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Royal College 2023 > Rheumatology > Flashcards

Rheumatology Flashcards

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1
Q

4 mechanisms by which OA predisposes to falls

A
  1. Unwilling to use joint b/c of pain = muscle atrophy
  2. Chronic pain and depression
  3. Impaired balance
  4. Nerve entrapment = peripheral neuropathy
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2
Q

Non-pharmacologic interventions for OA

A
  1. Exercise
  2. Self management programs
  3. Tai chi
  4. Weight loss
  5. Cane
  6. Knee brace
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3
Q

Pharmacologic tx for OA and risk of each

A
  1. Topical NSAID - contact dermatitis
  2. Oral NSAID - renal dysfunction, PUD
  3. Tylenol - liver toxicity
  4. Duloxetine - drowsiness
  5. Tramadol - CNS depressant
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4
Q

Surgical tx/invasive options for OA

A
  1. Total joint arthroplasty/replacement
  2. Unicompartmental knee arthroplasty
  3. Knee osteotomy
  4. Intra articular CS injection
  5. Intra articular hyaluronic derivative injection
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5
Q

8 complications post TKA that can cause pain

A
  1. Infection
  2. Hematoma
  3. DVT/PE
  4. Patellofemoral disorder
  5. Periprosthetic fracture
  6. Wound healing problem
  7. Aseptic loosening
  8. Complex regional pain syndrome
    ~20% patients have persistent pain
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6
Q

4 characteristics of gouty arthritis that differentiate older onset >65 from usual onset

A
  1. Frequent polyarticular presentation
  2. Increased tophi around elbows/hands
  3. Less frequent acute gouty episodes
  4. More indolent chronic course
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7
Q

CI for colchicine in elderly

A
  1. Renal dysfunction
  2. Avoid in dehydrated/malnourished - causes diarrhea and vomiting
  3. Use of P-gp inhibitor or CYP3A4 inhibitor in presence of renal/hepatic impairment
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8
Q

Allopurinol doses based on Cr Cl

A

> 60 = start 100 mg daily
30-60 = 50 mg daily
15-30 = 50 mg EOD
5-15 = 50 mg twice weekly
<5 = 50 mg once weekly

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9
Q

What are 2 causes of gouty arthritis?

A
  1. Obesity leading to rate overproduction
  2. Renal impairment leading to urate under excretion

Other
Underexcretion: HTN, drugs, dehydration, hypothyroid
Overproduction: alcohol, hypertriglycerides, B12 start

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10
Q

What is your target uric acid level for treatment?

A

<360 umol/L

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11
Q

8 risk factors for gout

A
  1. Older age
  2. Male
  3. HTN
  4. DLD
  5. T2DM
  6. CKD
  7. Alcohol
  8. Meds (ASA, thiazide)
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12
Q

Indications to start urate lowering therapy in patient with gout

A
  1. 1+ subcutaneous tophi
  2. Evidence of radiographic damage
  3. 2+ gout flares annually
    Conditional
  4. Prev >1 flare but <2/yr

Generally avoid during first gout flare unless CKD stage 3+, SU conc >9 or urolithiasis

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13
Q

What is first line therapy for uric acid lowering therapy and it’s mechanism of action?

A

Allopurinol
Xanthine oxidase inhibitor
Start 100 mg/d unless CKD

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14
Q

What is the second line uric acid lowering therapy?

A

Febuxostat (over probenecid)

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15
Q

What anti inflammatory prophylaxis to use when starting ULT? How long should you continue it?

A

Colchicine (low dose)
NSAIDs
Prednisone

Continue for 3-6 months

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16
Q

Gout flare management pharmacologic

A
  1. Colchine (low dose)
  2. NSAIDs
  3. Glucocorticoids (oral, intraarticular, intramuscular)
  4. IL-1 inhibitor if above ineffective
  5. Topical ice
17
Q

Presentation of RA elderly vs young

A

Presentation at onset
- Abrupt onset
- More constitutional symptoms
Joints
- Large joint involvement
Nodules
- Less likely
RF
- Low presence
Prognosis
- Less severe if mimicking PMR

18
Q

GCA features on exam

A

Temporal artery: beaded, prominent, no pulse
Low grade fever
Scalp tender
Limited ROM shoulder/neck/hip
Reduced visual acuity

19
Q

Tx of GCA

A

High dose steroids
Refer for temporal artery biopsy

20
Q

PMR clinical features

A

1.Pain/stiffness in shoulders, neck, hip
2. Flu like (fever, poor appetite, weak)
3. Subacute in onset
4. Ocular symptoms, jaw claudication, scalp tenderness if GCA

21
Q

Investigations for PMR

A

ESR/CRP
RF, anti CCP, ANA, CK
Radiographs

22
Q

Long term complications of PMR

A

Self limited mos-yrs
Eventually stop steroids

Royal College 2023 (79 decks)

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