Rheumatology Flashcards
Osteoarthritis
Synovial joint disease characterised by loss of articular cartilage and overgrowth of underlying bone, degenerative joint disease
Pain is usually aching or burning, worsening, localising to joint itself or the one below, worse after activity improved by rest
Hyperplasia of the synovium leads to deformity (Heberdens & Buchard nodes), chondral destruction causes varus deformity (walking on outside of feet)
Diagnosis: X ray shows classical changes LOSS: loss of joint space, osteophyte production, subchondral sclerosis and cysts
Rheumatoid Arthritis
Chronic systemic disease, primarily affecting synovial joints
Typically presents as insidious polyarthritis between 40 and 70
Articular manifestations: local pain, swelling, erythema, symmetrical stiffness following inactivity, Z thumb, swan neck deformity
Extra articular: nodules, vasculitis
X-Ray: soft tissue swelling, narrow joint space, articular erosion
Rheumatoid factor then anti-CCP
Treatment: DMARDS such as methotrexate
Ankylosing spondylitis
Recurrent enthesitis leads to fibrosis and ossification, occurs in mid-20s
Outer fibres of vertebral discs become inflamed where they attach to the vertebral body, overtime causes squaring, syndesmophyte production and fusing of joint
Presentation: lower back pain and stiffness improves with exercise
Eye inflammation, heart problems
Diagnosis and management: raised ESR, CRP. FBCs, x ray - bamboo spine
Physiotherapy, drugs (NSAIDs, DMARDS, local steroids)
Reactive arthritis
Aseptic arthritis that develops a few weeks after an anatomically distant infection eg shigella, salmonella, chlamydia
Presentation: asymmetrical and oligoarticular, dactylitis (sausage finger), conjunctivitis, urethritis, skin and mucosal lesions
Diagnosis and management: raised ESR and CRP and FBCs
Exclude septic arthritis by synovial fluid drain
Drugs (NSAIDs, local steroid, DMARDS in severe disease)
Enteropathic arthritis
Associated with Inflammatory Bowel Disease (crohns or UC)
Asymmetrical, mono or oligoarticular can develop
Worsens with severity of bowel disease
Diagnosis and management: GI tests to confirm flare, manage flare with steroids, sulfasalazine and biological agents, no NSAIDs.
Psoriatic arthropathy
Inflammatory arthritis associated with psoriasis
Presentation: check scalp and natal cleft for psoriasis
Diagnosis and management: raised ESR, CRP. FBCs RF is absent
Physiotherapy and drugs
Gout
Consequence of hyperuricaemia and uric acid crystal formation
Can be acute or chronic
Presentation: acute, extremely painful, accelerating monoarthritis of big toe, can also affect elbow
Chronic: deformity through destruction of joint cartilage, renal disease
Diagnosis and management: raised serum uric acid and normally ESR, CRP and WBC counts are raised
Crystal analysis: needle shaped crystals with negative bifringence
Acutely: NSAIDs, colchicine and corticosteroids
Prophylaxis - allopurinol
Pseudogout
Deposition of calcium pyrophosphate dihydrate crystals
Elderly females
Presentation acute: monoarthritis commonly of knee, swollen joint that resolves in a week
Crystal analysis: rhomboid or rod shape crystals with positive bifringence
Physiotherapy and drugs
Septic arthritis
Medical emergency
Seem more often in children young adults and elderly
Presentation: acutely hot and swollen joint of hip and knee
Fever and systemically unwell
All movement causes intense pain and weight bearing impossible
Passive exam isn’t possible
Diagnosis and management: raised ESR CRP and WBC
Conservative: analgesia, splinting and antibiotic therapy
Surgical - emergency drainage
De Quervain’s tenosynovitis
females 30-50
pain on radial side of the wrist
tenderness over the radial styloid process
abduction of the thumb against resistance is painful
made worse by activity and eased by rest
Polymyositis
Autoimmune inflammatory myopathy with onset over weeks and months and steady progression
Weakness in proximal muscles - difficulty going upstairs etc.
fatigue myalgia and muscle cramps may be present, fine motor movements not affected
Diagnosis with electromyography and muscle biopsy
Treat with steroids
Dermatomyositis
Same muscle weakness pattern as polymyositis with additional features: rash on upper eyelids, extensor surfaces of joints and fingers, and shawl shape, systemic upset with fever, malaise and weight loss, GI ulcers and infections, weak thoracic muscles with possible interstitial lung disease
Systemic sclerosis (scleroderma)
Autoimmune disease with increased fibroblast activity resulting in abnormal growth of connective tissue causing vascular damage and fibrosis
Px: raynauds, skin hardening, oesophageal symptoms, fatigue, mask pains, digit swelling
Can develop pulmonary fibrosis
ANA positive sensitive
Still’s disease (systemic onset juvenile idiopathic arthritis)
Swinging pyrexia, salmon pink rash, arthritis
hepatosplenomegaly, lymphadenopathy and anaemia
Paget’s disease
Increased bone turnover can lead to deformity, typical sites include skull, spine, pelvis, femur and tibia. Can cause nerve compression, particularly of CN8 causing sensorineural deafness
Normal serum calcium and phosphate, very high ALP
