Rheumatology Flashcards
1
Q
Common features of ANCA associated vasculitis
A
- Renal impairment
- Resp symptoms - dyspnoea, haemoptysis
- Systemic symptoms - fatigue, weight loss, fever
- Vasculitic rash
- Sinusitis
2
Q
cANCA associated with
A
Granulomatosis with polyangiitis
3
Q
pANCA associated with
A
Churg-Strauss
UC
Primary sclerosing cholangitis
Anti-GBM disease
Crohn’s
4
Q
Role of ANCA monitoring
A
Some correlation between cANCA levels and disease activity, not for pANCA
5
Q
Gene associated with ankylosing spondylitis
A
HLA B27
6
Q
Symptoms ankylosing spondylitis
A
Insidious onset low back pain and stiffness
Stiffness worse in morning, improves with exercise
7
Q
Examination features ankylosing spondylitis
A
Reduced lateral flexion
Reduced forward flexion
Reduced chest expansion
8
Q
What is Schober’s test
A
Line drawn 10cm above and 5cm below back dimples. Distance between the two lines should increase by more than 5cm when patient bends as far forward as possible
9
Q
Conditions associated with ankylosing spondylitis
A
- Apical fibrosis
- Anterior uveitis
- Aortic regurgitation
- Achilles tendonitis
- AV node block
- Amyloidosis
- Cauda equina syndrome
10
Q
XR findings ankylosing spondylitis
A
- Sacroilitis - subchondral erosions, sclerosis
- Squaring of lumbar vertebrae
- Bamboo spine
- Syndesmophytes
Apical fibrosis on CXR
11
Q
Spirometry ankylosing spondylitis
A
Restrictive defect (pulmonary fibrosis, kyphosis, ankylosis of costovertebral joints)
12
Q
Management ankylosing spondylitis
A
NSAIDs first line
DMARD
13
Q
Causes of antiphospholipid syndrome
A
Primary disorder
SLE
Lymphoproliferative disorders
Phenothiazines
14
Q
Features antiphospholipid syndrome
A
- Venous/arterial thrombosis
- Recurrent miscarriage
- Livedo reticularis
- Pre-eclampsia
- Pulmonary hypertension
15
Q
Investigation findings antiphospholipid syndrome
A
Positive antibodies
Thrombocytopenia
Prolonged APTT
16
Q
What antibodies in antiphospholipid syndrome
A
Anticardiolipin antibodies
Anti-beta2GPI antidbodies
Lupus anticoagulant
17
Q
Why prolonged APTT in antiphospholipid syndrome
A
Due to ex-vivo reaction of lupus anticoagulant autoantibodies with phospholipids in the coagulation cascade
18
Q
Management antiphospholipid syndrome
A
Primary thromboprophylaxis - low dose aspirin
Secondary thromboprophylaxis - for first A/VTE, warfarin with target 2-3. If recurrent, consider + low dose aspirin, target 3-4
19
Q
Adverse effects azathioprine
A
Bone marrow depression
Nausea/vomiting
Pancreatitis
Increased risk non-melanoma skin cncer
20
Q
Gene association Behcet’s
A
HLA B51
21
Q
Classic features Behcet’s syndrome
A
Oral ulcers
Genital ulcers
Anterior uveitis
22
Q
Other features Behcet’s syndrome
A
Thrombophlebitis
DVT
Arthritis
Neurological involvement e.g. aseptic meningitis
Abdominal pain, diarrhoea, colitis
Erythema nodosum
23
Q
What is positive pathergy test Behcets
A
Puncture site following needle prick becomes inflamed with small pustule
24
Q
Uses of bisphosphonates
A
Prevention and treatment of osteporosis
Hypercalcaemia
Paget’s disease
Pain from bone mets
25
Adverse effects bisphosphonates
Oesophageal reactions - oesophagitis, oesophageal ulcers
Osteonecrosis of the jaw
Increased risk of atypical stress fractures of the proximal femoral shaft
Acute phase response (fever, myalgia, arthralgia) following administration
Hypocalcaemia
26
How to take bisphosphonates
Swallow whole with water while sitting or standing, empty stomach 30 mins before breakfast (or other oral meds), sit or stand upright for at least 30 mins after taking
27
Lab findings osteoporosis
Normal calcium, phosphate, ALP and PTH
28
Lab findings osteomalacia
Low calcium and phosphate
High ALP and PTH
29
Lab findings primary hyperparathyroidism
High calcium
Low phosphate
High ALP
High PTH
30
Lab findings chronic kidney disease (→ chronic hyperparathyroidism)
Low calcium
Increased phosphate
Increased ALP
Increased PTH
31
Lab findings Paget's disease
Normal calcium and phosphate
Increased ALP
Normal PTH
32
Lab findings osteopetrosis
Normal
33
X-ray findings osteosarcoma
Codman triangle from periosteal elevation
Sunburst pattern
34
Risk factors osteosarcoma
Mutation of Rb gene
Paget's disease of bone
Radiotherapy
35
X-ray findings Ewing's sarcoma
'Onion skin' appearance
36
Most common site osteoma
Skull
37
Most common site giant cell tumour
Epiphyses long bones
38
Most common site osteosarcoma
Metaphyseal region long bones (prior to epiphyseal closure) - femur, tibia, humerus
39
Most common site Ewing's sarcoma
Pelvis and long bones
40
Most common side chondrosarcoma
Axial skeleton
41
Causes dactylitis
Spondyloarthritis, e.g. psoriatic and reactive arthritis
Sickle cell disease
TB
Sarcoidosis
Syphilis
42
What is dermatomyositis
Inflammatory disorder causing symmetrical, proximal muscle weakness and skin lesions
43
Cause dermatomyositis
Idiopathic
Connective tissue disorders
Malignancy - ovarian, breast, lung - 20-25% of cases
44
What is polymyositis
Variant of dermatomyositis where skin manifestations are not prominent
45
Skin features dermatomyositis
Photosensitivity
Macular rash over back and shoulder
Heliotrope rash in periorbital region
Gottron's papules
Mechanics hands
Nail fold capillary dilatation
46
What are Gottron's papules
Roughened red papules over extensor surfaces of fingers
47
What is mechanics hands
Extremely dry and scaly hands with linear cracks on palmar and lateral aspects of fingers
48
Non-skin features of dermatomyositis
Proximal muscle weakness +/- tenderness
Raynaud's
Respiratory muscle weakness
Interstitial lung disease, e.g. fibrosing alveolitis or organising pneumonia
Dysphagia, dysphonia
49
Investigation findings dermatomyositis
80% ANA positive
30% anti-synthetase antibodies, inc anti-Jo1, anti-STP, anti-Mi-2
50
Drug induced lupus vs SLE
In drug induced, renal and nervous system involvement unusual
Usually resolves on stopping drug
51
Features drug induced lupus
Arthralgia
Myalgia
Malar rash
Pleurisy
52
Antibodies drug induced lupus
ANA positive in 100%, dsDNA negative
Anti-histone in 80-90%
Anti-Ro/anti-Smith in 5%
53
Most common causes drug induced lupus
Procainamide
Hydralazine
54
Less common cause drug induced lupus
Isoniazid
Minocycline
Phenytoin
55
Inheritence Ehler-Danlos syndrome
AD
56
Features Ehler-Danlos syndrome
Elastic, fragile skin
Joint hypermobility, recurrent joint dislocation
Easy bruising
Cardiac lesions
Subarachnoid haemorrhage
Angioid retinal streaks
57
Cardiac lesions Ehler-Danlos syndrome
Aortic regurgitation
Mitral valve prolapse
Aortic dissection
58
Drugs causing gout
Diuretics - thiazides, furosemide
Ciclosporin
Alcohol
Cytotoxic agents
Pyrazinamide
Aspirin
59
Most common site gout
1st metatarsophalangeal joint
60
Uric acid suggestive of gout
≥360umol/L
61
Synovial fluid analysis in gout
Needle shaped negatively bifringent monosodium urate crystals under polarised light
62
Radiological features gout
Joint effusion
Well defined punched out erosions with sclerotic margins in juxta-articular distribution, often with overhanging edges
Relative preservation of joint space until late disease
Eccentric erosions
Soft tissue tophi
63
Acute management gout
NSAIDs and colchicine first line
Oral steroids if contraindicated
64
Limitations colchicine
- Slower onset of action
- Causes diarrhoea
65
Colchicine in renal impairment
Can be used with caution
Reduce dose if 10-50, avoid if <10
66
Urate lowering therapy in gout
Allopurinol first line
Febuxostat second line
67
Dose of allopurinol
Initial dose 100mg OD, titrated to aim for serum uric acid <360
68
When to aim for uric acid <300 in gout
Patients with tophi, chronic gouty arthritis, ongoing frequent flares despite uric acid <360umol/L
69
Best antihypertensive in gout
Losartan (uricosuric action)
70
Referred lumbar spine pain cause and location
Femoral nerve compression cause referred pain in hip
71
Referred lumbar spine pain features
Femoral nerve stretch test positive (lie patient prone, extend hip joint with straight leg then bend knee)
72
Cause of greater trochanteric pain syndrome
Due to repeated movement of fibroelastic iliotibila band
73
Features of greater trochaneteric pain syndrome
Pain and tenderness over lateral side of thigh
74
Cause meralgia paresthetica
Compression of lateral cutaneous nerve of thigh
75
Features meralgia paresthetica
Burning sensation over antero-lateral aspect of thigh
76
Risk factors avascular necrosis
High dose steroid therapy
Previous hip fracture or dislocation
77
Cause pubic symphysis dysfunction
Ligament laxity increases in response to hormonal changes of pregnancy
78
Features pubic symphysis dysfunction
Pain over the pubic symphysis with radiation to groin and medial aspect of thigh
Waddling gait
79
Transient idiopathic osteoporosis features
Uncommon condition seen in third trimester of pregnancy
- Groin pain associated with limited range of movement in the hip
- May be unable to weight bear
- ESR may be elevated
80
Conditions associated with HLA-A3
Haemochromatosis
81
Conditions associated with HLA-B51
Behcet's disease
82
Conditions associated with HLA-B27
Ankylosing spondylitis
Reactive arthritis
Acute anterior uveitis
Psoriatic arthritis
83
Conditions associated with HLA-DQ2/8
Coeliac
84
Conditions associated with HLA-DR2
Narcolepsy
Goodpastures
85
Conditions associated with HLA-DR3
Dermatitis herpetiformis
Sjorgens syndrome
Primary biliary cirrhosis
86
Conditions associated with HLA-DR4
T1DM
RA
87
Adverse effects hydroxychloroquine
Bull's eye retinopathy - severe and permanent visual loss
88
Hydroxychloroquine pregnancy
Can be used
89
Mechanism type I hypersensitivity reaction
Antigen reacts with IgE bound to mast cells
90
What reactions are type I allergic reactions
- Anaphylaxis
- Atopy (asthma, eczema, hayfever)
91
Mechanism type II hypersensitivity reaction
IgG or IgM binds to antigen on cell surface
92
What conditions involve type II hypersensitivity reactions
- Autoimmune haemolytic anaemia
- ITP
- Goodpasture's syndrome
- Pernicious anaemia
- Acute haemolytic transfusion reactions
- Rheumatic fever
- Pemphigus vularis/bullous pemphigoid
93
Mechanism type III hypersensitivity reactions
Free antigen and antibody (IgG, IgA) combine
94
What conditions involve type III hypersensitivity reactions
- Serum sicknes
- SLE
- Post streptococcal glomerulonephritis
- Extrinsic allergic alveolitis
95
Mechanism type IV hypersensitivity reactions
T-cell mediated
96
What conditions involve type IV hypersensitivity reactions
- Tuberculosis (and tuberculin skin reaction)
- Graft versus host disease
- Allergic contact dermatitis
- Scabies
- Extrinsic allergic alveolitis
- MS
- GBS
97
Mechanism type V hypersensitivity reactions
Antibodies that recognise and bind to cell surface receptor, either stimulating them or blocking ligand binding
98
What conditions involve type V hypersensitivity reaction
Graves disease
Myasthenia gravis
99
Features lateral epicondylitis
- Pain and tenderness localised to lateral epicondyle
- Pain worse on wrist extension against resistance with elbow extended, or supination of forearm with elbow extended
100
Inheritance pattern Marfans
AD
101
Features Marfans syndrome
- Tall stature
- High arched palate
- Arachnodactyly
- Pectus excavatum
- Pes planus
- Scoliosis of >20 degrees
- Heart lesions
- Repeated pneumothoraces
- Eye lesions
- Dural ectasia
102
Marfans syndrome heart lesions
- Dilation of aortic sinuses (90%) → aortic aneurysm, aortic dissection, aortic regurgitation
- Mitral valve prolapse (75%)
103
Marfans syndrome eye lesions
- Upwards lens dislocation
- Blue sclera
- Myopia
104
Adverse effects methotrexate
- Mucositis
- Myelosuppression
- Pneumonitis
- Pulmonary fibrosis
- Liver fibrosis
105
Features methotrexate induce pneumonitis
Typically within year of starting treatment, acute or subacute
- Non productive cough
- Dyspnoea
- Malaise
- Fever
106
Pregnancy methotrexate
Avoid pregnancy for 6 months after treatment (including men)
107
Co-prescribe with methotrexate?
Folic acid 5mg weekly, taken more than 24hours after methotrexate
108
Interactions methotrexate
Trimethoprim/co-trim (increased risk of marrow aplasia)
High dose aspirin (increased risk of methotrexate toxicity)
109
Treatment methotrexate toxicity
Folinic acid
110
Features of myopathies
- Symmetrical muscle weakness, proximal > distal
- Common problems rising from chair, getting out of bath
- Sensation normal, reflexes normal, no fasciculation
111
Causes myopathies
Inflammatory - polymyositis
Inherited - Duchennes/Beckers muscular dystrophy, myotonic dystrophy
Endocrine - Cushing's, thyrotoxicosis
Alcohol
112
When osteoarthritis can be diagnosed clinically w/ no investigations
Patient >45 years
Exercise related pain
No morning stiffness, or morning stiffness lasting <30 mins
113
First line treatment osteoarthritis
Topical NSAIDs
114
Second line treatment osteoarthritis
Oral NSAIDs
115
Role of paracetamol or weak opioids osteoarthritis
Do not offer unless infrequently for short term pain relief, or other options contraindicated/not tolerated/ineffective
116
Options of NSAIDs ineffective osteoarthritis
Intra-articular steroid infection
Joint replacement
117
X-ray changes osteoarthritis
Loss of joint space
Osteophytes forming at joint margins
Subchondral sclerosis
Subchondral cysts
118
Inheritance osteogenesis imperfecta
Autosomal dominant
119
Features osteogenesis imperfecta
Presents in childhood
Fractures after minor trauma
Blue sclera
Deafness secondary to otosclerosis
Dental imperfections
120
What is osteomalacia
Softening of bones secondary to low vitamin D levels leading to decreased bone mineral content
121
Osteomalacia vs rickets
Osteomalacia in adults, rickets in children
122
Causes osteomalacia
- Vitamin D deficiency - malabsorption, lack of sunlight, diet
- CKD
- Drug induced
- Inherited
- Liver disease, e.g. cirrhosis
- Coeliac disease
123
Drugs causing osteomalacia
Anticonvulsants
124
Features osteomalacia
Bone pain
Bone/muscle tenderness
Fractures, esp femoral neck
Proximal myopathy
125
Blood findings osteomalacia
Low vit D
Low calcium and phosphate
Raised ALP
126
X-ray findings osteomalacia
Translucent bands
127
Main risk factors osteoporosis
- History of glucocorticoid use
- Rheumatoid arthritis
- Alcohol excess
- History of parental hip fracture
- Low BMI
- current smoking
128
Medications worsening osteoporosis
- Glucocorticoids
- SSRIs
- Antiepileptics
- PPIs
- Glitazones
- Long term heparin therapy
- Aromatase inhibitors, e.g. anastrozolee
129
First line osteoporosis treatment
Bisphosphonates - alendronate, risedronate
130
Second line osteoporosis treatment
Denosumab
131
Other treatment options osteoporosis
Strontium ranelate
Raloxifene
Teriparatide
Tomosozumab
132
What is Paget's disease of bone
Disease of increased but uncontrolled bone turnover
133
Paget's disease features
Only 5% symptomatic
- Bone pain - pelvis, lumbar spine femur
- Bowing of tibia
- Bossing of skull
134
X-rays Paget's disease
Osteolysis in early disease → mixed lytic/sclerotic lesions later
Skull - thickened vault, osteoporosis circumscripta
135
Bloods Paget's disease of bone
Isolated rise ALP
136
Bone scintigraphy Paget's disease of bone
Increased uptake focally at sites of active bone lesions
137
Complications Paget's disease of bone
- Deafness (CN entrapment)
- Bone sarcoma
- Fractures
- Skull thickening
- High output cardiac failure
138
What is polyarteritis nodosa
Vasculitis affecting medium-sized arteries with necrotising inflammation leading to aneurysm formation
139
Infection associated with polyarteritis nodosa
Hep B
140
Features polyarteritis nodosa
- Fever, malaise, arthralgia
- Weight loss
- Hypertension
- Mononeuritis multiplex, sensorimotor polyneuropathy
- Testicular pain
- Livedo reticularis
- Haematuria, renal failure
141
Antibody associated with polyarteritis nodosa
pANCA (20%)
142
Features polymyalgia rheumatica
Typically >60 years
Usually rapid onset (<1 month)
Aching, morning stiffness in proximal limb muscles
Mild polyarthralgia
Lethargy
Depression
Low grade fever
Anorexia
Night sweats
Not weakness
143
Treatment PMR
Pred
144
What is pseudogout
Form of microcrystal synovitis caused by the deposition of calcium pyrophosphate dihydrate crystals in the synovium
145
Risk factors pseudogout
- Increasing age
- Haemochromatosis
- Hyperparathyroidism, low phosphate
- Acromegaly, Wilson's disease
146
Most common sites pseudogout
Knee, wrist, and shoulders
147
Joint aspiration pseudogout
Weakly positively birefringent rhomboid-shaped crystals
148
What is Raynaud's phenomenon
Exaggerated vasoconstrictive response of the digital arteries and cutaneous arteriole to the cold or emotional stress
149
Raynaud's phenomenon vs Raynaud's disease
Raynaud's disease is primary, Raynaud's phenomenon is secondary
150
Secondary causes of Raynaud's phenomenon
- Connective tissue disorders, e.g. scleroderma, RA, SLE
- Leukaemia
- Type I cryoglobulinaemia, cold agglutinins
- Use of vibrating tools
- Drugs
- Cervical rib
151
Drugs causing Raynaud's
- OCP
- Ergot
152
Factors suggesting underlying connective tissue disease in Raynaud's
- Onset after 40 years
- Unilateral symptoms
- Rashes
- Presence of autoantibodies
- Digital ulcers or calcinosis
153
Management Raynaud's
All patients should be referred to secondary care
First line - CCBs, nifedipine
Second line - IV prostacyclin infusions
154
Genetic association reactive arthritis
HLA-B27
155
Features reactive arthritis
- Urethritis
- Conjunctivitis, anterior uveitis
- Arthritis
- Dactylitis
156
Categories of reactive arthritis
Post-dysenteric form
Post-STI form
157
Organisms causing post-dysenteric reactive arthritis
Shigella flexneri
Salmonella typhi and enteritidis
Yersina enterocolitica
Campylobacter
158
Organisms causing post-STI reactive arthritis
Chlamydia trachomatis
159
Management reactive arthritis
Analgesia
NSAIDs
Intra-articular steroids
Sulfasalazine and methotrexate sometimes used for persistent disease
160
Pattern of arthritis in reactive arthritis
Typically asymmetrical oligoarthritis of lower limb
161
Skin manifestations reactive arthritis
Circinate balanitis
Keratoderma blenorrhagica
162
What is circinate balanitis
Painless vesicles on coronal margin of prepuce
163
What is keratoderma blenorrhagica
Waxy yellow/brown papules on palms and soles
164
Methotrexate side effects
Myelosuppression
Liver cirrhosis
Pneumonitis
165
Sulfasalazine side effects
Rashes
Oligospermia
Heinz body anaemia
Interstitial lung diseas
166
Side effects leflunamide
Liver impairment
Interstitial lung disease
Hypertension
167
Side effects leflunomide
Liver impairment
Interstitial lung disease
Hypertension
168
Side effects hydroxycholoroquine
Retinopathy
Corneal deposits
169
Side effects prednisolone
Cushingoid features
Osteoporosis
Impaired glucose tolerance
Hypertension
Cataracts
170
Side effects gold
Proteinuria
171
Side effects penicillamine
Proteinuria
Exacerbation of myasthenia gravis
172
Side effects etanercept
Demyelination
Reactivation of TB
173
Side effects of infliximab
Reactivation of TB
174
Side effects adalimumab
Reactivation of TB
175
Side effects rituximab
Infusion reaction common
176
Antibodies associated with rheumatoid arthritis
Rheumatoid arthritis
Anti-CCP
177
What other conditions are associated with positive RF
Felty's syndrome
Sjorgens syndrome
Infective endocarditis
SLE
Systemic sclerosis
General population (5%)
178
Role of CCP in RA diagnosis
May be detected 10 years before development, allows for early detection of patients suitable for aggressive anti-TNF therapy
Recommended in suspected RA with neg RF
179
First line treatment RA
DMARD monotherapy +/- short course of bridging prednisolone
180
Choices for initial DMARD RA
Methotrexate (most widely used)
Sulfasalazine
Leflunomide
Hydroxychloroquine (only if mild or palindromic)
181
Disease monitoring RA
Combination of CRP and disease activity
182
Management of flares of RA
Corticosteroids - oral and IM
183
Indication for TNF-inhibitor in RA
Inadequate response to at least 2 DMARDs including methotrexate
184
Poor prognostic features RA
RF positive
Anti-CCP antibodies
Poor functional status at presentation
Early erosions on x-ray (<2 years)
Extra articular features, e.g. nodules
HLA DR4
Insidious onset
185
X-ray findings RA
Loss of joint space
Juxta-articular osteoporosis
Soft tissue swelling
Periarticular erosions
Subluxation
186
Most common organism septic arthritis
Staphylococcus aureus
187
Most common organism septic arthritis in young people
Neisseria gonorrhoeae
188
Most common location septic arthritis adults
Knee
189
Synovial fluid findings septic arthritis
Leucocytosis with neutrophil predominance
Gram stain neg in 30-50% cases
190
Treatment septic arthritis
IV fluclox (clinda if allergic)
4-6 week treatment, typically switched to oral at 2 weeks
Needle aspiration to decompress joint
Arthroscopic lavage may be required
191
Features Sjorgen's syndrome
Dry eyes
Dry mouth
Vaginal dryness
Arthralgia
Raynaud's, myalgia
Sensory polyneuropathy
Recurrent parotidis
Renal tubular acidosis
192
Antibodies in Sjorgen's syndrome
RF - 50%
ANA - 70%
Anti-Ro - 70%
Anti-La - 30%
193
Management Sjorgens syndrome
Artificial saliva and tears
Pilocarpine (stimualte saliva production)
194
Cautions sulfasalazine
G6PD deficiency
Allergy to aspirin or sulphonamides (cross sensitivity)
195
Adverse effects sulfasalazine
- Oligospermia
- Stevens-Johnson syndrome
- Pneumonitis/lung fibrosis
- Myelosuppression, Heinz body anaemia, megaloblastic anaemia
- May colour tears
195
SLE skin features
Malar rash - spare nasolabial folds
Discoid rash - scaly, erythematous, well demarcated rash in sun exposed areas, may progress to become pigmented and hyperkeratotic before becoming atrophic
Photosensitivity
Raynaud's phenomenon
Livedo reticularis
Non-scarring alopecia
196
Sulfasalazine in pregnancy/breastfeeding
Safe to use
197
SLE MSK features
Arthralgia
Non-erosive arthritis
198
Cardiovascular features SLE
Pericarditis, myocarditis
199
Respiratory features SLE
Pleurisy
Fibrosing alveolitis
200
Renal features SLE
Proteinuria
Glomerulonephritis
201
Neuropsychiatric features SLE
Anxiety and depression
Psychosis
Seizures
202
SLE antibodies
ANA - 99%
RF - 20%
Anti-dsDNA and anti-Smith - high specificity, low sensitivity
203
Patterns of disease systemic sclerosis
Limited cutaneous systemic sclerosis
Diffuse cutaneous systemic sclerosis
Scleroderma (without organ involvement)
204
Features limited cutaneous systemic sclerosis
Raynaud's (may be first sign)
Scleroderma affecting face and distal limbs
205
Antibodies associated with limited cutaneous systemic sclerosis
Anti-centromere
206
Subtype limited cutaneous systemic sclerosis
CREST syndrome
207
Features CREST syndrome
Calcinosis
Raynaud's phenomenon
Oesophageal dysmotility
Sclerodactlyl
Telangiectasia
208
Features diffuse cutaneous systemic sclerosis
Scleroderma affects trunk and proximal limbs
Respiratory involvement - interstitial lung disease, pulmonary arterial hypertension
Renal disease and hypertension
209
Antibodies associated with diffuse cutaneous systemic sclerosis
Anti scl-70
210
Treatment renal disease diffuse cutaneous systemic sclerosis
ACE inhibitor - captopril typically used
211
Features scleroderma
Tightening and fibrosis of skin
Plaques or linear
212
Antibodies associated with systemic sclerosis
ANA positive 90%
RF positive 30%
213
Visual features temporal arteritis
Anterior ischaemic optic neuropathy (most common)
Diplopia
214
Treatment temporal arteritis
- Urgent high dose glucocorticoids as soon as diagnosis suspected
- Urgent opthal review
215
Steroid choice temporal arteritis
If no visual loss, high dose pred used
If evolving visual loss, IV methylpred
216
Who needs vit D supplementation
All pregnant and breastfeeding women
All children aged 6 months - 5 years unless formula fed >500ml/day
Adults >65y
Housebound patients
