Rheumatology Flashcards
What are the RFs for sciatica?
Age 40-65
Smoking
Tall
Occupation - strenuous job, vibrations
Causes of sciatica?
90% d/t disc herniation
Malignancy
Infection
Rarely due to a sciatic nerve disorder
What are the S+S in sciatica?
Pain in the distribution of the sciatic nerve in the thigh and below the knee (if not felt below the knee, it’s not sciatica)
Often accompanied by numbness and paraesthesia
Pain is exacerbated by coughing, straining, sneezing, laughing
Treatment of sciatica?
See notes
What are the two pain symptoms of Anky Spon?
Back pain and stiffness
What are the signs on clinical exam of Ank Spon?
Schobers test positive
Reduced lateral flexion
Reduced chest expansion
What is the Tx of Ank Spon?
Medical: NSAIDs (diclofenac/naproxen) Steroids (for surrounding disease) Anti-TNF (infliximab, etanercept) DO NOT USE DMARDS
Physio/hydrotherapy
Stop smoking
Support groups
Encourage exercise
What are the extra-articular symptoms of RA?
See notes
Other than RA, what disease is RF positive in?
SLE
Sjogrens
Hep C
Acute viruses/infections
What supplement need to be taken with DMARDs?
Folic acid
How to treat reactive arthritis?
No cure
Splint joint
NSAIDs/IA steroid injections
Consider DMARDs if >6 months
What are the nail changes in psoriatic arthritis?
Pitting, yellowing, onycholysis
What is seen on X-ray in psoriatic arthritis?
Pencil in cup deformity
How to treat psoriatic arthritis?
NSAIDs
Steroids
DMARDs
TNF-alpha
How long to wait after gout attack to start allopurinol? What is the alternative?
3 weeks
Febuxostat (more expensive)
What precipitates a gout flare up?
Infection, trauma, surgery, starvation, diuretics
Gout RFs
Male, meat + seafood (high in purines), alcohol, diuretics, obesity, HTN, coronary heart disease, DM, CKD, heart failure
Which blood is raised in pseudogout?
Neutrophils
Things that precipitate pseudogout attack?
dehydration, intercurrent illness, haemochromatosis (high iron), hyperparathyroidism, long-term steroids
Which Ca is more common in Sjogrens?
non-hodgkins lymphoma
Which Abs are positive in Sjogrens?
ANA, RF, Ro, La
Ix for Sjogrens?
Salivary gland USS
Schirmer’s test
Management of Sjogrens?
Tear and saliva replacement
Hydrochloroquine for fatigue, myalgia, arthralgia, rashes
Corticosteroids/immunosuppressants for organ-threatening extra-glandular disease
Biological therapies
Which immunosuppressant drug is given for systemic sclerosis?
IV cyclophosphamide
What is the pathophysiology of dermatomyositis?
Capillary obliteration cause ischamia and muscle infarction
What are the Ix for dermato/polymyositis?
Check autoantibodies o Anti-Jo1 (poly), anti-Mi-2 (derm), ANA Raised serum muscle enzymes – CK, aldolase Muscle biopsy Screen for malignancy
What is the Tx for dermato/polymyositis?
Steroids
Methotrexate
What is the Tx of SLE?
To treat flares -> cyclophosphamide + steroids
Maintenance -> NSAIDs + hydroxychloroquine
Biologics -> rituximab
Suncream, topical steroids
Investigations for GCA?
Raised CRP/ESP Raised ALP (inflammatory marker) Low Hb Temp art biopsy Temp art USS - halo sign
How long for steroids in GCA?
Minimal - 1 year, usually 2
What are the blood results like for PMR?
Raised CRP
Raised/normal ESR
Raised ALP
CK is normal
Characteristic presentation in PMR?
Tenderness + morning stiffness in the shoulders and proximal limb muscles (no weakness)
What type of cells can be seen on a blood film in myeloma?
Rouleaux cells (RBC stacking)
