Rheumatology 3 Flashcards
Dermatomyositis
autoimmune condition
50-70 years old
> Paraneoplastic !!
screen
what malignancy associated with dermatomyositis ?
ovarina
breast
lung
Ix findings for Dermatomyositis?
ANA +
anti-Jo 1
Rotator cuff muscle
internal rotation
subscapularis > anteriorly on you chest
Supraspinatus
top of shoulder
needed for first 20 degrees of abduction
Infraspinatus ?
posteriorly on superiro aspect of back
external rotation of shoulder
Teres minor
posterior on superior aspect of back
EXTERNAL ROTATION
what muscles help with external rotation of shoulders?
Teres minor
Infraspinatus
Osteoarthritis?
pain exacerbated by exercise
relieved by rest
reduction in internal rotation
age, obesity,RF
Azathiopurine
be careful of?
Myelosuppression - FBC
TPMT test needed : if abnormal can lead to azathiopurine toxicity
TPMT
thiopurine methyltransferase
some people genetically low
> myelosuppression
dermatomyositis is associated with which autoantibodies?
antinuclear
discoid lupus erythematosus
follicular keratin plugs
Mx:
Topical steroids
Oral hydroxychloroquine
Behcet’s syndrome
dermatological associations?
aphthous ulcers
genital ulcers
acne-lesions
erythema nodosum
what is erythema nodosum?
painful red lesions
inflammed subcut fat
shins
behcets HLA?
HLA b51
features of behcets?
oral ulcers
genital ulcers
anterior uveitis
thrombophlebitis
DVT
arthritis
neuro
GI
erythema nodosum
osetogenesis imperfecta
djusted calcium, PTH, ALP and PO4 results are usually NORMAL
why do allopurinol and azathiopurine interact?
bone marrow suppresion
xanthine oxidase inhibitor
active-6 mercaptopurine levels increases = increase bone marrow suppression
what is polymyositis?
raised CK proximal muscle weakness
no rash
caused by anti-jo 1 AB
polymyositis
t cell mediated cytotoxic
Ix polymyositis?
CK levels
muscle enzymes
EMG
muscle biopsy
autoantibodies
referred lumbar spine pain?
do the femoral nerve stretch test
> femoral nerve compression causes referred pain
lie the patient prone
who should be advised to take vitamin D supplementation?
all pregnant and breastfeeding women 10ug
all children 6m-5 yrs
> 65
housebound pts
granulomatosis with polyangiitis
cytoplasmic antineutrophil cytoplasmic antibody
cANCA
small vessel vasculitis
targets the serine proteinase 3
GPA -features
based on granulomas in kidneys and lung
> renal findings
renal impairment
Respiratory
ENT symptoms
CXR
Eosinophilic granulomatosis with polyangiitis
presents with allergic picture
asthma
associated with UC, PSC, anti-GBM
pANCA
perinuclear antinutrophil cytoplasmic antibodies
systemic sclerosis?
hardened sclerotic skin
3 types
Limited
Diffuse
Scleroderma
Diffuse cutaneous systemic sclerosis
respiratory involvement : ILD, pulomanry hypertension
ACEi given for renal disease: captopril
anti-SCl 70 ab
Limited cutaneous systemic sclerosis
raynaud first feature
anti centromere
CREST
CREST?
calcinosis
raynauds
oEsophageal dysmotility
sclerodactyly
telangiectasia
greater trochanteric pain syndrome?
sudden onset?
outside of hip
bad at night
marfan
deficiency in?
fibrillin
