Rheumatology

Question 1

Xray changes in Rheumatoid Arthritis

Answer 1

Early: loss of joint spcae, peri-articular osteoporosis, soft tissue swelling

Late: peri-articular erosions, subluxation

Question 2

Trigeminal Neuralgia

Features

Answer 2

unilateral severe electric-shock-like pain
limited to divisions of trigeminal nerve
worse with light touch, washing, shaving, smoking, talking, tooth brushing
worst in nasolabial fold or chin

Question 3

Trigeminal Neuralgia

Management

Answer 3

carbamazepine

?neurology if not responding or under 50y

Question 4

Ankylosing Spondylitis

Radiographic Features

Answer 4

• sacroilitis, subchondral erosions, sclerosis
• squaring of lumbar vertebrae
• bamboo spine with dagger sign down centre
• syndesmophytes (ossification of outer fibres of annulus fibrosus)
• apical fibrosis on chest xray

Question 5

Ankylosing Spondylitis

Management

Answer 5

Management:
regular exercise (swimming)
physio
NSAIDs

DMARDs only if peripheral joint involvement

anti-TNF if “persistently high disease activity despite conventional treatments”