Rheumatology Flashcards
How would you manage a high calcium?
IV fluids
IV bisphosphonates
if needed give Denosumab and steroid use
What two assessment scales can you do on a patient with suspected osteoporosis?
Which one is said to be better?
DEXA scan
Vertebral fracture assessment
What pathway do bisphosphonates work via?
HMG-CoA pathway
Explain the pharmacology of bisphosphonates?
- Bisphosphonates haven a high affinity for hydroxyapatite so head straight to the bone.
- Osteoclasts when they resorb bone also take up some bisphosphonates.
- The bisphosphonates disable the osteoclast activity. Causes apoptosis and thus reduces bone absorption
Give two significant SE of bisphosphonates?
Oesphagitis
Avascular necrosis of the jaw (happens after months of treatment)
AF
How will high calcium appear on ECG?
Short QT
How will low calcium present on ECG?
Long QT
What will the PTH levels look like in
A. Malignancy
B. Primary PTH
A. Low or normal
B. High
What does having a low Vit D do to the PTH levels?
Increases secondary PTH levels
Leading to increased bone resorption and thus significant risk of osteoporosis
What happens to blood test marker would go up in increased bone turnover?
Alkaline Phosphatase
What is seen on X Ray with someone with Ewing’s sarcoma?
Onion skin appearance
What is seen on X Ray with osteosarcoma ?
Sun burst appearance
What joint deformities will you get in osteoarthritis?
You will get Heberdens (distal) and Bouchard (proximal) nodes
What limb deformities will you get with rheumatoid arthritis?
Boutonnière deformity
Swan Neck deformity
What are two antibodies you will be looking for in the blood of a patient with Rheumatoid arthritis?
- anti CCP
2. RF
What are some of the extra articular joint manifestations of rheumatoid arthritis?
- Subcutaneous skin nodules
- Pleural effusions
- Pericarditis
- Cord compression
- Carpal Tunnel;
What is the first and then the second line treatment for rheumatoid arthritis?
1st line: pain relief + NSAIDs + methotrexate + folic acid
2nd line: biological agent such as infliximab or rituximab
What is a normal T score for a person?
T Score of > -1.0
What is osteomalacia?
The poor mineralisation of bone secondary to Vit D deficiency
What will the levels of calcium and phosphate be like in a patient with osteomalacia?
They will both be low- as in phosphate LOW and calcium LOW
Also increased Alk Phosph and also increased PTH
What is the treatment for osteomalacia?
Adcal
What are the crystals you get in a gout sample?
Monosodium urate crystals
What type of crystals do you get in a pseudo gout sample?
You get calcium pyrophosphate
What is tophaceous gout?
This is when you get monsodium urate crystal deposits in the peripheral joints such as the hands and toes.
These crystals release proteolytic enzymes that break down bone and lead to a punched out appearance to the bone.