RHEUMATOLOGY Flashcards
Morning stiffness
Joint pain
Joint swelling
Dx and treatment
Juvenile Rheumatoid Arthritis
Tx: nsaid
Most common resentstion of arthritis in SLE
Symmetrical arthritis of joints I the hands
Atlabtoaxial joint
Ra orOA
RA
Cervical and lumbar spine
RA Or OA
OA
1st carpometacarpal joint
1st Metatarsophalangeal joint
DIP
PIP
Knee joint
Hip Joint
OSTEOARTHRITIS
Most commonly affected in Pdeudogout
Knee
Non itchy, non-pitrinf swelling, laryngeal edema, abdominal pain,Vomiting and diarrhoea
Dx and investigation?
Hereditary angioedema
C1 and C4 levels
Mouth Ulverstone
Ain’t and swelling 8n both wrists and MCP joints
Dx?
SLE
Treatment of choice for acute gout
NSAIDS
Treatment for chronic gout
Allopurinol
Pain and stiffness hips and shoulders
Elevated ESR
Age over 50 years, typically 60-70
Polymyalgia Rheumatica
Specific antibody test for diagnosing SLE
Anti- d’s DNA
Screening test for SLE
Antinuclear Antibody
Specific antibody for idiopathic inflammatory myopathies
Anti jo 1 antibody
Sensitive marker for mixed connective tissue disease
Anti,-ribonucleoprotein antibody
Nodules
No skin erosions
Arthralgias in multiple joints
Dx:
Tx
Rheumatoid Nodulosis
Intralesional steroid injection
Both joints red, warm and tender
Ankle pain
Chronic alcohol use and binge drinking
Needle aspiration: needle shaped monosodium aspirate
Dx
Tx
Acute Gout
Prednisolone 50 mg / day
Left sided throbbing headache
Jaw claudication with unexplained fever
Inv
Dx
Temporal artery biopsy
Giant cell arthritis
Woman rheumatoid
On methotrexate and Hydroxychloroquine
Advice during pregnancy?
Yes continue to hydroxycholoroquine
But stop with methotrexate
Treatment for Giant cell ateritis
Rednisolone 40-60 mg mg/d
Atrophy of vast deferens
Sweat Chloride test
Cystic fibrosis
Calcinosis
Raynauds phenomenon
Abticebtromere antibodies
Systemic Sclerosis
Recurrent swelling of her face, arms and legs
Nonliving and nonpruiritic swelling
Inv
Dx
C1 AND c4 levels
Hereditary angioedema
Multiple sclerosis
Approx one person in how many
1000
Hypertension
Indapamide
Binge drinking every night
Acute Gout
ANCA positive
antiproteinase PR3
Antimyeloperoxidase or MpO
Wegeners Granulomatosis
Low back pain
Morning stiffness
Inflammatory Arthropathy
Dry mouth, gritty sensation in the eyes
Difficult to speak, no history of DM
Salivary glands enlarged
Management?
Schirmier test and measurement of antibodies
Unable to climb stairs
Rash on face, weakness on hip and shoulder girdle
Purplish red discolorations OT the eyes and erythermatous discolorations of fingers and joints
Dx?
Dermatomyositis
- heliotrope rash
**discoloration of the eyes that extends to the joints and extremities
Pain and swelling of wrists and knees
Several months fatigue
MCP joints and wrists tender and warm
Dx and
Inv
Rheumatoid Arthritis
And Rheumatoid Factor
Painful swollen knee
Cloudy fluid, wbc 50,000 mm3
More than 90,% PMN leukocytes
Glucose fluid level decreased
Dx?
Infectious Arthritis
Myopathy
Noncaseating Granulomas
Dx,?
Sarcoidosis
Worsening headaches,
Episodes of transfer visual loss
A Nd diploma
Jaw muscle stops chewing
Tender nodular at right temporal artery
Normocystic anaemia
Sedimentation rate 95
Dx?
Temporal arthritis
What is the most feared complication of temporal arthritis?
Blindness
Exposed to a children with febrile illness and rash
Parvovirus
Highest specificity for rheumatoid arthritis?
Anti Citrullinated Peptide Antibody
Ongoing back pain
Ain’t is severe at night and gets better after getting up and jojbt stiffness in the morning
Inv?
Dx¿?
Plain xrqy of the sacroiliac joints
Analysing spondylositis
What causes the increase risk for pseudogout
Hypothyroidism
What are the other factors for Pseudogout?
Haemochromatosis
Hyperparathyroidism
Hypercalcaemia
Hypomagnesemua
More than 70 years.family history
Joint pain both hands
Stiffness lasting for hours once she wakes up in the morning
Nocturnal pain
Swelling around MCP and PIP
Drug of choice?
Rheumatoid Arthritis
Doc: Methotrexate
Frequent fatigue and joint pain
Weight loss
Malar rash
And oral ulcers
SLE
What is incorrect about SLE?
Anti Smith antibody is highly sensitive for SLE
Knee pain
Negative birefringent test
Gout
***needle shaped monosodium urate crystals with brightly birefringent in polarised light with negative elongation
Drugs that doesn’t cause SLE
Nitrofurantoin
Interphalangeal joints tender and rash noted on cheeks and nose
What initial investigation to do on this?
Antinuclear antibodies
- SLE - best initial screening test
What are the clinical symptoms of SLE
Arthritis
Malar rash
And anaemia
Generalised pain to the neck and shoulder girdle, elbow, low back pain and legs
Fibromyalgia
- pain in all 4 quadrants in the body
Pain and swelling around the wrists hand joints more than 1 hr
Which is correct regarding the dx of rheumatoid Arthritis?
Anti CCp sensitivity is 50-60 percent
Specificity is 95-98%
