Rheumatology Flashcards
Peripheral nerve sensory distribution hand
Ulnar nerve - little finger and half of ring finger dorsal and palmar side
Median nerve - 1st 3.5 fingers palmar side and tips of dorsal side
Radial nerve - 1st 3.5 fingers dorsal side (except the tips)
Where are Heberden’s nodes and Bouchard’s nodes found
Bouchard - PIP
Heberden’s - DIP
Signs of median nerve pathology
Wasting of the thenar eminence, weakness of thumb abduction, sensory loss over the palmar side of the 1st 3.5 fingers
Signs of ulnar nerve pathology
Wasting of the hypothenar eminence
Weakness of finger abduction
Sensory loss over the palmar and dorsal side of the 5th and half of 4th finger
Signs of radial nerve pathology
Wrist drop
Weak wrist and MCP extension
Sensory changes over the dorsal side of the 1st 3.5 fingers (but no the finger tips)
What are the extra-articular manifestations of RA?
Eyes - scleritis, episcelritis, dry eyes Anaemia Lungs - fibrosis, effusions Heart - pericarditis Skin - pyoderma gangrenosum Abdomen - Felty's with splenomegaly Kidneys - nephrotic syndrome Nervous - mononeuritis multiplex
What is the treatment for rheumatoid arthritis ?
- DMARDs
- Steroids if active flare
- Biologics - TNF alpha inh, IL1 antagonists
What are the systemic manifestations of psoriasis?
Gout - PA is associated with hyperuricaemia Eyes - uveitis Resp - apical fibrosis Heart - aortic regurgitation, aortitis Enthesitis
What are the patterns of joint involvement of psoriatic arthritis?
- Asymmetric oligoarthropathy - mainly affecting DIPs, can get dactylitis
- Bilateral deforming polyarthropathy resembling RA
- DIP arthropathy
- Mutilans - aggressive and deforming
- Spondylitis +/- sacroiliitis
Apart from the skin changes what else might differentiate psoriatic arthritis from rheumatoid arthritis clinically?
Dactylitis
Enthesitis
Spinal involvement - spondylitis/sacroiliitis
Apical fibrosis
X-ray features of RA?
Decreased joint space
Deformity - ulnar deviation, Volar subluxation, swan neck, Boutonniere’s
Erosions
Periarticular osteopaenia
X-ray features of psoriatic arthritis?
Pencil in cup Telescoping Fluffy periostitis Osteolysis Periarticular proliferation
What is meant by enthesitis? which condition is it seen in? where?
Inflammation of tendons, ligaments etc at the insertion into the bone. Seen in psoriatic arthritis and ank spon. Especially Achillies and Plantar Fasciitis
What is meant by dactylitis? which condition is it seen in?
Inflammation of the tendon sheath and soft tissue causing swelling of the finger - “sausage digit”
How do you treat psoriatic arthritis?
Analgaesic and NSAIDs
AVOID STEROIDS - can flare psoriasis
Conventional DMARDs - not when axial involvement
Biologics - anti-TNF agents
What are the nail changes in psoriasis called?
Onycholysis, subungual hyperkeratosis, transverse ridging, pitting
What are the systemic manifestations of ank spon (the As + others )?
Anterior Uveitis Apical fibrosis Aortic Regurg AV conduction problems Achilles tendonitis (enthesitis) Atlanto-axial subluxation Amyloid Inflammatory bowel disease
What are the seronegative arthropathies?
Psoriatic Arthritis
Ankylosing Spondylitis
Enteropathic arthritis
Reactive Arthritis
What is the treatment for ankylosing spondylitis?
Analgesia and NSAIDs
Steroids - no real role
DMARDs - may help for peripheral disease but not axial
Biologics - anti-TNF alpha, IL 17 inhibitors
X-ray findings in ankylosing spondylitis
Sacroiliitis - subchondral erosions, sclerosis and proliferation on the iliac side of the SIJ
Spondylitis - Small erosions at the corners of the vertebral bodies, vertebral body squaring, syndesmophytic ankylosis - bamboo spine, dagger spine - fusion of the posterior longitudinal ligament
X-ray changes in the different arthropathies
RA - marginal erosions
Gout - juxtarticular punched out erosions, tophi
OA - osteophytes, subchondral sclerosis, decreased joint space, subchondral cysts
Psoriatic - fluffy periostitis, pencil in cup deformity
Difference between rheumatoid nodule and gouty tophi?
Age and sex - if young female gout less likely
Joint involvement - if DIP involvement then not RA
What are the seronegative spondyloarthropathies?
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
Enteropathic arthritis
