Rheumatology Flashcards
how are flares of rheumatoid arthritis usually managed?
corticosteroids - oral or intramuscular
What are the features of osteoarthritis?
usually bilateral
one joint at a time is affected over a period of several years
the carpometacarpal joints and distal interphalangeal joints are affected most
painless nodes:
herbeden’s nodes at the DIP joints
bouchard’s nodes at the PIP joints
squaring of the thumbs
What are the features of takayusu’s arteritis?
systemic features of vasculitis e.g. malaise, headache
unequal blood pressure in upper libs
carotid bruit and tenderness
absent or weak peripheral pulses
upper and lower limb claudication on exertion
Aortic regurgitation
what is the management of a displaced hip fracture?
total hip replacement or hemiarthroplasty
total hip replacement is favoured to hemi if patients:
- were able to walk independently outdoors with no more than the use of a stick and
- are not cognitively impaired and
- are medically fit for anaesthesia and the procedure
What is the management of ankylosing spondylitis?
NSAIDS
tnf-alpha blockers e.g. infliximab, etanercept
what antibodies are associated with limited (central) cutaneous systemic sclerosis?
anti-centromere antibodies
what antibodies are associated with diffuse cutaneous systemic sclerosis?
anti-scl 70 antibodies
When should people with ank. spond be considered anti-tnf therapy\?
in axial ank spond that has failed on 2 different NSAIDs and meets criteria for active disease on 2 occasions 12 weeks apart
what is the management of perthes disease?
- keep femoral head within acetabulum - cast, braces
- if less than 6 years: observe
- older: surgical management with moderate results
- operate on severe deformities
What are the features of hypercalcaemia?
- bones, stones, groans and psychic moans
- corneal calcification
- shortened qt interval on ECG
- hypertension
What is myasthenia gravis associated with?
thymomas in 15%
autoimmune disorders: pernicious anaemia, autoimmune thyroid disorders, rheumatoid, SLE
thymic hyperplasia in 50-70%
what is seen on synovial fluid analysis in gout?
needle shaped negatively birefringent monosodium urate crystals under polarised light
How high would the CK be in rhabdomyolysis?
> 10,000
what are the features of drug-induced lupus?
arthralgia
myalgia
skin - malar rash and pleurisy are common
ANA positive in 100%
anti-histone antibodies are found in 80-90%
Anti-Ro, anti-Smith positive in 5%
what medication can make Raynaud’s worse?
propranolol
what are the features of limited cutaneous systemic sclerosis?
skin fibrosis is limited to the hands and forearms, feet and legs, and head and neck
also called CREST syndrome:
Calcinosis
Raynauds
Eosophageal dysmotility - GORD/dysphagia
Sclerodactyly - bright shiny skin of hands and feet
Telangiectasia
what are the features of diffuse cutaneous systemic sclerosis?
multi-system autoimmune disease - key features are abnormalities of blood vessels and fibrosis of the skin and internal organs
skin involvement is over widespread areas at onset and is characterised by early visceral involvement
features:
- family history of systemic sclerosis
- raynauds phenomenon
- digital pits or ulcers that can be painful and lead to functional disability
- skin thickening, sclerodactyly and loss of function of the hands
- telangiectasia
What are the features of still’s disease?
arthralgia
elevated serum ferritin
rash: salmon pink, maculopapular
pyrexia: typically rises in late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash
lymphadenopathy
rheumatoid factor and anti-nuclear antibody negative
has a bimodal age distribution 15-25 years and 35-46 years
what is the general prognosis of sarcoidosis?
it remits without treatment in approximately 2/3 of people
what are poor prognostic factors of sarcoidosis?
insidious onset, symptoms > 6 months
absence of erythema nodosum
extrapulmonary manifestations
CXR: stage III-IV features
Black people
What is the management of osteoporosis?
treatment is indicated following osteoporotic fragility fractures in post-menopausal women who are confirmed to have osteoporosis
vit D and calcium supplementation should be offered to all women unless the clinician is confident they have adequate calcium intake
alendronate is first line
What are the features of ank. spond on x-ray?
radiographs may be normal in early disease, later changes include:
- sacroiliitis: subchondral erosions, sclerosis
- squaring of lumbar vertebrae
- bamboo spine - late and uncommon sign
- syndesmophytes
what should be done before starting biologic therapy in people with RA?
chest X-ray to look for tb prior to srtarting
what is dermatomyositis?
inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions
may be idiopathic or may be associated with connective tissue disorders or underlying malignancy - typically breast and lung - screening for an underlying malignancy is usually performed following a diagnosis of dermatomyositis
polymyositis is a variant of the disease where skin manifestations are not present
