Rheumatology 🅾️ Flashcards
sx of temporal/giant cell arteritis
rapid onset <1 month
headache and jaw claudication
morning stiffness
temporary visual loss
anterior ischaemic optic neuropathy
diplopia
ix of temporal/giant cell arteritis
tender palpable temporal artery
raised ESR, CRP
temporal artery biopsy - skip lesions
Sx of rheumatoid arthritis
Stiffness worse in mornings
Swollen and painful joints in hands and feet
PIP and MCP swelling
Investigations that should be ordered for rheumatoid arthritis
First line rheumatoid factor
Anti-CCP
X-ray hands and feet
Mx rheumatoid arthritis
DMARDs
If no response TNF inhibitors e.g. infliximab
Symptoms of osteoarthritis
Pain worse on movement and towards the end of day
Pain improves with rest
Morning stiffness not prolonged
Decreased ROM
On x ray what would you see for a patient with osteoarthritis
LOSS
Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis
Investigations for osteoarthritis
X ray
Mx osteoarthritis
If high BMI - weight loss
Analgesia
Symptoms of gout
Episodes lasting a few days
MTP joint generally affected
Can affect hands
What would an x ray look like for gout
Joint effusion
Punched out erosions
Peri-articulate tophi
Joint space reduction in later stage
Mx of gout
Analgesia
Urate lowering therapy - allopurinol
Lifestyle modification
Difference between pseudo gout and gout
Pseudogout caused by rhomboid calcium crystals
Positive birefringence
Pseudogout usually occurs in knee rather than big toe MTP in gout
Symptoms of fibromyalgia
Chronic pain at multiple sites
Lethargy
Cognitive impairment
Sleep disturbance
Headaches
Dizziness
Symptoms of polymyalgia rheumatica
Proximal joint pain
Pain/stiffness in morning
Reduced ROM
Fever
Weight loss
Fatigue
Investigations for polymyalgia rheumatica
ESR and CRP,
If these are normal unlikely to be Polymyalgia rheumatica
But sometimes ESR is normal and CRP is raised which is more likely to indicate polymyalgia rheumatica
Mx polymyalgia rheumatica
Corticosteroids
Prevention and management of steroid induced osteoporosis
Screen for complications
what is systemic lupus erythematosus
inflammatory autoimmune connective tissue disease
affects multiple organs and systems
more common in women and those of afro-Caribbean descent and in Asians
how would SLE present
non-specific sx
systemic upset
joint and/or skin involvement - photosensitive malar rash “butterfly shaped rash across the nose and cheek bones”
management of gout
1st line - NSAIDs unless contraindicated e.g GI problems, CKD or heart failure
2nd line - colchicine - CI in end-stage kidney failure or on dialysis
steroids can be used too
risk factors
male sex
obesity
diet
chronic kidney disease
age over 50
family history
hypertension
diabetes
lab findings for gout
negatively birefringent needle-shaped crystals
what would you see on an x-ray for gout
normal joint space
soft tissue swelling
periarticular erosions
