Rheumatology Flashcards
Management of patients above 75 years old who has sustained a fragility fracture?
Patients who’ve had a fragility fracture and are >= 75 years of age are presumed to have underlying osteoporosis and should be started on first-line therapy (an oral bisphosphonate), without the need for a DEXA scan.
Most common organism in septic arthritis?
Most common organism overall is Staphylococcus aureus.
In young adults who are sexually active, Neisseria gonorrhoeae is the most common organism (disseminated gonococcal infection).
Antibody associated with neonatal lupus?
Anti-RO antibodies.
- SLE in pregnancy there is a risk of maternal autoantibodies crossing the placenta leading to neonatal lupus erythematosus.
- Neonatal complications include congenital heart block.
Causes of drug induced lupus?
Most common:
- Procainamide
- Hydralazine
Less common:
- Isoniazid
- Minocycline
- Phenytoin
Azathioprine cannot be administered with which drug?
Allopurinol.
Azathioprine and allopurinol have a severe interaction causing bone marrow suppression.
Investigation for Behcet disease?
1) oral ulcers 2) genital ulcers 3) anterior uveitis
- Thrombophlebitis and deep vein thrombosis
- Associated with HLB51
- No definitive test
- Diagnosis based on clinical findings
- Positive pathergy test is suggestive (puncture site following needle prick becomes inflamed with small pustule forming)
Treatment for scleroderma renal crisis?
Captopril (ACE inhibitor).
Azathioprine increases risk for what cancer?
Increased risk of non-melanoma skin cancer.
Pharmacological treatments for fibromyalgia?
- Pregabalin
- Amitriptyline
- Duloxetine
Most sensitive antibody for SLE?
Over 99% of patients with SLE are ANA positive, therefore it is a useful rule out test.
- Anti-Smith is highly specific for SLE (>99%), but not very sensitive (30%).
- Anti-dsDNA is highly specific to SLE (>99%), but less sensitive (70%).
Treatment for familial Mediterranean fever?
Colchicine.
FMF is an autosomal recessive disorder which typically presents by the second decade. It is more common in people of Turkish, Armenian and Arabic descent.
Features:
- Pyrexia
- Abdominal pain (due to peritonitis)
- Pleurisy
- Pericarditis
- Arthritis
- Erysipeloid rash on lower limbs
Which DMARDs are safe to use in pregnancy?
SAH
- Sulfasalazine
- Azathioprine
- Hydroxychloroquine
Pharmacological management for discoid lupus erythematous?
The patient typically presents with an erythematous rash with an adherent scale in both ears. This is a classic location for discoid lupus erythematosus (DLE) and is known as ‘Schuster’s sign’ when it affects the conchal bowl of both ears.
A biopsy demonstrating interface dermatitis is typical.
The first-line treatment of discoid lupus is topical steroids.
Oral hydroxychloroquine may be used second line.
Gold standard investigation for polymyositis?
Muscle biopsy is the gold standard investigation for the diagnosis of polymyositis.
Even though it is less commonly used today due to its invasive nature and difficulty in accessing the appropriate muscle group, it remains the most sensitive and specific test in identifying polymyositis histopathologically, provided that the right area of muscle is biopsied.
Common cause of osteomyelitis in sickle cell patients?
Blood and bone infections caused by non-typhi salmonella (NTS) are typically associated with malaria and homozygous sickle cell disease, especially in children.
