Rheumatology Flashcards
Monoarthritis
SA, gout, CPPD, OA, trauma (haemarthrosis)
Polyarthritis
Symmetrical - RA, OA, viruses (hep ABC, mumps) systemic conditions
Asymmetrical - reactive, psosriatic
Heberdens nodes
Bouchards nodes
B proximal
H distal
Felty’s syndrome
RA + splenomegaly + neutropenia
DMARDS, tx RA
a combination of
methotrexate (pneumonitis (get urgent respiratory help), oral ulcers,hepatotoxicity)
sulfasalazine (rash, sperm count, oral ulcers) hydroxychloroquine (irreversible
retinopathy (request annual ophthalmology review))
Then biological agents - SE - Serious infection, including reactivation of TB (screen and consider prophylaxis) and hep B; worsening HF etc
Ankylosing Spondylitis
HLA B27 +ve
progressive loss of spinal movement (all
directions)—hence reduced thoracic expansion.
kyphosis, neck hyperextension
(question-mark posture)
spino-cranial ankylosis.
enthesitis- esp Achilles tendonitis, plantar fasciitis,
at the tibial and ischial tuberosities, and at the iliac crests.
Anterior mechanical chest pain due to costochondritis and fatigue may feature
Acute iritis occurs in~⅓ of patients and may lead to blindness if untreated
osteoporosis (up to 60%)
aortic valve incompetence (<3%)
pulmonary apical fibrosis.
Sacroiliitis is the earliest X-ray feature
Tx - exercise, NSAIDs, bisphosphonates, TNFa blockers
Spondylarthritidies
AS
Enteric arthropathy - IBD, coeliac, GI bypass, Whipples – improves w tx of bowel
Psoriatic Arthritis - symmetrical, NSAIDS,
sulfasalazine, methotrexate and ciclosporin
Reactive arthritis - sterile, affects lower limbs 1-4 weeks after urethritis/ dysentery,
Autoimmune connective tissue diseases
systemic sclerosis primary Sjögren’s syndrome , idiopathic inflammatory myopathies (myositis), mixed connective tissue disease relapsing polychondritis Behçet’s disease
Systemic sclerosis
Scleroderma/vascular disease
Two types:
Limited cutaneous
Diffuse cutaneous
Polymyositis Tests
Screening
Treatment
Muscle enzymes (ALT, AST, LDH, CK & aldolase) in plasma
EMG - fibrillation potentials
**muscle biopsy
MRI muscle oedema in acute
anti-Mi2, anti-Jo1—associated with a syndrome
of acute onset and interstitial lung fibrosis that should be treated aggressively.
SCREEN MALIGNANCY
Steroids
Immunosuppressives
Dermatomyositis
Macular rash (shawl sign)
Lilac-purple (heliotrope) rash on eyelids often
with oedema
Nailfold erythema (dilated capillary loops)
Gottron’s papules: Roughened red papules over the knuckles, also seen on elbows and knees
(pathognomonic if CK high + muscle weakness);
Subcutaneous calcifications
Anti-La, anti Ro
Sjögren’s
Anti-Smith
SLE
Anti Jo-1; Anti-Mi-2
Polymyositis, dermatomyositis.
Anti-Scl70
Diffuse systemic sclerosis.
Antimitochondrial Ab
Primary biliary cirrhosis (>95%), autoimmune hepatitis
30%), idiopathic cirrhosis (25–30%
Anti-smooth muscle Ab (SMA)
Autoimmune hepatitis (70%), primary biliary cirrhosis (50%), idiopathic cirrhosis (25–30%)
Coeliac disease ab
a gliadin Ab, antitissue transglutaminase, anti-endomysial Ab
C ANCA
Granulomatosis + polyangiitis
Perinuclear (p-ANCA), MPO +ve
Microscopic polyangiitis
(45%), Churg–Strauss,
Anti-voltage-gated Ca2+-channel Ab:
Lambert Eaton Syndrome
Anti-aquaporin 4:
Devic’s disease - neuromyelitis optica
Anti-double-stranded DNA
SLE
Antihistone Ab
drug induced SLE
