Rheumatology Flashcards
What is rheumatology?
- The medical management of musculoskeletal disease
What is inflammation?
- Reaction of microcirculation
- Movement of fluid and WBCs into extra-vascular tissues
What are the 4 pillars of inflammation?
- Rubor
- Dolor
- Calor
- tumour
What is spondyloarthritis (SpA)?
- A group of over-lapping conditions that are all associated with tissue type HLA B27
What are the clinical features of SpA?
- inflammatory arthritis of skeleton (spine/rib cage)
- Enthesitis (inflammation of ligament junction)
- inflammation of eye
- IBD (occasionally)
- SPINEACHE
What is ankylosing spondylitis (AS)?
- Inflammatory arthritis of the spine and rib case
- Can lead to new bone formation
- Starts late teens
- Worst prognosis = male, smoker, B27+
What is the treatment for AS
- TNFi - most beneficial drug
- Physio (not bed rest)
- High-dose NSAIDS
What is psoriatic arthritis (PSA)?
- Develops in some people with psoriasis
- Distal joints mainly
What is dactylitis?
- inflammation of tendon sheaths and joints
- Sausage digit !
How do you manage psoriatic arthritis?
- Early intervention with DMARDS (sulfasalazine)
- Anti-TNF drugs
What is reactive arthritis (RA)?
- Arthritis
- Conjunctivitis
- Sterile urethritis
- Occurs after an infection
- Can’t climb up a tree, see a tree or wee by a tree
How would you treat reactive arthritis?
- Clear original infection (antibiotics if STI)
- painkillers
- DMARDs
What should you be aware of when thinking about spondyloarthritis? (5)
- Inflammatory back pain
- Large joint arthritis
- Skin psoriasis
- IBD
- inflammatory eye disease
What is crystal disease?
- Rapid onset
- Very red and hot joints
- Relevant history - differs for gout and infection
What is rheumatoid arthritis?
- A disease of synovial joints
- inflammation
- proliferation
- chronic and severe
- symmetrical
What are the symptoms of rheumatoid arthritis?
- joint pain (often worse in the morning)
- morning stiffness
- loss of function
- general fatigue
- extra-articular involvement
How would you investigate rheumatoid arthritis?
- rheumatoid factor (would be positive)
- anaemia
- high ESR/CRP
What is vasculitis?
- Inflammation and necrosis of blood vessel walls with impaired blood flow
How does vasculitis present?
- No single typical presentation
- unwell, fever, arthritis, rash
- easily confused with other diseases
What is giant cell (temporal) arteritis (GCA)?
- Arteries in the temple get inflammed
- incidence increases with age
How goes GCA present?
- headache
- scalp tenderness
- acute blindness
How would you treat GCA?
- corticosteroids e.g. prednisolone
- steroid sparing agents e.g. methotrexate
What is osteoarthritis?
- Age-related pattern of a joint in response to injury
- All tissues of joint are involved
- Articular cartilage most affected
What are the risk factors for osteoarthritis?
- Age (uncommon under 45)
- Gender
- Genetic predisposition
- Obesity
- Occupation
- SHATTERRED
