Rheumatology Flashcards
Systemic lupus erythematosus - Autoantibodies
- Anti-nuclear antibodies
- Raised anti-dsDNA antibody (v specific)
- Anti-Ro
- Anti-Sm
- Anti-a
- Rheumatoid factor (40%)
Vasculitis - ANCA
- Anti- neutrophil cytoplasmic antibodies
- Small vessel usually +ve
- Large vessel -ve
- Medium vessel -ve
Rheumatoid Arthritis - Bloods
- Positive Rheumatoid Factor
- Positive anti-cyclic citrullinated peptide (Anti-CCP)
- Normochromic normocytic anaemia
- ESR +/or CRP raised
Osteoarthritis - Clinical presentation
- Joints pain (worse on movement)
- Distal interphalangeal joints
- 1st carpometacarpal joint (base of thumb)
- 1st metatarsophalangeal joint of foot
- Weight bearing joints - Transient morning stiffness (<30mins)
- Crepitus (grating)
- Heberden’s nodes at DIPJs
- Bouchard’s at PIJPs
B before H –> more proximal
Unsymmetrical!
Rheumatoid Arthritis - Extra-articular manifestations LUNG
- Pleural effusions
- Fibrosing alveolitits
- Pneumoconiosis
- Interstitial lung disease
- Bronchiectasis
RA - Extra-articular manifestations HEART
- Pericarditis
- Pericardial rub
- Raynauds
- Pericardial effusion
RA - Extra-articular manifestations NEURO
- Peripheral sensory neuropathies
- Compression/entrapment neuropathies
- Cord compression
RA - Extra-articular manifestations KIDNEY
- Amyloidosis
- Nephrotic syndrome
- CKD
RA - Extra-articular manifestations SKIN
SC nodules
RA - X ray
- Soft tissue swelling (early)
- Joint space narrowing (late)
- Peri-articular erosions
Mechanical lower back pain - Treatment
- Analgesia
- Physio
- Avoid excessive rest
- Re-education in lifting
- Comfortable sleeping position
Bone tumour - X ray
- Mets as osteolytic A w bony destruction
- Visible = <60% bone density - Osteosclerotic (increased bone density) mets -> prostatic carcinoma
Gout - risk facotrs
- Purine rich foods
- High alcohol intake
- High fructose intake
- High sat fat
- Drugs –> low dose aspirin
Systemic lupus erythematous - Treatment
- IV cyclophosphamide + high dose prednisolone
- NSAIDs
- Anti-malarials
- Chloroquine or hydroxychloroquine - Immunosuppressives
- Oral azathioprine / methotrexate - Biologicals
- Rituximab (anti-CD20)
Giant cell arteritis - Clinical presentation
- Severe headache
- Scalp/temple tenderness
- Claudication of jaw
- Sudden painless vision loss = emergency
- Unequal/weak pulses
Bone/joint infection - causative organisms
- Staph aureus
- H. influenzae (vaccine)
- Neisseria gonorrhoea
- Streptococci
- Gram -ve bacteria
Prosthetic joint infection - causative organisms
- Staph aureus
- Coagulase -ve staph
- hip replacement - Gram +ves
Joint pain- types
- Inflammatory
- RA
- Septic arthritis
- Spondyloarthropathies
- CT disease - Non-inflammatory
- OA (degenerative)
- Fibromyalgia (non-degenerative)
RA - Clinical presentation
- Symmetrical peripheral polyarthritis
- DIJPs spared
- Ulnar deviation
- Swann neck/Z thumb
- Swollen, tender and warm
HLA-B27
Seronegative spondyloarthropathies
- Ankylosing spondylitis
- Reactive arthritis
- Psoriatic arthritis
Osteoporosis - Treatment
- Biphosphonates (oral alendronate) –> slow osteoclasts –> less bone turnover
- Denosumab
(inhibits RANK –> less osteoclast activation) - Strontium renlate (less fractures)
- HRT –> menopausal women
- Raloxifene –>activate oestrogen receptor on bone
Septic arthritis - Definition
Medical emergency - acutely inflamed joint
Septic arthritis - Diagnosis
- Urgent joint aspiration of synovial fluid
- MC+S
- Before antibiotics
Carpal tunnel syndrome - Definition
Compression of median N by flexor tendons
Carpal tunnel syndrome - Presentation
- Pain
- Numbness
- Tingling
- Weakness
- Wasting of M supplied by median N
Fracture - Classification
Salter-Harris fracture classification 1. If involving physis (growth plate) 2, Higher = more damage 3. Epiphysis and metaphysis 4. Growth arrest
Osteoporosis - DEXA scan
Dual energy X-ray absorptiometry (DEXA) 1. Gold standard 2. T score --> SD score compared to gender matched 25yr old average -1 to -2.5 = osteopenia matched to same age
FRAX score
Risk of fracture in next 10 yrs
Allopurinol action
Inhibits xanthine oxidase –> less uric acid production –> less monoNa urate production
- Gout (can trigger it)
- Kidney stones
- Hyperuricaemia
Giant cell arteritis - Treatment
- High dose prednisolone
- Stop vision loss
- LT - GI and bone protection
- Lansoprazole
- Alendronate
- Ca2+
- Vit D
RA - Treatment DMARDs
Disease Modifying Anti-Rheumatic drugs
- Methotrexate
- Sulfasalazine
- Leflunomide
RA - Treatment biological
- TNF-alpha blocker
- IV infliximab
- SC etanercept
- SC adalimumab - B cell inhibitors
- Rituximab - IL blockers
- Tocilzumab - T cell activation blocker
- Abatacept
Pseudogout - Joint fluid aspiration + microscopy
Ca pyrophosphate crystals
(+ve bifringent crystals under polarised light - rhomboid)
Pseudo = Pos
Culture - septic arteritis
Gout - Joint fluid aspiration + microscopy
Long needle shaped monosoduim urate crystals
-ve bifringent under bipolarised light