Rheumatology Flashcards
symptoms of reactive arthritis
conjunctivitis
arthritis
urethritis
“Can’t see, can’t pee, can’t stand on one knee”
features of polymyositis
proximal muscle weakness and wasting
problems getting out of chairs/walking up stairs
can also have oesophageal dysmotility problems and sclerodactyly
low grade fever
Ix for polymyositis
anti-Jo antibodies
raised CK
ANA positive
anti-Jo association
polymyositis
anti-Ro associations
Sjogren’s, SLE, congenital heart block
anti-La association
Sjogren’s syndrome
anti-scl-70 association
diffuse cutaneous systemic sclerosis
anti-centromere association
limited cutaneous systemic sclerosis (CREST syndrome)
symptoms in limited cutaneous systemic sclerosis
CREST calcinosis raynaud's oesophogeal dysmotility sclerodactyly telangectasia
areas affected in limited cutaneous systemic sclerosis
face, forearms and lower legs
diseases predisposing to osteoporosis
endo: cushings, GH def, hyperthyroid, hypogonadism (Turner's syn, testosterone def), hyper PTH GI: IBD, malabsorption, liver disease multiple myeloma, lymphoma CKD RA osteogenesis imperfecta, homocystinurea
OA Mx
weight loss, exercise
1: paracetamol and topical NSAID (for knee/hand)
2: oral NSAID/COX2i + PPI, opiods, capsaicin cream
non pharm: supports, TENS
secondary causes of Raynaud’s phenomenon
CT dz: scleroderma (most common), RA, SLE,
type I cryoglobulinaemia, cold agglutinins
OCP
use of vibrating tools (hand-arm vibration syndrome)
Mx of raynauds
calcium channel blocker eg nifedipine
IV prostacyclin infusions - last several weeks/months
pathology behind Paget’s disease
increased and uncontrolled bone turnover
RFs for Paget’s disease
increasing age
male
increased latitude
FH
clinical features of Paget’s disease?
bone pain (lumbar spine, femur, pelvis) raised ALP - calcium and phos are typically normal classically untreated: bowing of tibia, bossing of skull
indication for Rx of Pagets and what is the Rx
bone pain, fracture, skull or long bone deformity, periarticular Pagets
bisphosphonates (eg risedronate)
calcitonin (less commonly used now)
complications of Pagets
deafness (CN entrapment)
high output cardiac failure
fracture
osteosarcoma
classical history of ankylosing spondylitis
25 yo male with insidious onset lower back pain and stiffness that is worse in the morning and improves with exercise. He gets pain at night which improves when he gets up
features of Ank Spond
reduced chest expansion and lumber flexion apical fibrosis anterior uveitis aortitis achilles tendonitis amyloidosis arthritis (peripheral)
cANCA association
Wegener’s in >90%
pANCA association
immune crescentic glomerulonephritis (80%)
microscopic polyangitis (60%)
Churg-Strauss syn (60%)
primary sclerosing cholangitis (70%)
Anti-cyclic citrullinated peptide antibody association
Rheumatoid Arthritis - detectable 10 yrs before symptomatic
conditions with positive RF
RA 70-80% Sjogrens 100% Felty's syn 100% (RA, neutropenia, splenomegaly) infective endocarditis 50% SLE 25% systemic sclerosis 30% general population 5%
classical triad of Behcet’s syndrome
other Sx
1: oral ulcers, 2: genital ulcers, 3: uveitis thrombophlebitis arthritis GI: abdo pain, diarrhoea, colitis erythema nodosum, DVT
features of Churg-Strauss syndrome
Allergic phase - asthma or allergic rhinitis
Eosinophilic phase - hypereosinophilia, causing abdominal pain, GI bleeding, night sweats
Vasculitic phase - RF, abdo or heart problems
~50% die from cardiac disease, eosinophilic coronary myocarditis
Mx of Churg-Strauss
glucocorticoids. 20% need cytotoxics (azathioprine and cyclophosphamide)
Most common organism causing septic arthritis
Mx
staph. aureus
Mx - synovial aspiration and culture.
fluclox and fusidic acid (clinda if pen allergic) - 2wks IV, 4 weeks PO
May need surgical wash out or repeat aspirations
If young monoarthritis - think gonococcus (10/7 ceftriaxone)
if older/immunosuppressed - ?listeria ?gram neg. Taz instead of fluclox
What is Schirmer’s test?
What does it test for?
Litmus paper in lower eyelid, Sjögren’s syndrome
Positive if <5mm in 5mins
What is Takayasu arteritis?
granulomatous vasculitis of large vessels, with intimal fibrosis
Sx: TIAs, claudication, hypertension (renal artery stenosis)
Mx: steroids
Which bacterial infection is linked with RA in susceptible individuals?
Proteus mirabilus - urine infections.
Mx of Ank Spond
NSAIDs and physio in early disease
sulphasalazine improves peripheral joint arthritis
later TNF-a antagonists (eg etanercept) can be used.
Risk factors for avascular necrosis
lupus, steroids, antiphospholipid syndrome, sickle cell disease, alcoholism
Caisson’s disease (decompression sickness “the bends”)
Gaucher’s disease (genetic lipid accumulation disease)
Indication for starting osteoporosis treatment following DEXA scan
T score < -2.5 in normal adults or < -1.5 in patients on steroids.
Oral bisphosphonates used 1st line.
Mx of Feltys syndrome
(hepatosplenomegaly, RA and neutropenia)
pulsed corticosteroid and/or cyclophosphamide
splenectomy if medical Rx fails.
