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Year 3 - Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Rheumatoid arthritis - state the following:
- Pathophysiology
- Typical patient
- Presentation
- Investigations
- Management

A

Pathophysiology:
- Chronic autoimmune inflammatory condition
- Autoantibodies attack the synovial membranes of joints, bursa and tendon sheaths, leading to chronic inflammation (synovitis)

Typical patient:
- Middle age onset
- (3x) F > M
- Family history of RA

Presentation:
- Joint pain / swelling / stiffness, particularly of the small/distal joints
- Symmetrical and affects many joints
- Onset can be sudden or more gradual
- Pain is worse in the morning and worse on rest
- May have some signs in the hands
Systemic symptoms:
- Fatigue
- Weight loss
- Flu-like illness
- Myalgia and weakness

Investigations:
Diagnosis is clinical but want back up of:
- Specific bloods for rheumatoid factor (RF) and then anti-CCP if RF negative
- Routine bloods e.g. FBC, ESR, CRP
- X-rays hands and feet
- Ultrasound of joints to confirm synovitis if unsure

Management:
1. One early DMARD (disease modifying anti-rheumatic drugs) e.g. Methotrexate, Leflunomide or Sulfasalazine
2. Two DMARDs
3. Methotrexate + biologic (e.g. TNF inhibitor Infliximab)
4. Methotrexate + Rituximab (Anti-CD20)
- Use of steroids to settle first presentation and for flares
- Surgery can be used to improve joint complications of RA but not used as much now due to early interventions

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2
Q

List some signs in the hands of someone with established rheumatoid arthritis

A
  • Ulnar deviation of fingers (at MCP joints)
  • Bouchard nodes (flexed PIP and extended DIP)
  • Swan neck deformity (extended PIP and flexed DIP)
  • Z shaped deformity of thumb
    + rheumatoid nodules on elbows
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3
Q

List some extra-articular manifestations of rheumatoid arthritis (3 CAPS)

A

(3)CAPS

3 C’s:
- Carpal tunnel syndrome
- Cardiovascular disease (increased risk)
- Cord compression (atlanto-axial subluxation)

3 A’s:
- Anaemia of chronic disease (normochromic and normocytic)
- Amyloidosis
- Arteritis

3 P’s:
- Pulmonary disease e.g. fibrosis, bronchiolitis obliterans, bronchiectasis
- Pleural disease
- Pericarditis

3 S’s:
- Sjogren’s syndrome (secondary)
- Scleritis / episcleritis
- Splenomegaly (Felty’s syndrome if with neutropaenia)

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4
Q

List the x-ray changes seen in rheumatoid arthritis

A

LESS!

Loss of joint space
Erosions
Soft tissue swelling
See-through bones (osteopenia)

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5
Q

Outline the DAS28 score for rheumatoid factor and what it’s used for

A

DAS 28 score - disease activity score of 28 joints
Points given for:
- Swollen joints
- Tender joints
- ESR / CRP level

Useful for monitoring disease activity and response to treatment

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6
Q

List some side effects of Methotrexate

A
  • GI upset e.g. N&V and diarrhoea
  • Pulmonary fibrosis
  • Mouth ulcers and mucositis
  • Bone marrow suppression / leukopenia
  • Thrombocytopenia
  • Teratogenic
  • Hepatotoxic
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7
Q

List some side effects of NSAIDs

A
  • Indigestion
  • Peptic ulcer disease
  • VTE e.g. DVT/PE
  • Peripheral oedema
  • Slight increased risk of stroke and heart attack
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8
Q

List some side effects of corticosteroids e.g. Prednisolone

A
  • Immunosuppression
  • Diabetes mellitus
  • Osteoporosis
  • Suppression of HPA axis
  • Teratogenic
  • Increased BP
  • Cataracts and glaucoma
  • Oedema

Cushing’s syndrome
- Thin skin, easy bruising
- Obesity distributed centrally
- Increased hair growth (hirsutism)
- Striae

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9
Q

List some side effects of Sulfasalazine

A
  • Myelosuppression
  • Nausea
  • Rash
  • Oral ulcers
  • Infertility / decreased sperm count
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10
Q

List some side effects of Biologic therapy (e.g. Adalimumab)

A
  • Immunosuppression
  • Reactivation of TB
  • Allergic reaction / reaction at infusion site
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11
Q

Systemic lupus erythematosus (SLE) - state the following:
- Pathophysiology
- Typical patient
- Presentation
- Investigations
- Management

A

Pathophysiology:
- Systemic autoimmune condition targeting the connective tissue
- Characterised by ANA antibodies (anti-nuclear) against own cell nuclei in proteins
- Often has a relapsing-remitting course

Typical patient:
- Women
- Young-middle age
- Asian

Presentation:
- Usually young-middle aged adults
- F > M and Asians
- Photosensitive malar rash
- Systemic features: fatigue, weight loss, fever
- Hair loss
- Joint pain and inflammatory arthritis
- Myalgia
- Mouth ulcers
- Lymphadenopathy
- Raynaud’s
- SOB
- Chest pain

Investigations:
Criteria used based on clinical features and presence of anti-nuclear antibodies
- Specific bloods for ANA and anti-dsDNA antibodies
- Routine bloods e.g. FBC, ESR, CRP
- Further bloods e.g. C3, C4, immunoglobulins
- Urinalysis and protein:creatitine ratio to test for kidney involvement
- Renal biopsy if lupus nephritis suspected

Management:
First line:
- Hydroxychloroquine
- NSAIDs
- Prednisolone (steroids)
- Skin protection e.g. suncream
If not responding/severe:
- Immunosuppressants e.g. Methotrexate, Mycophenolate mofetil
- Biologics e.g. Rituximab

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12
Q

List some complications of SLE

A

Cardiovascular disease (HTN and coronary artery disease) = LEADING CAUSE OF DEATH

  • Infection (disease + immunosuppressants)
  • Lupus nephritis (inflammation in kidneys)
  • Anaemia of chronic disease (bone marrow suppression)
  • Pericarditis
  • Pleuritis
  • Interstitial lung disease (fibrosis)
  • Neuropsychiatric (optic neuritis, transverse myelitis or psychosis)
  • Recurrent miscarriages
  • Antiphospholipid syndrome, leading to VTE
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13
Q

Gout - state the following:
- Pathophysiology
- Typical patient
- Presentation
- Investigations
- Management

A

Pathophysiology:
- Crystal arthropathy which occurs as a result of chronic hyperuraemia
- Sodium urate crystals are deposited in the joint causing joint to become painful, swollen and hot

Typical patient:
- Male
- Obese
- Family history
- Existing cardiovascular or renal disease

Presentation:
- Single painful, swollen and hot joint
- Acute, severe onset
Key differential should be septic arthritis

Investigations:
- Diagnosed clinically or by joint aspiration
- X-ray of affected joint
KEY = exclude septic arthritis

Management:
Acute attack
- NSAIDs
- Colchicine
- Steroids
Prophylaxis/prevention
- Allopurinol (only once acute attack has resolved)
- Lifestyle changes e.g. lose weight, hydration, limit alcohol and limit purine-based foods

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14
Q

List some risk factors for gout (modifiable and non-modifiable)

A

Modifiable
- Alcohol intake / high purine diet
- Obesity
- Diuretics

Non-modifiable
- Male
- Family history
- Existing cardiovascular or renal disease

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15
Q

List some typical joints that are affected in gout

A
  • Base of the big tole (MTP)
  • Base of thumb (MCP)
  • Bigger joints e.g. knee and ankle
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16
Q

List 3 things seen in a joint aspiration from a gouty joint

A
  • Monosodium urate crystals (needle-shaped)
  • Negative birefringent of polarised light
  • Absence of bacteria
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17
Q

List 2 things that x-ray of a gout joint will show

A
  • Punched out erosions (with overhanging edges and sclerotic margins)
  • Lytic bone lesions

Joint space is generally maintained

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18
Q

Outline how pseudogout differs from gout

A

Pseudogout involves calcium pyrophosphate (rather than monosodium urate) crystals being deposited into joints

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19
Q

Osteoporosis - state the following:
- Pathophysiology
- Typical patient
- Presentation
- Investigations
- Management

A

Pathophysiology:
- Reduced density of bones (low bone mass) leading to reduced bone strength
- Increased risk of fractures

Typical patient
- Post-menopausal women
- White / south asian

Presentation:
- Generally not symptomatic
- Often discovered upon an unusual fracture e.g. low energy fracture

Investigations:
- FRAX assessment to assess risk
- DEXA scan to confirm (dual energy x-ray absorptiometry)

Management:
Based on results from a FRAX prediction or DEXA scan
Conservative
- Weight bearing exercise
- Limit alcohol intake
- Stop smoking
- Increase dietary calcium
Medical
- Vitamin D and calcium supplements (AdCal D3)
- Oral bisphosphonates (IV if not tolerated)
- Then Denosumab 2nd line

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20
Q

List the risk factors for developing osteoporosis (modifiable and non-modifiable)

A

Modifiable:
- Low mobility (non-weight bearing)
- Low calcium diet / low sun exposure (vitamin D deficiency)
- Smoking
- Excess alcohol intake
- Low BMI/weight
- Corticosteroids

Non-modifiable:
- Female
- Post-menopausal
- Family history of osteoporosis
- Increased age
- White or south asian
- Premature menopause

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21
Q

Outline how a DEXA scan is used to diagnose osteoporosis

A

DEXA scan is gold standard for diagnosis of osteoporosis
- Assesses the bone mineral density using x-rays
- Measures how much radiation is absorbed by the bones, which indicates how dense the bones are
- Reading taken at the hip is key
- T score used (can also use Z score)

T score < - 2.5 = osteoporosis
T score > -1 = normal
T score between those two is osteopenia

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22
Q

Briefly outline how the FRAX score is calculated and it’s use in osteoporosis

A

FRAX score gives a risk of fragility fracture in the next 10 years (assess risk of osteoporosis)

Performed on individuals at risk of osteoporosis
- Women over 65
- Men over 75
- Anyone at increased risk e.g. low BMI, long-term steroids

Calculated using information e.g. age, BMI, co-morbidities, smoking, alcohol and family history
Can also enter results of a DEXA scan for a more accurate result

Overall gives a 10 year risk of having either:
- Major osteoporotic fracture
- Hip fracture

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23
Q

Osteomalacia - state the following:
- Pathophysiology
- Presentation
- Investigations
- Management

A

Pathophysiology:
- Condition of ineffective bone mineralisation (soft bones)
- Caused by insufficient vitamin D

Presentation:
- Rickets if happens in childhood
May not have any symptoms!
- Bone pain
- Muscle pain / weakness
- Fatigue
- Fractures

Investigations:
- Serum vitamin D (25-hydroxyvitamin D)
- X-ray / DEXA scan showing osteopenia
Blood tests may also reveal
- Hypocalcaemia
- Hypophosphataemia
- Secondary hyperparathyroidism

Management:
- Vitamin D3 supplements (initial treatment followed by a life-long maintenance dose)

24
Q

List some risk factors for developing osteomalacia

A
  • Darker skin tone
  • Reduced UV radiation exposure (lack of sunlight)
  • Malabsorption disorders e.g. IBD, coeliac disease
25
Polymyalgia rheumatica (PMR) - state the following: - Pathophysiology - Typical patient - Presentation - How diagnosis is made - Management
Pathophysiology: - Inflammatory condition leading to pain and stiffness in: shoulders, pelvic girdle and neck - Closely associated with GCA Typical patient: - Over 50 - Female - Caucasian - Association with GCA Presentation: - Pain and stiffness in: shoulders, pelvic girdle and neck - Worse on movement - Interferes with sleep - Stiffness for > 45 mins in morning - Systemic features e.g. weight loss, fatigue - Upper arm tenderness - Carpal tunnel syndrome - Peripheral oedema How diagnosis is made: - Clinical diagnosis based on symptoms plus response to steroids - May need to exclude other conditions - Inflammatory markers usually raised also (ESR, CRP and plasma viscosity) Management: - Steroids e.g. Prednisolone (then assess response) - Check after 1 week: if poor response, probably not PMR - Check after 1 month: should expect 70% improvement, then start to wean off
26
Outline the mnemonic 'don't STOP' for long-term steroid use
don't stop steroids suddenly Sick day rules (double dose) Treatment card (steroid card) Osteoporosis PPI cover (gastric protection)
27
Ankylosing spondylitis - state the following: - Pathophysiology - Typical patient - Presentation - Investigation and special test - Management
Pathophysiology: - Inflammatory condition mainly affecting the spine - Leads to progressive pain and stiffness in mainly the sacroiliac joints and the vertebral column joints - Can progress to fusion of sacroiliac joints and spine - Seronegative spondyloarthropathy: related to reactive arthritis and psoriatic arthritis (HLA-B27 gene) Typical patient: - Young male - Late-teens or 20's Presentation: - Gradual development > 3 months - Lower back pain and stiffness - Buttock/sacroiliac pain - Worse with rest, better on movement - Worse in morning and at night, can wake from sleep - > 30 min early morning stiffness Symptoms can fluctuate with flares Investigation and special test: - Blood tests e.g. CRP, ESR - HLA B27 genetic test - X-ray spine and sacrum - MRI spine may show bone marrow oedema in early disease - Special test: Schober's test Management: Conservative - Physiotherapy - Avoid smoking - Surgery if deformity Medical - NSAIDs to help with pain - Steroids for flares - MAB e.g. Adalimumab or Infliximab or Anti-TNF e.g. Etanercept
28
List some x-ray changes seen in ankylosing spondylitis (including the main one)
Main: bamboo spine (due to spine fusion) - Squaring of vertebral bodies - Subchondral sclerosis and erosions - Syndesmophytes - Ossification of ligaments, discs and joints - Fusion of sacroiliac and facet/costovertebral joints
29
Osteoarthritis - state the following: - Pathophysiology - Typical patient - Presentation - How diagnosis is made - Management
Pathophysiology: - General wear and tear of joints (non-inflammatory) - Imbalance of cartilage wearing down and chondrocyte repair - Occurs in synovial joints Typical patient: - Female - Increased age - Obese - Family history Presentation: - Joint pain, worse on movement - Joint stiffness, worse throughout the day - May have signs of OA in the hand - History of risk factors How diagnosis is made: - Can be made without any investigations - May do an x-ray to confirm Management: Conservative - Patient education - Weight loss - Activity modification / physiotherapy Medical - Paracetamol / NSAIDs (topical or oral) - Opiates e.g. Co-codamol or Morphine - Intra-articular joint replacement - Surgery joint replacement
30
Outline x-ray changes seen in osteoarthritis
LOSS! Loss of joint space Osteophytes Subchondral sclerosis Subchondral cysts However, x-ray findings don't always correlate with clinical symptoms
31
List some risk factors for osteoarthritis
- Increased age - Female - Obesity - Previous trauma leading to articular damage - Occupation - Family history
32
List commonly affected joints in osteoarthritis
- Hips - Knees - Sacroiliac joints - MCP (thumb) - DIPs (hands) - Wrist - Cervical spine
33
List signs of osteoarthritis in the hands
- Squaring of base of thumb - Heberden's nodes (DIPs) - Boucharde's nodes (PIPs) - Weak grip - Reduced ROM
34
Fibromyalgia - state the following: - Pathophysiology - Typical patient - Presentation - How diagnosis is made - Management
Pathophysiology: - Disorder of central pain processing - Can be triggered by a traumatic event or sleep deprivation Presentation: - Chronic widespread pain in all 4 quadrants of the body - Allodynia (heightened and painful response to innocuous stimuli) - Unrefreshed sleep - Fatigue - Numbness - Headaches - IBS / bladder syndrome - Fibro-fog - Depression and anxiety How diagnosis is made: - No specific diagnostic test - May have tender points on palpation, but otherwise no abnormalities - May want to rule out other differentials with blood tests Management: Conservative - Improve sleep hygiene - Increase physical activity levels - CBT Medical - Low dose Amitriptyline - Pregabalin or Gabapentin
35
List some risk factors for fibromyalgia
- Female (9:1) - 40-50 - Obvious triggers e.g. emotional or physical event
36
Psoriatic arthritis - state the following: - Pathophysiology - 3 typical patterns of affected joints - Presentation - Investigation - Management
Pathophysiology: - An inflammatory arthritis associated with psoriasis - Varies in severity, from mild pain/stiffness to complete joint destruction (arthritis mutilans) - Occurs in 10% of patients with existing psoriasis - Seronegative spondyloarthropathy: related to reactive arthritis and ankylosing spondylitis (HLA-B27 gene) 3 typical patterns of affected joints: 1. Symmetrical polyarthritis - similar to RA but MCP joints less likely 2. Asymmetrical pauciarthritis - mainly digits of hands and feet 3. Spondylotic pattern - back stiffness, sacroiliitis and atlantoaxial joint Presentation: - Joint pain/stiffness (as described previously) - Psoriatic plaques - Nail pitting - Onycholysis - Dactylitis (sausage fingers) - Inflammation of tendon insertion points - Anterior uveitis or conjunctivitis Investigation: - Routine bloods including CRP - X-ray showing pencil-in-cup (central erosions of bone beside joints) Management: - Similar to RA management - NSAIDs - DMARDs - TNF inhibitors
37
Reactive arthritis - state the following: - Pathophysiology - Presentation - Investigation - Management
Pathophysiology: - Inflammation of synovial joint, as a reaction to a recent infective trigger - Seronegative spondyloarthropathy: related to reactive arthritis and ankylosing spondylitis (HLA-B27 gene) Presentation: - Generally an acute monoarthritis - Hot, swollen and painful joint Investigation: - Joint aspiration and send for gram staining and MC&S - Crystal examination if gout suspected Management: - Give Abx until possibility of septic arthritis can be excluded - Treat underlying infection - NSAIDs - Steroid infection into affected joint - Systemic steroids may be needed if multiple joints affected Most cases resolve within 6 months (may need DMARDs or anti-TNF if not)
38
List 2 conditions that can commonly cause reactive arthritis
- Gastroenteritis - Sexually transmitted infection (chlamydia or gonorrhoea)
39
List some conditions associated with reactive arthritis (helpful phrase)
- Balanitis - Anterior uveitis - Bilateral conjunctivitis + reactive arthritis 'can't see, can't pee, can't climb a tree'
40
Systemic sclerosis - state the following: - Pathophysiology (list 2 types) - Autoantibodies (2) - Management
Pathophysiology: - Autoimmune inflammatory and fibrotic connective tissue condition - Cause is actually unclear - Mostly affects the skin, but also affects internal organs 2 types: 1. Limited 2. Diffuse Autoantibodies: - ANA antibodies - Anti-centromere antibodies (limited mainly) - Anti Scl-70 antibodies (diffuse mainly) - Nailfold capillaroscopy (helps to find systemic sclerosis in patients with Raynaud's) Management: Conservative - No smoking - Emollients - Occupational /physiotherapy Medical: - Manage complications - Can use steroids and immunosuppressants in diffuse
41
List some features of limited and diffuse systemic sclerosis
Limited: CREST Calcinosis Raynaud's Eosophageal dysmotility Sclerodactyly Telangiectasia Diffuse: Cardiovascular problems - HTN and coronary artery disease Lung problems - pulmonary HTN and pulmonary fibrosis Kidney problems - glomerulonephritis
42
Giant cell arteritis (GCA) - state the following: - Pathophysiology - Typical patient - Presentation - Investigation - Management
Pathophysiology: - Systemic vasculitis of the medium and large arteries - Strong link with polymyalgia rheumatica Typical patient: - Over 50 - Female - Caucasian - Association with polymyalgia rheumatica Presentation: - Severe unilateral temporal headache - Scalp tenderness - Jaw claudication - Vision changes (blurred or double vision) - Systemic symptoms e.g. fever, muscle aches, fatigue, loss of appetite Investigation: - Temporal artery biopsy which show multinucleated giant cells (although can be falsely negative) - Bloods including ESR Management: Initial - High dose steroids (Prednisolone) - Aspirin - PPI while on steroids If vision changes - same day referral to ophthalmologist If no vision changes - discuss with specialist and refer using GCA fast-track pathway Continue on steroids until symptoms have resolved, can take years
43
List some complications of giant cell arteritis (early and later)
Early: - Permanent vision loss - Stroke Late: - Relapse of GCA - Long-term steroid complications - Stroke - Aortitis (risk of aortic aneurysm and dissection)
44
Sjogren's syndrome - state the following: - Pathophysiology - Typical patient - Presentation - Investigation - Management
Pathophysiology: - Autoimmune condition targeted against exocrine glands - Leads to dry mucous membranes such as dry eyes, dry mouth and dry vagina 2 types: Primary Sjogren's: occurs alone Secondary Sjogren's: associated with SLE or RA Typical patient: - Female (80%) - 40-50 - Caucasian Presentation: (MADFRED) Myalgia Arthralgia Dry eyes Fatigue Raynaud's Enlarged parotids Dry mouth Investigations: - Specific blood tests for anti-Ro and anti-La - Schirmer's test (tear production/collection) - May need salivary gland biopsy Management: - Artificial tears - Artificial saliva / sugar free gum/pastilles - Vaginal lubricants - Hydroxychloroquine to halt disease progression
45
List some complications of Sjogren's disease
Eyes: - Conjuntivitis - Corneal ulcers Mouth: - Dental cavities - Candida Vagina: - Sexual issues/dysfunction - Candidiasis
46
Briefly describe the pathophysiology of vasculitis
Pathophysiology: - Inflammation of the blood vessels (can be arteries or veins) - Categorised by the size of vessel affected (small, medium or large) - Leads to damage of blood vessel walls and subsequent thrombus formation, ischaemia, bleeding or aneurysm formation
47
Briefly describe the pathophysiology of vasculitis
Pathophysiology: - Autoimmune condition resulting in inflammation of the blood vessels (can be arteries or veins) - Categorised by the size of vessel affected (small, medium or large) - Leads to damage of blood vessel walls and subsequent thrombus formation, ischaemia, bleeding or aneurysms
48
Give 2 examples of each type of vasculitis - Small vessel vasculitis - Medium vessel vasculitis - Large vessel vasculitis
Small vessel vasculitis - Granulomatosis with polyangiitis (Wegner's) - Microscopic polyangiitis Medium vessel vasculitis - Kawasaki disease - Polyarteritis nodosa Large vessel vasculitis - Giant cell arteritis - Takayasu's arteritis
49
List some generic features of most types of vasculitis
- Purpura (small purple spots under skin) - Peripheral neuropathy - Renal impairment - HTN - Anterior uveitis - Scleritis - Joint and muscle pain - GI disturbance Systemic features - Fatigue - Weight loss - Fever - Loss of appetite
50
List investigations for vasculitis including antibodies
Bloods: - Inflammatory markers (CRP and ESR raised) Antibodies: - ANCA (anti-neutrophil cytoplasmic antibodies)
51
Describe the general medical approach to managing vasculitis
Steroids: - Tailor administration route to target affected areas - Oral / IV / nasal / inhaled Immunosuppressants: - Cyclophosphamide - Methotrexate - Azathioprine - Rituximab / other MAB
52
Hypermobility spectrum disorder - state the following: - Pathophysiology - Presentation - Investigation - Management
Pathophysiology: - Pain syndrome in people whose joints move beyond normal limits - Due to laxity of ligaments, tendons and capsules - Can affect any number of joints Presentation: - Pain around joints, worsens after activity - Abnormal skin - Marfan qualities e.g. arachnodactylyl - Hernias and prolapses Investigations: - Do a Beighton's score to assess likelihood Management: Aim to reduce pain and reduce disability - Analgesia (Paracetamol) - Physiotherapy - Splinting - Surgical interventions
53
Raynaud's syndrome - state the following: - Pathophysiology - Presentation (including classic pattern) - Management
Pathophysiology: - Vasospasm of the blood vessels of the digits - Precipitated by cold or stress - Common in young women (may be familial) Presentation: - Painful cold fingers Classic pattern - White (inadequate blood flow) - Blue (venous stasis) - Red (re-warming hyperaemia) Management: Conservative - Avoid cold / keep hands warm - Avoid smoking Medical - CCB - Phosphodiesterase-5 inhibitors - Prostacyclins
54
List some diseases associated with Raynaud's disease
If symptoms develop < 30 years old, suspect underlying disease - SLE - Systemic sclerosis - Sjogren's syndrome - Dermatomyositis and polymyositis PLUS - Cervical rib - Coagulopathies (sticky blood) e.g. cryoglobulinemia
55
List a physical cause and a drug that causes Raynaud's
Physical cause: - Use of heavy vibrating tools Drug: - Beta blockers
56
List 3 complications of Raynaud's phenomenon
- Digital ulcers - Severe ischaemia - Infection
57
Behcet's disease - state the following: - Pathophysiology - Presentation - Investigations - Management
Pathophysiology: - Rare multi-organ disease caused by a systemic vasculitis Presentation: - Recurrent oral ulcers - Recurrent genital ulcers - Uveitis - Erythema nodosum Investigations: - No specific test for Behcet's - Usually aim is to rule out other differentials e.g. rheumatoid factor, ANA or ANCA - Can use Pathergy test for exaggerated skin injury after minor trauma, however is unreliable - May investigate system related to specific symptoms Management: - Immunosuppressive treatment with biologic drugs, corticosteroids, Colchicine, Azathioprine or Methotrexate - Some need treatment of flares only, some need ongoing treatment

Year 3 - Medicine (8 decks)

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