasalazine - if spinal
Ciclosporin +/- retinoids +/- anti-TNF +/- secukinumab +/- ustenkinumab - if severe