Rheumatology Flashcards
How will you monitor this person on a biologic DMARD?
My considerations for patients on bDMARDS are
- infusion reactions
- increased risk of infection
- malignancy
- can cause demyelination / autoimmune phenomena
To monitor:
- will need to continue regular review of disease activity to monitor therapeutic effect
- ensure vaccinations are UTD and avoid live vaccines
- routine biochemical monitoring with FBE/UEC/LFT
- keep UTD with malignancy screening and skin checks
- if requiring a surgical procedure, will need to be withheld several weeks prior in conjunction with Rheum team
How will you monitor this person on Methotrexate?
Concerns are myelosuppression, hepatotoxicity and lung toxicity
- FBE / UEC / LFT every 3 months
- monitor for symptoms of above (SOB / infections)
How will you monitor this person on Leflunomide?
Concerns are GI upset, hepatotoxicity, HTN, ILD
Monitoring same as methotrexate =
- FBE / UEC / LFT every 3 months
- monitor for symptoms of above (SOB / infections / HTN)
How will you monitor this person on Azathioprine?
Concerns are GI upset, myelosuppression, infection, skin cancers
- FBE, skin checks
How will you monitor this person on Hydroxychloroquine?
Opthal review for retinal toxicity at baseline and then 5 year mark
How will you determine activity of SLE?
Clinically
- fatigue
- severity of current symptoms
- development of symptoms suggesting new organ manifestation
Biochemically
- low complement
- elevated dsDNA
- active urinary sediment
- cytopaenias
How will you manage this person previously on cyclophosphamide?
Concerns:
- Infertility -> counselling
- Bladder -> annual urinalysis + cytology indefinitely
Also causes increased risk of haem malignancies
Whilst on it -> high risk of infection / myelosuppression
How will you assess the activity of their inflammatory arthritis?
Clinically
- degree of morning stiffness / fatigue / change in functional capacity
- number of tender and swollen joints
- active synovitis
- development of extra-articular manifestations
Biochemically
- CRP / ESR
- albumin / plts
Radiologically
- XR to look for disease progression
What are main extra-articular manifestations of RA?
- Eyes-> epislceritis/uveitis/keratitis
- Sicca symptoms
- ILD
- Serositis
- Haematological -> cytopaenias / splenomegaly
- Cutaneous vasculitis + neuropathy
- Nodules
What would your approach to treating a flare of RA be?
In an acute flare:
- if one / few joints involved -> could consider local steroid injection
- if widespread -> initiating/increasing level of systemic steroid, to then wean when flare resolved
- if recurrent flares, then background DMARD therapy needs to be escalated in conjunction with Rheum
- > dose increase
- > decrease interval of dosing
What is a myositis ab panel?
CK U1RNP SRP Jo-1 MI-2 (can also do lupus / Sjogren's ab)
What are poor prognostic factors in RA?
Clinical = - high number of joints affected - extra-articular features - significant functional limitations Biochemical = - seropositivity - early erosions - high inflam markers
What is difference between AL / AA amyloidosis?
AL -> refers to ‘primary’ amyloidosis.
A complication of plasma cell dyscrasia with deposition of light chain fragments in organs
AA -> ‘secondary’, complicates chronic inflammatory diseases. It is fragments of an acute phase reactant serum amyloid A protein that is deposited
Can also have organ-specific amyloid, or dialysis-related
What are manifestations to ask about in AL amyloidosis?
- Mucocutaneous
- Renal -> nephrotic syndrome
- Neuro -> neuropathy
- Cardiac infiltration
- GIT -> haemorrhage / malabsorption
What are the main manifestations of sarcoidosis to ask about?
- Lung -> diffuse ILD, can have pulm HTN
- Eyes -> uveitis / plaques
- Cardiac
- Neuro -> nerve palsies
- Renal -> - Hypercalcaemia / hypercalciuria
- Skin -> erythema nodosum, rash, plaques
- Arthritis
- Endocrine infiltration
