Rheumatology

Question 1

Acutely red, inflamed, painful joint-Treat as septic arthritis:

Answer 1

1. need to do synovial fluid sampling first
2. then need to start abx (Flucloxacillin- to cover for Gram-Positive cocci)

Question 2

Differentiating between Psoriatic Arthritis and Rheumatoid Arthritis:

Answer 2

Psoriatic: Asymmetrical joint pains and ‘pencil in cup’ appearance on x-ray.

Question 3

If patient is allergic to aspirin, which other DMARD would also result in an allergic reaction?

Answer 3

Sulfasalazine- often triggers a similar allergic reaction to aspirin as it contains a salicylate(main functional group in aspirin).
-Another caution of sulfasalazine= in G6PD Deficiency.

Question 4

Reactive Arthritis(also called Reiter’s Syndrome)- (Acute) management:

Answer 4

-1st line: analgesia, NSAID as long as there are no contraindications
- next line: Glucocorticoids(intra-articular) and then Methotrexate

Question 5

Polymyalgia Rheumatica classical Presentation and Mx:

Answer 5

• Aching and morning stiffness in proximal limb muscles but in absence of weakness, patient is usually more than 60 yrs old, has a rapid onset of symptoms of less than a month.
  -increased ESR but normal creatinine kinase.
  -managed by Prednisolone: 15mg once daily-if steroids don’t seem to improve symptoms= then consider alternative diagnosis= as steroids should show dramatic improvement. 2nd line mx: Methotrexate

Question 6

Rheumatoid Arthritis management:

Answer 6

1st line= Methotrexate

Question 7

SLE management:

Answer 7

Hydroxychloroquine

Question 8

Polymyalgia Rheumatica association condition:

Answer 8

Temporal Arteritis(giant cell arteritis)

Question 9

Henoch-Schloein Purpura:

Answer 9

• Type of vasculitis
• Feature: Purpura (non-blanching rash), IgA Nephritis

Question 10

Eosinophilic Granulomatosis with Polyangitis:

Answer 10

-Type of vasculitis
-P-Anca
-Raised Eosinophils
-Late onset asthma, sinusitis, rhinitis