Rheumatology Flashcards
What is rheumatology?
the medical management of musculoskeletal disease
What are the 4 pillars of inflammation?
rubor- red
dolor- pain
calor- hot
tumour- swollen
What are the two categories of joint pain?
inflammatory and degenerative
How does joint pain respond to NSAIDS?
inflammatory- does respond to NSAIDS
degenerative- less convincing response to NSAIDS
What is osteomyelitis?
infection localised to bone
What are the symptoms of acute osteomyelitis?
onset over several days
dull pain at the site
may be aggravated by movement
What are the signs of systemic osteomyelitis?
fever
rigors
sweats
malaise
What are the signs of local osteomyelitis?
For both acute and chronic:
tenderness, warmth, erythema, swelling
with chronic you may also get:
draining sinus tract, deep/ large ulcers that fail to heal despite extensive treatment, non-healing fractures
What is the differential diagnosis for osteomyelitis?
soft tissue infection
charcot joint
avascular necrosis of bone (e.g. due to steroids or sickle cell anaemia)
gout
fracture
malignancy
What is a Charcot joint?
bone and joint changes that occur secondary to loss of sensation and is most often associated with diabetes, syphilis, syringomyelia, spina bifida, traumatic spinal cord injury, and leprosy
What is a Charcot joint?
bone and joint changes that occur secondary to loss of sensation and is most often associated with diabetes, syphilis, syringomyelia, spina bifida, traumatic spinal cord injury, and leprosy
What is the management of infection due to a prosthesis?
antibiotic
debridement and retention of prothesis
excision arthroplasty
one stage exchange arthroplasty
two stage exchange arthroplasty
amputation
What is arthroplasty?
a surgical procedure to restore the function of a joint
Describe inflammatory arthritis
onset of new joint swelling
in sinovial joints
red and warm to touch
worst in morning
What are the causes of joint inflammation?
inflammatory arthritis
septic arthritis
What are the risk factors for gout?
beer
renal impairment
diuretics
aspirin
family history
What joints are affected by psoriatic arthritis?
big joints asymmetrically
the odd digit
affects spine
What joints are affected by rheumatoid arthritis?
affects small joints symmetrically
does not affect the spine
Describe uric acid levels in gout?
during a flare up uric acid levels in the blood will be low/ normal and the uric acid is concentrated in the joint, not the blood
when not in a flare up the blood uric acid levels will be above normal
Why does beer cause gout?
beer contains a lot of purine (namely guanosine) which the body converts to uric acid
Describe the mechanism of which we base the treatment for gout.
the last two steps of uric acid synthesis is hypoxanthine to xanthine to uric acid
both of these two steps are catalysed by xanthine oxidise (XO)
the treatment for gout is based on inhibition of XO
the inhibitors are called allopurinol or febuxostat (more potent)
What happens if gout goes untreated?
there are 4 clinical phases if left untreated:
- asymptomatic hyperuricaemia
- acute/ recurrent gout
- intercritical gout
- chronic tophaceous gout
What is chronic tophaceous gout?
uric acid deposits in the skin
What are the complications of gout?
disability and misery
tophi
renal disease
Describe the x-ray of a patient with rheumatoid arthritis.
x-ray of affected limb will be normal until about 6 months of disease
Describe the x ray changes over time in a patient with rheumatoid arthritis.
soft tissue swelling
periarticular osteopenia
joint space narrowing
bone erosion
What is pleuritic chest pain?
chest pain upon inspiration
What categories of illness cause multi system disease?
infection
autoimmune connective tissue diseases
metabolic disease
endocrine disease
cancer
Name the inherited connective tissue diseases.
Marfan’s syndrome
Ehler Danlos syndrome
What is SLE?
Systemic lupus erythematosus
What is SLE?
Systemic lupus erythematosus
