Rheumatology

Question 1

What is Polymyalgia Rheumatica (PMR)?

Answer 1

PMR is a common condition seen in older people characterised by muscle stiffness and raised inflammatory markers.

Question 2

What vascular condition is Polymyalgia Rheumatica associated with?

Answer 2

Temporal/Giant cell arteritis

Question 3

What are the features of Polymyalgia Rheumatica?

Answer 3

Over 60 yrs old
Rapid onset (Eg 1 month)
Aching, morning stiffness in proximal limb muscles (neck, shoulders, pelvis etc)
Mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats

Question 4

What Ix results are expected in Polymyalgia Rheumatica?

Answer 4

High ESR
Normal Creatinine kinase
Normal EMG

Question 5

How do you manage Polymyalgia Rheumatica?

Answer 5

Prednisolone 15mg OD

When give long-term steroids, consider giving Calcium and vit D supplements, + possibly bisphosphonates as corticosteroids increase risk of osteoporosis

Question 6

What is Gout?

Answer 6

Increased urate in blood crystallising + accumulating in a joint.

Question 7

What is the treatment for Gout?

Answer 7

Treat acutely with Colchicine + NSAIDs.

Manage chronically with Allopurinol to lower urate to <400.
Never start Allopurinol during an acute attack as worsens it, but is 1st line for chronic.

Question 8

What is Housemaid’s knee?

Answer 8

AKA Pre-patellar bursitis
Common in pt with jobs requiring kneeling for extended periods
Will not usually have systemic symptoms + will be able to walk on the knee.
DD: septic arthritis.
Treat with NSAIDs

Question 9

What is Spondylodiscitis/ Discitis?

Answer 9

Collection of pus between spinal discs