Rheumatology Flashcards
Vasculitis category
Large:
- Takayasu’s
- Giant cell arterits
- Buergers disease
Medium:
- Polyarteritis nodosa
- Kawasaki disease
Small:
- ANCA associated vasculitidies (W, CS, MPA)
- Immune complex associated
- Henoch-Schonlein purpura
- Cryoglobulinaemic vasculitis
- Rheumatoid vasculitis
Variable:
- Behcets
- Cogans
ANCA associated vasculitides
Wegners granulomatosis
Churg-Strauss
Microscopic polyangitis
Takayasu’s arteritis
- Inflammatory, obliterative arteritis affecting aorta and branches
- Females> Males
- Symptoms include upper limb claudication
- Clinical findings include diminished or absent pulses
- Carotid bruit, AR 20%
- ESR often affected during the acute phase
Buergers disease
- Segmental thrombotic occlusions of the small and medium sized lower limb vessels
- Commonest in young male smokers
- Proximal pulses usually present, but pedal pulses are lost
- An acuter hypercellular occlusive thrombus is often present
- Tortuous corkscrew shaped collateral vessels may be seen on angiography
Giant cell arteritis
- Systemic granulomatous arteritis that usually affects large and medium sized vessels
- Females > Males
- Temporal arteritis is commonest type
- Granulomatous lesions may be seen on biopsy (although up to 50% are normal)
Polyarteritis nodsa
- Systemic necrotising vasculitis affecting small and medium sized muscular arteries
- Most common in populations with high prevalence of hepatitis B
- Renal disease is seen in 70% cases
- Angiography may show saccular or fusiform aneurysms and arterial stenoses
Wegeners granulomatosis
- Predominantly affects small and medium sized arteries
- Systemic necrotising granulomatous vasculitis
- Cutaneous vascular lesions may be seen (ulceration, nodules and purpura)
- Sinus imaging may show mucosal thickening and air fluid levels
Bechets syndrome
- Characterised by oral and genital ulcers
- Other clinical features include ocular disease, vascular disease, neuro disease, GI involvement nad arthritis
- involves ALL vessel size
- more common along silk road - most common in turkey (370/100000)
- Large vessel effect: DVT, SVC/IVC obstruction, Pulmonary artery occlusion, aortic aneurysm
Antiphospholipid syndorme
Features:
- venous/arterial thrombosis
- recurrent miscarriage
- livedo reticularis
- thrombocytopenia
- prolonged APTT
- Pre-eclampsia, pulmonary HTN
Associated with SLE
Mx:
- Initially venous thromboembolism warfarin INR 2-3 6 months
- Recurrent venous thromboembolic events warfarin INR 3-4 lifelong
- arterial thromboembolism life long warfarin INR 2-3
Polmyalgia rheumatica
Path, Features, Ix, Mx
Path: giant cell vasculitis, “skip lesions”
Features:
- > 60 years
- rapid onset <1 month
- aching morning stiffness in proximal limbs
- mild polyarthralgia, lethargy, depression, low grade fever, anorexia, night sweats
Ix: ESR > 40 mm/hr, reduced CD8 T cells
normal CK and EMG
Mx: prednisolone 15mg/OD
Ankylosing spondylitis features
HLA-B27 associated spondylarthropathy
Males 20-30
Features - lower back pain with insidious onset
- worse in morning and improves with exercise
- pain at night that improves when they get up
Exam:
- reduced lateral flexion
- reduced forward flexion
- reduced chest expansion
Others (As)
- Apical fibrosis
- Anterior uveitis
- Aortic regurge
- Achilles tendonitis
- AV node block
- Amyloidosis
- Cauda equina
- peripheral arthritis
Schirmers test
Sjogrens syndrome
Anti-Ro and Anti-La
nb nearly 100% RF positive
Alendronate GI SE Mx
Change to Risedronate or etidronate
Bisphosphonate “holidays”
Assess risk 5 years after taking using FRAX score and DEXA scan
If high risk continue
If low risk discontinue and reassess at 2 years
Poor prognostic features of RA
RF + Poor functional status at presentation HLA DR4 X-ray early erosions Extra articular erosions Insidious onset anti-CCP antibodies
