Rheumatology

Question 1

What condition is characterised by periorbital oedema, heliotrope rash on the eyes and Grottons Papules / Mechanics hands?

Answer 1

Dermatomyositis/Myositis

Question 2

What condition causes difficulty in combing hair, rising from a chair, night pain and early morning stiffness?

• Dec ROM
• Pain and stiffness in neck, shoulders and hip joints

Answer 2

Polymyalgia Rheumatica

• neck
• shoulders
• Hip Girdles

Elevated inflammatory markers
age 70 -80
Rare < 50

Associated with GCA - temporal artery biopsy

25% systemic symptoms

Question 3

How to treat polymyalgia rheumatica?

Answer 3

Lifestyle changes

Steroids - Prednisolone daily 15mg (rapid response within 5 days)

• if poor response - unlikely to be PMR
• Reduce pred slowly to prevent replase

Methotrexate - DMARD - steroid sparing - reduce steroid use and for those who relapsed

Question 4

What are the features/ presentation of SLE?

Answer 4

Fatigue
Joint pain and stiffness
Malar rash (butterfly) - spare nasolabial flares
Discoid rash - red, scaly, well demarcated in sun exposed areas
Photosensitivity

Soap brain 
serositis - pleurisy and pericarditis 
oral mouth ulcers 
Arthritis 
Photosensitivie rash - malar and discoid 

Blood disorder - lympho and thrombocytopenia 
Renal involvement - GN 
Autoimmiune - ANA ab positive 
Immunological - decreased complement 
Neurological - Seizures and psychosis

Question 5

What is the presentation for Reactive arthritis?

Answer 5

Previous GI/Gu infection

Reiter’s triad - Can’t see, can’t wee, can’t climb a tree
conjunctivitis, urethritis, arthritis

Keratoderma blemmorhagia - brown, raised plaques on palms

Question 6

What TB drug induces lupus?

Answer 6

Isoniazid induces Lupus (rash, fatigue, arthralgia)

as well as TNF inhibitors and mirocycline