Rheumatology Flashcards
Lower back and alternating buttock pain
Worse in the mornings
Disturbs the patient’s sleep
Ankylosing spondylitis
X ray in ankylosing spondylitis
syndesmophytes (fusion of vertebra)
Bamboo spine (fusion of spinal column)
squared vertebra
4 conditions associated with ankylosing spondylitis
anterior uveitis
upper lobe pulmonary fibrosis
inflammatory bowel disease
achilles tendonitis
Lace like rash on the back of the legs
Livedo reticularis
found in antiphospholipid syndrome
Mx of antiphospholipid syndrome
Warfarin
in pregnancy: LMWH + aspirin
Gout and common Px
uric acid buildup
paintful MTP joint in the big toe, red, swollen
Pseudogout cause and Ix
calcium pyrophosphate crystal buildup
Positive rhomboid
Px and Ix of churg-strauss syndrome
eosinophilic granulomatosis with polyangiitis
rash, asthma
raised eosinophils
pANCA positive
Px and Ix of Wegener’s granulomatosis
Granulomatosis with polyangiitis
1. URT: epistaxis’s saddle shaped nose
2. LRT: haemoptysis, dyspnoea
3. glomerulonephritis: proteinuria (frothy urine) + haematuria
cANCA +
Mx of Giant Cell Arteritis
oral prednisolone
Px of Rheumatoid arthritis
swan neck deformity, boutonnieres hand, C spine involvement
morning stiffness that is better after activity
Px of reactive arthritis
conjunctivitis
urethritis
arthritis
pregnant woman with rhuematoid. meds?
hydroxychloroquine, sulfasalazaline, folic acid
GCA mx
oral prednisolone if no visual compromise
IV methylprednisolone if there is visual compromise
antibody in SLE
anti ds DNA
antibody in polymyositis/dermatomyositis
anti Jo 1
antibody in rheumatoid arthritis
Anti CCP
autoimmune hepatitis antibody
anti smooth muscle
antibody in cutaneous systemic sclerosis
anti centromere
young, history of Hep B, systemic upset (CNS, GI, fever upset), nodular rash
polyarteritis nodosa
Mx of polyarteritis nodosa
corticosteroids
young woman presents acutely with blood pressure discrepancy, absent extremity pulses, fever, night sweats, limb claudication, stroke
takayasu’s arteritis
what is sjogrens syndrome
decreased secretion production from lacrimal & salivary glands
fatigue, dry mouth, dry eyes, dysapereunia,
sjogrens syndrome
antibody in sjogrens
anti ro
limited cutaneous systemic sclerosis acronym
CREST
calcinosis
raynauds
oesophageal dysmotility
sclerodactyly
telangectasia
what is the key Ix in gout
joint aspiration to look for sodium monourate crystals
key features of polymyositis
proximal muscle weakness (hip and shoulder girdle)
leads to respiratory and then pharyngeal muscles
key features of dermatomyositis
same muscle weakness as polymyositis
heliotrope rash on eyelids
gottrons papules
Mx of reactive arthritis
oral NSAIDs
then oral prednisolone
Pt with diffuse systemic sclerosis
sudden headache, renal dysfunction
hypertension
what is it and MX???????
scleroderma renal crisis
1. ACEis
2. calcium channel blockers
3. dialysis
Fetlys syndrome
rheumatoid arthrtiis
splenomegaly
neutropenia
Difference between diffuse vs limited systemic sclerosis
Limited is hands, fingers, face
Diffuse is elbows, knees
Polymyalgia rheumatica vs polymyositis
PMR is proximal joint pain and stiffness
Polymyositis is proximal muscle pain, raised myoglobin and creatine kinase
what investigation to do when you suspect ankylosing spondylitis
pelvic MRI
Antibody in diffuse systemic sclerosis
Anti scl 70
causative agents of reactive arthritis
chlamydia
salmonella
shigella
campylobacter
Bone pain, tenderness and proximal myopathy
osteomalacia
vitamin D deficiency
chronic stiffness and pain in the distal interphalangeal (DIP) joints
symmetrical indicates what?
asymmetrical indicates what?
symmetrical = rheumatoid
assymmetrical = psoriatic
Blood tests results for rheumatoid arthritis
Anemia of chronic disease
Raised crp
Raised platelets
Mx of patients at risk of glucocorticoid-induced osteoporosis: two ways depending on age
> 65 IV alendronic acid
<65 do a DEXA scan. if. < -1.5 give IV alendronic acid
methotrexate monitoring
FBC, U+E, LFTs every 3 months
