Rheumatology Flashcards
Reiters syndrome is precipitated by which infections
Chlamydia Salmonella Campylobacter Shigella Yersinia
antiphospholipid syndrome
multisystem vasculopathy manifested by recurrent thromboembolic events, spontaneous abortions and thrombocytopenia
Type I immune reaction
formation of IgE -> release of immunologic mediators from basophils/ mast cells -> diffuse inflammation
Asthma, allergic rhinitis
Type II immune reaction
Cytotoxic
Formation of antibody -> deposits and binds to antigen on cell surface -> phagocytosis or lysis of target cell
Autoimmune haemolytic anemia, Graves disease, pernicious anaemia
Type III immune reaction
Immune complex
Formation of antigen antibody complexes -> activation of complement -> attracts inflammatory cells and release of cytokines
SLE, PAN, post strep glomerulonephritis, serum sickness
Type IV immune reaction
cell mediated/ delayed hypersensitivity
release of cytokines by sensitised T cells and T cell mediated cytotoxicity
contact dermatitis
Fibromyalgia
chronic (>3 month) widespread non articular pain with characteristic tender points
Fibromylagia epidemiology
F:M 3:1
ages 25-45, some adolescents
strong association with psychiatric illness
Signs and symptoms of fibromyalgia
widespread aching, stiffness
easy fatiguability
sleep disturbance
symptoms aggravated by physical activity
patient feels that joints are diffusely swollen although joint examination is normal
neurologic symptoms of hyperalgesia, paraesthesias
associated with IBS, migraines, tension headaches, restless legs syndrome, obesity, depression and anxiety
Treatment for fibromyalgia
conservative education exercise program physical therapy stress reduction, CBT biofeedback, meditation, acupuncture Medical: low dose TCSa - amitriptyline
Giant cell arteritis
Inflammation of medium and large sized arteries
characteristically involves one or more branches of the carotid artery, particular the temporal artery
what condition is giant cell arteritis associated with?
polymyalgia rheumatica
Age and sex demographic of giant cell arteritis
almost exclusively occurs in individuals greater than 50 years
more common in women
Clinical features of giant cell arteritis
fever, anaemia, high ESR
headaches
systemic inflammation: malaise, fatigue, anorexia, weight loss, sweats, arthralgias, polymylagia rhumatica
In patients with involvement of the cranial arteries headache is the predominant symptom and may be associated with a tender or nodular artery which may pulsate early in the disease
visual disturbances and facial pain on chewing
Diagnosis of Temporal Arteritis
Biopsy of the temporal artery
Classification criteria for temporal arteritis
Age >50 years at onset New Headache Temporal artery abnormality Elevated ESR abnormal artery biopsy with mononuclear cell infiltrate, granulomatous inflammation, usually with multinucleated giant cells
Local manifestations of temporal arteritis
Temporal headaches blindness (tranisent amarousis) sclap necrosis scalp tenderness jaw claudication
What is psuedogout?
calcium pyrophosphate dehydrate arthropathy
acute monoartropathy similar to gout and typically affects l larger joints: knee, wrist or hip
Risk factors for psuedogout
old age OA Dm hypothyroidism hyperparathyroidism haemochromatosis Wilson's Disease
Investigations for pseudogout?
polarised light microscopy of synovial fluid - weakly positive birefringent crystals
Associated with chondrocalcinosis: soft tisse calcium deposits on Xray
Antibody associated with miced connective tissue disease
anti nRNP (ribonucleoprotein)
What joint are Heberdon’s nodes found on?
DIP
What joint are Bouchards nodes found on
PIP
radiographic Hallmarks of osteoarthritis
Joint space narrowing
subchondral sclerosis
subchondral cysts
osteophytes
treatment for osteoarthritis
no treatment alters the natural history of OA
non pharmacologic therapy
- weight loss
- physiotherapy: heat/cold, low impact exercise programs
occupational therapy: aids, splints, cane, walker, bracing
- NSIS, glucosamine
joint injections
topical NSAIDs
Polyarteritis Nodosa (PAN)
systemic vasculitis characterised by necrotising inflammatory lesions that affect small and medium sized arteries
preferentially occurs at vessel bifurcations and branch points
POlymyalgia rheumatica
characterised by pain and stiffness of the extremities
closely related to giant cell arteritis
no muscle weakness
age of onset >50 years
signs and symptoms of polymylagia rheumatica
constitutional symptoms prominent (fever, weight loss, malaise)
pain and stiffness of symmetrical proximal muscles (neck, shoulder and hip girdles, thighs)
muscle pain persisting for at least one month
gel phenomenon (stiffness after prolonged activity)
pysical exam reveals tender muscles but no weakness or atrophy
genetic predisposition rheumatoid arthritis
HLA-DR4/DR1
Extra articular features of rheumatoid arthritis
cutaneous ulcers rheumatoid nodules episcleritis scleritis pulmonary fibrosis pleuritis peripheral neuropathy: sensory stocking glove Splenomegaly
Felty’s Syndrome
arthritis, splenomegaly, neutropenia
Sjogren’s Syndrome
keratoconjuctivitis sicca and xerostomia (dry eyes and mouth)
Scleroderma
non inflammatory autoimmune disorder
widespread small vessel vasculopathy and fibrosis
affects T cells, b cells, affects fibroblasts
scl70
ANA positive
CREST
limited systemic sclerosis
Calcinosis: calcium deposits on the skin
Raynaud’s phenomenon
Esophageal dysfunction: acid reflux
Sclerodactyly: tightening of skin on digits
Telangiectasia: superficial dilated blood vessels
