Rheumatology Flashcards
problems with joints
OA
Crystal arthritis (gout, pseudogout)
RA
Spondyloarthritis (AS, Psoriatic arthritis, IBD, reactive arthritis)
multi-system problems
- connective tissue disease (SLE, Sjogrens, systemic sclerosis)
- vasculitis (takayasu’s, GCA, polyarteritis nodosa, HSP)
bone/soft tissue problems
- metabolic bone disease (osteoporosis, osteomalacia)
- inherited disorders of connective tissue
- soft tissue disease (Bursitis, tendiopathy)
- fibromyalgia
signs of OA
Herberden’s
Bouchard’s
Squaring at base of thumb
joints: DIP, PIP, CMC
mx of OA
pain management
physio
aids for daily living
injection
surgery
which joints are affected in RA?
wrist joints
MCP joints
PIP joints
>10 joints in total
management of RA
- analgesic
- NSAID
- steroid prep
- csDMARDS (e.g. methotrexate)
- biological DMARDs
- tsDMARDS (e.g. JAK inhibitors)
X-ray findings of AS
bilateral sacroiliitis
sclerosis
erosive damage
fusion of joint
reduced joint space
treatment of AS
doesn’t respond to conventional DMARDs
use biologicals e.g. TNFa or IL17
signs of psoriatic arthritis
small joints of PIP/DIP
psoriatic nail changes (oncycholysis, pitting, subungal hyperkeratosis)
connective tissue diseases are all…
ANA +ve
dsDNA
SLE
ENA
Sjogrens (Ro, La)
cytoplasmic
Myositis (t-RNA, Jo1)
limited vs diffuse sclerosis
limited = skin changes limited to forearm/calf, more distal and to peri oral area
= anti-centromere
cANCA is against
enzyme proteinase 3
pANCA is against
myeloperoxidase
score system for osteoporosis and treatment
FRAX score
Tx: bisphosphonate, anti-RANK ligand PTH analogue
RA disease monitoring
Disease Activity Score 28 (DAS28)
CRP monitoring
X-ray loss of joint space RA vs OA
RA: loss of joint spaces in proximal joints
OA: loss of joint spaces in distal joints
RA X-ray changes (LESS)
loss of joint space
erosions (periarticular)
soft tissue swelling
subluxation and deformity
X-ray findings in Gout
punched out erosion
rat bites