Rheumatology Flashcards
What is classically impaired in adhesive capsulitis (frozen shoulder)? Which patient population is more likely to get this?
Pain upon external rotation both on active and passive movement
Diabetes is major RF - 20% of diabetics develop this
Drug causes of gout?
diuretics: thiazides, furosemide
ciclosporin
alcohol
cytotoxic agents
pyrazinamide
aspirin
RFs for avascular necrosis of hip?
long-term steroid use
chemotherapy
alcohol excess
trauma
Differences between limited cutaneous systemic sclerosis and diffuse cutaneous systemic sclerosis?
Limited:
- Mainly affected proximal limbs + face
- Anti-centromere antibodies
Diffuse:
- Mainly affects trunk + proximal limbs
- Anti Scl-70 antibodies (higher risk of severe interstitial lung disease)
Features of systemic sclerosis? (scleroderma, limited cutaneous systemic sclerosis and diffuse cutaneous systemic sclerosis)
Condition of unknown aetiology characterised by hardened, sclerotic skin and other connective tissues.
It is four times more common in females
Main cause of death in diffuse cutaneous systemic sclerosis?
Respiratory involvement seen in 80% - ILD and PAH
other complications include renal disease (start on ACEi) and HTN
Examples of TNF-inhibitors?
Etanercept
Infliximab
Adalimumab
Inhertiance of Familial Mediterranean Fever?
Autosomal recessive
Features of familial mediterranean fever? mx?
Reoccurring episodes of abdo pain, fever, arthralgia and chest pain
Colchicine can help
DMARD safe in pregnancy and breastfeeding?
Sulfasalazine
Adverse effects of Sulfasalazine?
Oligospermia
SJS
Pneumonitis / lung fibrosis
Myelosuppression
May colour tears / contact lenses
Reactive arthritis features?
classic triad of urethritis, conjunctivitis and arthritis
(can’t see, pee or climb a tree)
Defined as arthritis develops following infection where organism can’t be recovered from joint
Features of osteomalacia?
Bone pain, tenderness and proximal myopathy (-> ?waddling gait)
Which individuals are susceptible to azathiopurine? Safe in pregnancy?
TPMT deficient people
Safe in pregnancy
Behcets triad?
oral ulcers, genital ulcers and anterior uveitis (HLA B51)
Also get thrombophelbitis and DVTs +
arthritis
neurological involvement (e.g. aseptic meningitis)
GI: abdo pain, diarrhoea, colitis
erythema nodosum
Behcets epidemiology?
Eastern mediterraneans
Men»_space; with more severe disease
Young adults 20-40y
30% have FHx
What is deposited in pseudogout?
calcium pyrophosphate dihydrate (CPPD) crystals
RFs for pseudogout?
Increasing age (main)
If younger:
Haemochromatosis
Wilsons
Hyperparathyroidism
low Mg, low PO4
acromegaly
Inflammatory arthritis involving DIP swelling + dactylitis (finger/toe swelling looks like sausages)-> ????
Psoriatic arthritis
Can also cause spinal stiffness and reduced cervical spine mobility
Type of collagen in osteogenesis imperfecta?
Type 1 collagen
What are Heberden’s nodes and Bouchard’s nodes? Which disease are they found in?
Heberdens node (painless bony swelling at DIP)
Bouchards node (painless bony swelling at PIP)
Found in OA due to osteophyte formation
Think about which letter is proximal / distal in alphabet
When to be careful giving sulfasalazine to patients?
If they have G6PD deficiency (Tito)
Allergy to aspirin / sulphonamides due to cross reactivity
What are the issues for SLE and pregnancy?
Risk of maternal autoantibodies crossing placenta -> neonatal lupus erythematosus
Complications inc. congenital heart block (associated strongly with anti-Ro ab) - Ro block!
Anti-ribonuclear protein (anti-RNP) is found in which disease? How do they present?
Mixed connective tissue disease
Present with:
- Raynauds before most sx (90%)
- Polyarthralgia / arthritis
- Myalgia + Dactylitis
M:F - 1:3
30-40y avg age
Which complements are low in active SLE disease?
C3, C4 due to formation of immune complexes and consumption
Mx of ank spond?
1st line - Exercise + NSAIDs
2nd - DMARDs only if peripheral joint involvement
Main target for pANCA and cANCA?
cANCA - serine proteinase 3 (PR3)
pANCA - myeloperoxidase (MPO)
Muscular inflammation + skin manifestations (red, scaly bumps over knuckles) - what disease? what is clinical sign? what is the main autoantibodies?
Dermatomyositis
Grotton’s papules - red scaly bumps over knuckles
Anti-Mi-2 - HIGH SPECIFIC (seen in 25%)
ANA (60%)
positive birefringent rhomboid-shaped crystals are seen in which disease?
Pseudogout
What is polyarteritis nodosa? Associated with which infection?
PAN - vasculitis affecting medium-sized arteries with necrotizing inflammation leading to aneurysm formation
Associated with Hep B infection
Fever, malaise, arthralgia
Mononeuritis multiplex, sensorimotor polyneuropathy
Livedo reticularis
Renal impairment +- haematuria
Which condition is this?
Polyarteritis Nodosa
Arterial/venous thrombosis, miscarriage, livedo reticularis → which disease and antibodies?
Antiphospholipid syndrome
Anticardiolipin + Anti-Beta2 glycoprotein I ab
gradual onset leg and back pain, weakness and numbness which is brought on by walking (with a normal clinical examination)
Diagnosis? Differentiate from claudication? Ix/ mx?
Spinal stenosis
Differentiation:
- Positional element - sitting > standing + easier to walk uphill v downhill
Ix: MRI
Mx: Laminectomy
CXR finding in ank spond?
Apical fibrosis
Organism for osteomyelitis? When is a different organism more likely?
Staph aureus
Salmonella more common in sickle cell
Fever/back pain with pain on extension of the hip
Diagnosis?
Iliopsoas abscess
What feature suggests psoriatic arthritis v RA?
Assymetrical oligoarthritis
XR features in ank spond? what if no changes but still suspecting
XR sacroiliac joint:
- Sacroilitis - subcondral sclerosis + sclerosis
- Squaring of lumbar vertebrae
- Syndesmophytes - ossification of outer fibres of annulus fibrosis
- Bamboo spine - LATE AND UNCOMMON
Early disease may not show XR changes so should get MRI - can show inflammation of sacroiliac joints (BM oedema)
Purple/red rash on upper eyelids - what is this called? seen in which disease? which ab?
Heliotrope rash - seen in dermatomyositis
Anti-Jo1 ab
Marfans gene? protein affected?
FBN1 gene chromosome 15
Protein fibrillin 1
Eye features in marfans?
Upward lens dislocation (superotemporal ectopia lentis)
Blue sclera
Myopia (near sightedness)
Low serum calcium,
low serum phosphate,
raised ALP and raised PTH
which disease?
Osteomalacia
Bisphosphonate MoA?
Inhibits osteoclasts
Which feature helps distinguish pseudogout from gout?
x-ray: chondrocalcinosis - knee this can be seen as linear calcifications of the meniscus and articular cartilage
worse on resisted wrist extension/suppination whilst elbow extended is suggestive of which disease?
Lateral epicondylitis (tennis elbow - also seen in house painting)
TENNIS IS LATERAL AS YOURE HITTING IT AWAY FROM THE OPONENT
GPA - which antibody?
Eosinophilic granulomatosis w/ polyangitis + other - which antibody?
cANCA = granulomatosis with polyangiitis
pANCA = eosinophilic granulomatosis with polyangiitis + others
Advice on how to take bisphosphonate?
Take at least 30 minutes before breakfast with plenty of water + sit-upright for 30 minutes following
Pain on the radial side of the wrist/tenderness over the radial styloid process + worse upon ulnar deviation?
De Quervain’s tenosynovitis
Cause of bulls eye retinopathy? what does this lead to?
Can lead to severe and permenant visual loss
Seen in Hydroxychloroquine use (see how many OOOOOO there is like a bullseye)
Denosumab MoA?
RANKL inhibitor (nuclear factor kappa-I)
Apremilast MoA? When is it used?
phosphodiesterase type-4 (PDE4) inhibitor - used in active psoriatic arthritis - if patients have inadequate response / intolerant to prev DMARD therapy
HLA in reactive arthritis?
HLA B27
patients older than 65 years who have taken, or who are likely to remain on oral corticosteroids for more than 3 months
Need what tx and why?
Oral bisphosphonates - osteoporosis protection
Drug that can cause exposed bone in oral cavity? Sign name?
Osteonecrosis of jaw secondary to bisphosphonate use
Pain is usually elicited by resisted wrist flexion with pronation while keeping the elbow flexed 90 degrees or resisted forearm pronation with the elbow extended
Suggestive of which condition?
Medial epicondylitis (Golfer’s elbow)
No trauma
Painful swelling on posterior elbow
Middle aged man
Diagnosis?
Olecranon bursitis
Poor prognostic features of RA?
rheumatoid factor positive
anti-CCP antibodies
poor functional status at presentation
X-ray: early erosions (e.g. after < 2 years)
extra articular features e.g. nodules
HLA DR4
insidious onset
What is an early XR finding in RA?
Juxta-articular osteoporosis/osteopenia
Which patients should be offered prophylaxis against gout?
All patients after their 1st attack (2-4 weeks post acute)
How is risk of osteonecrosis of jaw increased in those with bisphosphonates?
IV therapy v oral
What happens to prophylactic allopurinol dose during acute gout attack?
Continue allopurinol in current dose
What are syndesmophytes and when are they seen?
This is the ossification of the outer fibres of annulus fibrosus seen in Ank Spond
Gram staining in septic arthritis is …..
Gram staining is negative in around 30-50% of cases
Anti-Jo1 ab seen in?
Anti-Jo-1 (Polymyositis/Dermatomyositis):
‘Jo can’t flex her muscles’ (muscle weakness in polymyositis/dermatomyositis).
(anti-mi2 is more secific for dermatomyositis)
Anti-dsDNA seen in?
Anti-dsDNA (Systemic Lupus Erythematosus - SLE):
‘Double Stranded DNA gets SLE-iously messed up’ (dsDNA links to lupus).
Anti-Smith ab seen in?
Anti-Smith (Anti-Sm) (SLE):
‘Smith is sleek for SLE’ (Smith exclusively ‘slinks’ to lupus).
Anti-Ro / La seen in?
Anti-Ro/Anti-La (Sjögren’s Syndrome and SLE):
‘Ro and La make you dry like the Sahara’ (dryness in Sjögren’s).
Anti-centromere is seen in?
(Limited Systemic Sclerosis - CREST):
‘Centering on limited CREST’ (centromere links to limited CREST).
Anti-Scl-70 is seen in?
Anti-Scl-70 (Diffuse Systemic Sclerosis):
‘Scl-erosis spreads like 70 mph across the body’ (diffuse systemic sclerosis).
Anti-Mitochondrial (AMA) is seen in?
Anti-Mitochondrial (AMA) (Primary Biliary Cholangitis):
‘Your bile ducts scream ‘AMA-zing, we’re out of order!’’ (Primary Biliary Cholangitis).
apremilast MoA?
phosphodiesterase type-4 (PDE4) inhibitor → suppression of pro-inflammatory mediator synthesis and promotion of anti-inflammatory mediators
Sjogrens patients are at increased risk of which ca?
Lymphoid ca
Mx of discoid lupus in order?
topical steroid cream
oral antimalarials may be used second-line e.g. hydroxychloroquine
avoid sun exposure
What are the features of Felty syndrome?
(RA + splenomegaly + low white cell count)
Extra articular manifestations of RA?
respiratory: pulmonary fibrosis, pleural effusion, pulmonary nodules, bronchiolitis obliterans, methotrexate pneumonitis, pleurisy
ocular: keratoconjunctivitis sicca (most common), episcleritis, scleritis, corneal ulceration, keratitis, steroid-induced cataracts, chloroquine retinopathy
osteoporosis
ischaemic heart disease: RA carries a similar risk to type 2 diabetes mellitus
increased risk of infections
depression
An X-ray of the skull is performed, which shows large, well-defined lytic lesions and a thickened vault.
Can be seen in which disorder - raised ALP? What other markers of bone turn over are also raised?
Pagets disease of bone:
procollagen type I N-terminal propeptide (PINP)
serum C-telopeptide (CTx)
urinary N-telopeptide (NTx)
urinary hydroxyproline
Who does Raynauds disease (primary) typically present in and how?
Young women with bilateral sx
What is the majority (90%) of cases of gout due to?
decreased renal excretion of uric acid
What are the main features of SLE mx?
Basics: Use NSAIDs + sun-block
Hydroxycholoroquine - tx of choice
If internal organ involvement eg renal, neuro, eye - consider pred and cyclophosphamide
What are the antibodies associated with anti-phospholipid syndrome?
Anti-cardiolipin antibodies and anti-beta2 glycoprotein I antibodies
Which antibodies for CREST syndrome
CREST = Limited (central) systemic sclerosis = anti-centromere antibodies
Which ab are most specific and sensitive for SLE?
ANA is 99% sensitive
anti-Sm & anti-dsDNA are 99% specific
Mx of Familial Mediterranean Fever?
colchicine may help
Clotting in antiphospholipid syndrome?
Prolonged APTT + Thrombocytopaenia
Mx of Raynauds if CCB doesnt work / CI?
IV prostacyclin (eg epoprostenol) infusion - effects can last weeks - months
What examination findings can be seen with carpal tunnel?
weakness of thumb abduction (abductor pollicis brevis)
wasting of thenar eminence (NOT hypothenar)
Tinel’s sign: tapping causes paraesthesia
Phalen’s sign: flexion of wrist causes symptoms
patients aged 75 and over with a history of fragility fractures
Mx of osteoporosis?
Start bisphosphonates w/out DEXA
What DEXA score quantifies osteoporosis?
the BMD threshold for defining osteoporosis is a T-score of - 2.5 SD or below
tingling in the little and ring finger and worsening of symptoms when the elbow is bent for prolonged periods
Suggestive of which dx?
Cubital tunnel syndrome
features of polyarteritis nodosa?
fever, malaise, arthralgia
weight loss
hypertension
mononeuritis multiplex, sensorimotor polyneuropathy
testicular pain
livedo reticularis
haematuria, renal failure
perinuclear-antineutrophil cytoplasmic antibodies (ANCA) are found in around 20% of patients with ‘classic’ PAN
hepatitis B serology positive in 30% of patients
PAN - what antibody is likely to be positive?
No antibodies - rarely pANCA (20%)
Reflexes and nerve roots pneumonic?
S1, S2: Ankle jerk, or “buckle my shoe”
L3, L4: Knee jerk, or “kick the door”
C5, C6: Biceps and brachioradialis reflexes, or “pick up sticks”
C7, C8: Triceps reflex, or “lay them straight”
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
What nerve root is affected?
L5 compression
Which nerve roots when compressed show +ve femoral stretch and sciatic nerve stretch?
+ve sciatic nerve stretch test: L5, S1
+ve femoral stretch test: L3, L4
Similarities and differences between L3 /4 compression
Both:
+ve femoral stretch test
reduced knee reflex
weak hip adduction
Weak knee extension
L3:
Sensory loss over anterior thigh
Weak hip flexion
L4:
Sensory loss anterior aspect of knee and medial malleolus
Features of lateral epicondylitis?
worse on resisted wrist extension/supination whilst elbow extended
Which connective tissue disorder is most associated with raynauds?
Scleroderma (systemic sclerosis)
Also - RA + SLE
What are the skin features of reactive arthritis?
circinate balanitis (painless vesicles on the coronal margin of the prepuce)
keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)
Mycophenolate mofetil MoA?
Inhibits of inosine-5’-monophosphate dehydrogenase which is needed for purine synthesis
What indicates poor prognosis in Polymyositis?
ILD - eg fibrosing alveolitis or organising pneumonia
Seen in 20%
What is the defect in osteogenesis imperfecta?
Type I collagen (mutations in the COL1A1 or COL1A2 genes)
What can relieve carpal tunnel pain in some patients?
Shaking their hands
What antibody is associated with systemic sclerosis?
anti-centromere (CREST - limited cutaenous)
anti-scl-70 (diffuse cutaneous)
Which systemic sclerosis is more likely to involve ILD and PAH?
Diffuse cutaneous systemic sclerosis
Main difference between limited cutaneous and diffuse cutaneous systemic sclerosis?
Diffuse cutaneous systemic sclerosis = trunk + proximal limbs mainly
Limited cutaneous systemic sclerosis = face and distal limbs predominately
What are the causes of drug induced lupus?
Most common causes
> procainamide
> hydralazine
Less common causes
> isoniazid
> minocycline
> phenytoin
What are the features of Ank spond?
6As:
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
L5 lesion features?
loss of foot dorsiflexion + sensory loss dorsum of the foot
Which condition is likely to display DIP swelling and dactylitis?
psoriatic arthritis
Mx of GCA?
Uncomplicated GCA (no visual involvement and/or jaw/tongue claudication) - oral pred
Complicated GCA (with visual involvement and/or jaw/tongue claudication) - IV methylpred 3 days before oral pred
Same day ophthal rv
Bone protection w bisphosphonates if long course of steroids
What is a possible complication of Temporal arteritis / GCA which presents with swollen pale disc and blurred margins on fundoscopy?
anterior ischemic optic neuropathy
What can happen to the eyes in Marfans syndrome?
upwards lens dislocation (superotemporal ectopia lentis)
blue sclera
myopia
Mx of Sjogrens?
Artificial salvia + tears
Pilocarpine can help stimulate saliva production
Approximately what percentage of patients with psoriasis develop an associated arthropathy?
10-20%
Marfans inheritance?
AD
Mx of secondary thromboprophylaxis in antiphospholipid syndrome?
Initial VTE - lifelong warfarin 2-3 INR
Recurrent whilst on Warfarin - life long increase INR to 3-4 and consider low dose aspirin
Arterial thrombosis - life long aspirin 2-3
Ab associated with congenital heart block in SLE?
Anti-RO = ROad Block = Congenital heart block in SLE.
How can you distinguish pseudogout from gout on XR?
Chondrocalcinosis helps to distinguish pseudogout from gout
Anti-U1 RNP is +ve in which disorder?
What other ab may be positive?
Mixed connective tissue disease
ANA is usually +ve
Dermatomyositis antibodies
Most common v most specific?
Most common = ANA (60%)
Most specific = Anti Mi 2
patients usually experience exacerbated pain upon wrist extension against resistance when their elbow is extended
seen in which disorder?
Lateral epicondylitis
Mx of Pagets?
bisphosphonates - oral risendronate / IV zoledronate
How does radial tunnel syndrome present?
similarly to lateral epicondylitis however pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation
numbness or tingling sensations in the dorsum of the hand or fingers may occur due to compression of the radial nerve, further supporting a diagnosis of radial tunnel syndrome.
McArdles disease - deficiency?
Myophosphorylase deficiency
Azathioprine - Moa?
Metabolised to active compound which inhibits purine synthesis
RF type of ab?
IgM against Fc portion of IgG
Birbeck granules on electron microscopy (tennis racket shaped granules) dx?
Langerhans cell histiocytosis
Which condition most commonly has anti-jo1?
Polymyositis > dermatomyositis
Complications of pagets?
deafness (cranial nerve entrapment)
bone sarcoma (1% if affected for > 10 years)
fractures
skull thickening
high-output cardiac failure
Ankle - Ottawa rules?
An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:
> bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)
> bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)
> inability to walk four weight-bearing steps immediately after the injury and in the emergency department
Presentation of mixed connective tissue disorder?
Raynaud’s phenomenon often precedes other symptoms and occurs in 90% of cases
Polyarthralgia/arthritis
Myalgia
‘Sausage fingers’(dactylitis)
What can present with tingling/numbness of the 4th and 5th finger? cause?
Cubital tunnel syndrome caused by compression of ulnar nerve
When should oral NSAIDs be used in mx of OA in 1st line?
Hip OA- topical is mainly for hand / knee OA
hydroxyproline what disease is this implicated in?
increased serum and urine levels of hydroxyproline in Pageets
Pseudoxanthoma elasticum cardiac features?
mitral valve prolapse, increased risk of ischaemic heart disease
How does azathioprine toxicity in those with TPMT deficiency present?
Presents as BM suppression -> pancytopaenia
Azathioprine adverse effects
bone marrow depression
consider a full blood count if infection/bleeding occurs
nausea/vomiting
pancreatitis
increased risk of non-melanoma skin cancer
What is characterised by follicular keratin plugs?
Discoid lupus erythematosus
Golimumab Moa?
TNF-a inhibitor used in refractory ank spond
Leflunomide Adverse effects?
DMARD used in RA can cause:
gastrointestinal, especially diarrhoea
hypertension
weight loss/anorexia
peripheral neuropathy
myelosuppression
pneumonitis
Features of Stills 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
Which one of the following cells secretes the majority of tumour necrosis factor in humans?
Macrophages
Which foods to avoid in gout?
Those that are high in purines e.g. Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products
Pathophysiology of de quervains tenosynovitis?
inflammation of the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons
Painful arc on shoulder exam is suggestive of what injury?
shoulder impingement, most commonly secondary to supraspinatus tendonitis
What are the different rotator cuff muscles and their function?
Supraspinatus aBDucts arm before deltoid
Most commonly injured
Infraspinatus Rotates arm laterally
teres minor aDDucts & rotates arm laterally
Subscapularis aDDuct & rotates arm medially
SItS
What disease can present as widening of the wrist joints due to an excess of non-mineralized osteoid at the growth plate?
Rickets
Will TNF inhibitors help with radiological progression of ank spond?
No
EDS defect?
Type III defect
Looser’s zones x-ray (areas of incomplete fracture that appear as lucent bands perpendicular to the surface of the bone, usually bilateral and symmetric)
Suggestive of what dx?
Osteomalacia
What is important to check for in osteoporosis in a man?
Testosterone, SHBG, FSH, LH levels
DEXA score interpretations?
T score is based on bone mass of young refrence population
Z score is adjusted for age, gender and ethnicity
Ix findings in PMR?
raised inflammatory markers e.g. ESR > 40 mm/hr
note creatine kinase and EMG normal
What is the minimum steroid intake a patient should be taking before they are offered osteoporosis prophylaxis?
Equivalent of prednisolone 7.5 mg or more each day for 3 months
Which features are common / not common for drug induced lupus?
Common:
Arthralgia, myalgia and skin + pulmonary involvement
Glomerulonephritis is unusual in drug-induced lupus
When should Z score be used in osteoporosis?
A Z-score is helpful in diagnosing secondary osteoporosis and should always be used for children, young adults, pre-menopausal women and men under the age of 50
AVN of hip v trochanteric bursitis?
AVN: GROIN pain, pain on internal rotation
Trochanteric bursitis: lateral hip, pain on internal and external rotation
how does trochanteric bursitis present?D
isolated lateral hip/thigh pain with tenderness over the greater trochanter
lower back pain associated with neurological problems such as bladder and bowel dysfunction
In a marfans pt - dx?
Dural ectasia
What is the greatest predictor of future thrombosis in patients with anti-phospholipid syndrome?
Lupus anticoagulant
Cardiac features in antiphospholipid syndrome?
Normal
proximal myopathy in combination with mechanic hands
What dx? what sx is important to ask ab?
Anti-synthetase syndrome - important to check re ILD (lung involvement)
T score interpretation?
Normal: T-score ≥ -1.0
Osteopaenia: T-score between -1.0 and -2.5
Osteoporosis: T-score ≤ -2.5
How can relapsing polychondritis present?
As well as ear problems, relapsing polychondritis may present with nasal chondritis, respiratory tract involvement and arthralgia
What is magic syndrome?
Mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome refer to a condition in which features of Behcet’s disease and relapsing polychondritis occur in the same individual
What is recommended 2nd line in osteoporosis of PM women who cant tolerate oral alendronate?
PO risendronate
Double contour sign on knee US - dx?
Gout
Ank spond pain at night?
It is worse and improves when they get up
Which joints are involved in hand OA?
Carpometacarpal
DIPs
Bloods in osteopetrosis?
normal calcium, phosphate, ALP and PTH levels
bone hardening due to the malfunction of osteoclasts -> increased risk of fractures
Reactive arthritis mx?
symptomatic: analgesia, NSAIDS, intra-articular steroids
sulfasalazine and methotrexate are sometimes used for persistent disease
symptoms rarely last more than 12 months
Joint involvement in RA? moa of 1st line mx?
symmetrical involvement of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints
1st line = Methotrexate = Reversible dihydrofolate reductase inhibitor
reoccurring episodes of abdominal pain, fever, arthralgia, and chest pain
dx? and inheritance?
FMF - autosomally recessive
Criteria for antiphospholipid dx?
Clinical criteria
1. Vascular thrombosis: ≥1 clinical episode of arterial, venous, or small-vessel thrombosis in any tissue or organ, validated by imaging studies or histopathology
2. Pregnancy morbidity: e.g. unexplained, consecutive, and spontaneous abortions
Laboratory criteria
1. Positive for LA on ≥2 occasions at least 12 weeks apart
2. Positive aCL on ≥2 occasions at least 12 weeks apart
3. Positive anti-β2GP1 antibodies on ≥2 occasions at least 12 weeks apart
What is the most common cardiac defect seen in Marfan’s syndrome?
dilation of the aortic sinuses which may predispose to aortic dissection
