RHEUMATOLOGY Flashcards
BISPHOSPHONATES
-Osteoporosis
-Hypercalcemia
-Pagets disease
-Pain from cancer mets
-IV BIS. HIGHER RISK FOR OSTEONECROSIS OF JAW
-‘all patients with cancer and patients with poor dental status should have a dental check-up … before bisphosphonate treatment’
METHOTREXATE AND TRIMETHOPRIM
-Synergistic anti folate effect that leads to BONE MARROW SUPRESSION
METHOTREXATE TOXICITY
-Caused by adminstration of methotrexate with aspirin secondary to reduced excretion
-TREATED WITH FOLINIC ACID
Most imp investigation in Marfan
ECHO: Due to Aortic aneurysm and dissection
RA XRAY
PERIARTICULAR EROSIONS MORE SPECIFIC THAN LOSS OF JOINT SPACE
ACTIVE SLE
LOW C3 C4
McARDLES SYNDROME
-Muscle pain and cramps following short exercise
-Myoglobinuria and elvated CK
-Low lactate during exercise
-Second wind phenomena
-AUTOSOMAL RECESSIVE
-MYOPHOSPHORYLASE DEFECIENCY
SEPTIC ARTHRITIS
MOST COMMON IS HEMATOGENOUS SPREAD
ADHESIVE CAPSULITIS
WOMAN OLDER THAN 50 WITH DIABETES
restriction of EXTERNAL ROTATION and active and passive movements
confirmed by arthrography
MIXED CONNECTIVE TISSUE DISEASE
Anti RNP
-RAYNAUDS
-HAND SWELLING BUT NO SYNOVITIS
-PAIN :ARTHRALGIA MYALGIA
POSITIVE ANA
PAINS
1) Internal Rotation of Hip joint implies Avascular Necrosis of Femoral bone
2) External Rotation of shoulder joint - Frozen shoulder
3) aBDUction of shoulder joint (arc) - Supraspinatus tendonitis (Rotator cuff)
4) Extension of wrist or supination of forearm causing elbow pain - Tennis elbow (Lateral epicondylitis)
5) Flexion of wrist or pronating forearm causing elbow pain - Golf elbow (Medial epicondylitis)
6) Pain increased on pronating forearm ( no references of wrist movements and tenderness distal to elbow joint) - Radial tunnel syndrome
7) Pain at wrist (base of thumb) while moving towards ulnar side - De Quervain tenosynovitis
PANCYTOPENIA WITH LOW TPMT LEVELS
AZATHIOPRINE
other side effects;
-NON MELANOMA SKIN CANCER
-PANCREATITIS
FIBRILIN IN MARFAN
GLYCOPROTEIN WHICH USUALLY WRAPS AROUND ELASTIN
SULFASALAZINE
PATIENTS ALLERGIC TO SULFA MAYBE ALLERGIC TO ASPIRIN OR SULPHONAMIDES
SIDE EFFECTS:
-oligospermia
Stevens-Johnson syndrome
pneumonitis / lung fibrosis
myelosuppression, Heinz body anaemia, megaloblastic anaemia
may colour tears → stained contact lenses
BONE PAIN PROXIMAL MYOPATHY AND WADDLING GATE
OSTEOMALACIA
DERMATOMYOSITIS
PROXIMAL MUSCLE WEAKNESS AND SKIN LESION:
-HELIOTROPE RASH
-GOTRONS PAPULES
-MECHANICS HAND
MACULAR RASH
-PHOTOSENSITIVE
-NAIL FOLD CAPILLARY DILATATION
OSTEOGENESIS IMPERFECTA
AUTOSOMAL DOMINANT
BDSM:
-BLUE SCLERA
-DENTAL IMPERFECTIONS
-SENSORINEURAL HEARING LOSS DUE TO OSTEOSCLEROSIS
-MULTIPLE FRACTURES
INV ALL NORMAL
HEARING LOSS
-OSTEOPOROSIS
-PAGET
-OSTEOGENESIS IMPERFECTA
PSEUDO GOUT
-HYPERPARA
-HYPOTHYROID
-LOW MG AND PO4
-HEMOCHROMATOSIS
ACROMEGALY
-WILSONS
LONG TERM TREATMENT FOR SLE
HYDROXYCHLOROQUINE
DACTILYTIS AND DIP ARTHRITIS
PSORIATIC
Calcification found on X RAY
CHONDROCALCINOSIS PSEUDO GOUT
LIVEDORETICULARIS
-SLE
-ANTIPHOSPHOLIPID
-PAN
Cyclophosphamide
PREMATURE OVARIAN FAILURE
INFERTILITY IN MEN AND WOMEN
PAN
-MONONEURITIS MULTIPLEX
-Negative ANCA
-HEP B SURFACE ANTIGEN
-LUNG IS SPARED
-HEMATURIA WITH NO CASTS NO GN
-NO GRANULOMA
VASCULITIS IN WEGNERS
NOT PRESENT IN UPPER RESPIRATORY BIOPSY
AVN
PROGRESSIVE PAIN
LIMITED MOBILITY
MRI
EHLERS DANLOS
-AD
-JOINT HYPERMOBILITY AND FREQUENT DISLOCATIONS
-ELASTIC EXTENDABLE SKIN
-MITRAL VALVE PROLAPSE : MID DIASTOLIC CLICK
AZATHIOPRINE
CONVERTED TO ACTIVE FORM: MERCAPTOPURINE
INHIBITS PURINE SYNTHESIS
S1 INJURY FEATURES
-SENSORY LOSS OF POSTEROLATERAL ASPECT OF LEG AND LATERAL FOOT
-WEAKNESS IN PLANTAR FLEXION
-POSITIVE SCIATIC STRETCH TEST
MARFAN
DURAL ECTASIA
CALCIFICATION OF TRIANGULAR FIBROCARTILLAGE
CHONDROCALCINOSIS PSEUDOGOUT
TEMPORAL ARTERITIS
PALE AND EDEMATOUS DISC DUE TO ANTERIOR ISCHEMIC OPTIC NEUROPATHY
GOUT PATIENTS TAKING WARFARIN
AVOID NSAIDS
USE COLCHICINE OR STEROIDS (AVOID IN DM)
HYDROXYCHLOROQUINE
BULLS EYE RETINOPATHY:
-PHOTOPHOBIA AND FLASHING LIGHTS
-DECREASED VISUAL ACUITY
-CENTRAL MACULA DEPIGMENTATION SURROUNDED BY HYPERPIGMENTATION
STILL’S DISEASE
-RF AND ANA AND RHEUMATOID NODULES ARE NEGATIVE
-FEVER ARTHRALGIA MACULOPAPULAR SALMON PINK RASH
-FIRST LINE NSAIDS THEN STEROIDS THEN METHOTREXATE THEN IL1 (ANAKINRA) THEN RITUXIMAB
-STILL :
Salmon pink rash
Temperature
Inflammatory markers raised ; ESR,CRP,Ferritin
Lymphadenopathy
Liver ; raised transaminase
Keratoderma Blennorrhagica
-hard nodules on the sole of the foot
-diagnostic for reactive arthritis
-MAYBE ALSO YELLOW RASH
LEFLUNOMIDE
-MONITOR WITH BP AND CBC AND LFT
-SIDE EFFECTS:
-MYELOSUPRESSION
-PNEUMONITIS
-DIARRHEA
-HTN
-WEIGHT LOSS
-POLYNEURPATHY
-Use CHOLESTYRAMINE to stop it
MERALGIA PARASTHETICA
-Diagnosed by PELVIC COMPRESSION JUST BELOW THE ASIS
TREATMENT IS BY INJECTION OF LOCAL ANESTHETIC
DISCOID LUPUS
-RAISED ERYTHEMATOUS RASH
-CAUSES SCARRING ALOPECIA
-Rx: TOPICAL STEROIDS THEN HYDROXYCHLOROQUINE
Atypical shaft femur stress fractures
BISPHOSPHONATES
LEG PAIN INCREASED ON WALKING AND RELIEVED BY SITTING DOWN AND CROUCHING
SPINAL STENOSIS
-Also normal vascular examination
-MRI diagnostic
PAIN WORSE ON EXTENSION AND ON FACET PALPATION
FACET JOINT
Inhibition of 5inosine monophosphate dehydrogenase
MYCOPHENOLATE MOFETIL
DECREASES LYMPHOCYTES PRODUCTION
MARKERS OF BONE TURNOVER
-procollagen type I N-terminal propeptide (PINP)
-serum C-telopeptide (CTx)
-urinary N-telopeptide (NTx)
-urinary and serum hydroxyproline
TENDERNESS OVER LATERAL HIP WITH HIP PAIN AND LIMITATION OF MOVEMENTS
TROCHANTERIC BURSITIS
AKA GREATER TROCHANTERIC PAIN SYNDROME
TNF INHIBITORS IN ANKYLOSING IMPROVE ALL BUT?
RADIOLOGICAL PROGRESSION
-IMPROVED ONLY BY NSAIDS
-DMARDS ONLY USEFUL WITH PERIPHERAL JOINTS INVOLVEMENT
FEATURE LESS COMONLY SEEN IN DRUG LUPUS
GLOMERULONEPHRITIS
Hand-Arm vibration syndrome
-Secondary Raynauds
-Loss of fine touch and proprioception
Arthroscopy findings in RA
-Marked profileration of vascularity on synovial membrane with increased permeability
XRAY In Mixed lytic and sclerotic phase of Pagets disease
-Bone expansion
-Trabecular and cortical thickening
-After treatement new bone is lamellar not woven
Disabling osteoarthritis in elderly who live alone
Joint replacement
