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.
Definitive investigation for primary Sjogren’s syndrome?
Salivary gland biopsy is the most definitive way of confirming the diagnosis of primary Sjogren’s syndrome - sections will show a typical lymphocytic infiltrate.
Blood findings on osteomalacia?
- Low vitamin D levels
- Low calcium, phosphate (in around 30%)
- Raised alkaline phosphatase (in 95-100% of patients)
Biochemical markers that is abnormal in Paget’s disease?
Serum non-isomerised C-telopeptide (CTx) is an extremely sensitive marker of increased bone turnover observed in Paget’s disease and is useful in monitoring disease progression or treatment efficacy.
Second line option for urate lowering therapy?
The second-line agent when allopurinol is not tolerated or ineffective is Febuxostat (also a xanthine oxidase inhibitor).
What are the features of adult onset Still’s disease?
- Arthralgia
- Elevated serum ferritin
- Rash: salmon-pink, maculopapular
- Pyrexia
typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash - Lymphadenopathy
- Rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative
Antibody for polymyositis?
Anti-synthetase antibodies:
Anti-Jo-1 antibodies are seen in pattern of disease associated with lung involvement, Raynaud’s and fever.
When should colchicine be avoided?
Should be used with caution in renal impairment: the BNF advises to reduce the dose if eGFR is 10-50 ml/min and to avoid if eGFR < 10 ml/min BNF.
the main side-effect of colchcine is diarrhoea
Mx for Raynaud’s?
First-line: calcium channel blockers e.g. nifedipine.
Second line: IV prostacyclin (epoprostenol) infusions: effects may last several weeks/months.
Mx for Methotrexate toxicity?
Folinic acid is the treatment of choice for methotrexate toxicity.
