Rheumatology Flashcards
Define ankylosing spondylitis
Chronic inflammatory disease of the spine and sacroiliac joints
Which arthritis spares DIP?
Rheumatoid arthritis
When is joint pain and stiffness worse in RA?
Morning
What is the CREST syndrome?
Calcinosis Reynaud's phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia
If a patient presents with calcinosis, Reynaud’s phenomenon, reflux and telangiectasia. What is the diagnosis?
Scleroderma
Which disease is associated with the CREST syndrome?
Scleroderma
What are the 4 characteristics of OA on x-ray?
LOSS Loss of joint space Osteophytes Subchondral cysts Subarticular sclerosis
Which joints are most commonly affected in RA?
PIP, MCP, wrist and MTP
Xray features of RA?
SOLED Soft tissue swelling Osteoporosis/osteopaenia Loss of joint space Erosions Deformity
what are the seronegative spondyloarthopathies
ankylosing spondyloarthritis
reiter syndrome
enteritis-associated arthritis
psoriatic arthritis
what is Charcot joint
neuropathy leads to loss of protective mechanisms of the joint –> extreme traumatic damage
Treatment of acute attack of gout
High dose NSAIDs (voltaren, indomethacin, piroxicam, ibuprofen) for 3-5 days. Then cut back to standard dose and cease after 6 weeks.
(colchicine or intra-articular steroids if NSAIDs contraindicated)
Treatment of chronic gout
Once acute attack is controlled, start allopurinol at lowest possible dose with NSAID cover.
Increase dose slowly until you reach good control of serum urate (less than 0.3mmol/L)
Dx of osteoporosis
DEXA scan T score -2.5 or lower
Difference between T score and Z score in DEXA scans?
T score is with reference to a healthy 30 year old female matched to same age and ethnicity
Z score is with reference to same age, sex and ethnicity
Dx of severe osteoporosis
DEXA scan T score -2.5 or lower
AND
1 or more fractures
Dx of osteopaenia
DEXA T score between -1 to -2.4
First line Rx of osteoporosis
Bisphosphonates
What do bisphosphonate names start or end with?
End with -dronate
What is the mechanism of action of bisphosphonates?
Cause osteoclast apoptosis
What are the main concerns with long term bisphosphonate Rx?
Oesophageal cancer
Osteonecrosis of the jaw
What is the Thomas test and what does it test for?
Pt lies supine. Place fist under lumbar lordosis. Lift Pt’s right leg and flex at knee. Left hip should stay on bed. If left hip raises off bed = right hip pathology.
Tests for fixed flexion hip deformity
What is Schober’s test and what does it test for?
Mark point between PSIS (~L5) and 5cm above. Have Pt flex at hip and gap should increase to 10cm or more.
Tests for lumbar flexion
What is Trendelenburg’s sign and what does it test for?
Have Pt stand on one foot. Positive = opposite side of hip drops
Tests for weakness of the hip abductors (gluteus medius and minimus)
What is the straight leg raised test and what does it test for?
Have Pt lie supine. Passively raise leg to flex hip. Ask if causes pain esp shootiing down leg
Tests for ipsilateral sciatica esp from L5 disc herniation
which joints of the hand are typically involved in OA?
PIP, DIP, MCP (especially base of thumb)
which joints of the hand are typically involved in RA?
MCP, PIP, wrist
Symmetrical
