Rheumatology and Musculoskeletal System Flashcards
What are 3 autoimmune diseases?
[ones we focused on]
- Rheumatoid arthritis
- Rheumatic fever
- Lupus
What is commonly associated with common rheumatology conditions?
- Inflammation / connective tissue diseases
- Mechanical musculoskeletal conditions.
How are common rheumatology conditions managed?
With immunosuppressants and antibiotics.
List some S & S of rheumatoid arthritis.
- 3x more common in women
- Pain worse in the morning
- Several affected joint areas
- Symmetrical involvement
- Osteoporosis is a common finding
- Malaise
- Fatigue
- Hand, wrist, hip and knee joints are mainly affected
- Cervical spinal issues.
- Sepsis is a side effects due to local inflammation around organ sites.
- Neutropenia
- Splenomegaly
List medications/drugs to treat rheumatoid arthritis. [6]
- Aspirin
- Paracetamol
- NSAIDS [Naproxen, ibrupofen, diclofenac/voltarol]
- Corticosteroids [prednisolone]
- Disease modifying anti-rheumatic drugs [DMARDS]
- Biological disease modifying anti-rheumatic drugs [bDMARDS]
What serious presentation can acute monoarthritis lead to?
Septic arthritis
List 6 risk factors for septic arthritis.
- Inflammatory/rheumatoid
- Diabetes mellitus
- > 80 yrs of age
- Joint surgery
- Joint prosthesis
6 Overlying skin infection
How does septic arthritis present?
- Joint pain
- Limited movement of affected joint
- Joint swelling
- Sweats
- Rigors
- Febrile
What is psoriasis?
A common skin complaint.
What is erythroderma? [part of psoriasis]
Total body redness.
What can pustular be caused by? [psoriasis]
- Pregnancy
- Topical treatments
- Medication
- Oral steroids
What might palma plantar look like?
- Eczema
- Impaired self-care
- Thickened skin [keratoderma]
What causes a flare or rebound in psoriasis?
Altered medication/poor compliance with medication.
What is psoriatic arthropathy?
Arthritic joint disease associated with skin inflammation and scaling, followed by certain genitourinary [chlamydia], gastrointestinal [shigella, salmonella, campylobacter], and HIV and co-infection’s of STI’s infections.
Affects 10-40% of Pt’s with pre-existing psoriasis.
What is rheumatic fever?
An inflammatory disease, that may develop after an infection with Streptococcus. The disease affects joints, skin, heart and nervous system.
It mainly affects children 6-15 and occurs approx 20days after step throat or scarlet fever. Common cause of chronic structural heart disease in developed countries. Causes 90,000 deaths per year and chronic rheumatic heart disease in up to an estimated 30 million children & adults.
What is the major criteria for rheumatic fever? [4]
- Carditis
[symptomatic pericarditis with pain and/or congestive cardiac failure with SOB & heart block]. - Sydenham’s chorea (St Vitus’ Dance).
[Choreiform (jerky involuntary movement), rarely transient psychosis]. - Subcutaneous Aschoff nodules
[Firm, painless, mobile nodule near bony prominences on the extensor surfaces of the wrists, elbows and knee’s]. - Rash
[5% of ARF, blanching, present on trunk & inner part of arms & legs, frequently changes, exacerbated by heat].
What are the 2 main types of Lupus?
- Systemic Lupus Erythematosus (SLE)
2. Discoid Lupus
What is systemic lupus erythematosis?
The underlying mechanism is an autoimmune response with production of autoantibodies and a failure of the body to suppress them. These autoantibodies may induce immune complex formation resulting in different disease manifestations.
Occurs in 20-40% of females, mortality after diagnosis is 5%/yr
What other conditions may present in systemic lupus erythematosis?
- Renal injury/failure, haematuria
- CNS, seizures, stroke, psychosis, migraines.
- Hematologic - hemolytic, anemia, thrombocytopenia, leukopenia.
- Peripheral vasculitis/gangrene
- Immediate management is symptomatic
What is the chronic management plan for SLE?
- Anti-inflammatory drugs [aspirin, ibruprofen, corticosteroids].
- Avoidance of emotional stress, physical fatigue, excessive sun exposure.
What is 2 common presentations of SLE?
Serositis & effusion
What is a common presentation of rheumatoid arthritis (RA)?
Nodules [airway obstruction]
What is 2 common presentations of spondyloarthropathies?
Breathing problems and acute respiratory distress syndrome [ARDS]
What is a common presentation of relapsing polychondritis?
Breathing problems
What is a common presentation of polymyositis and dermatomyositis?
Breathing problems
What is a common presentation of scleroderma?
Breathing problems
What is 2 common presentations of vasculitides wegener granulomatosis?
Breathing problems & bronchospasm and haemoptysis
What is a common presentation of polyarteritis nodosa?
Hypoxia
List some non-traumatic musculoskeletal issues.
- Bursitis - inflammation of a bursa.
- Tendonitis
- Osteoarthritis
- Torticollis
- Adhesive capsulitis
- Plantar fasciitis
- Carpal tunnel syndrome
- Non-traumatic neck/back pain
- Scoliosis
- Gout & pseudogout
What is bursitis?
The condition happens when your bursae, small fluid-filled sacs near your joints, get irritated and swollen.
Tennis elbow [lateral epicondylitis].
Golfers elbow [medial epicondylitis].
Results from any activity that causes repetitive strain.
What is olecranon bursitis?
The olecranon is the top part of the ulna. It is inflammation and swelling behind the elbow.
What is prepatellar bursitis?
Swelling and pain above the patella or kneecap.
What is tendonitis?
Inflammation of the tendons due to overuse or injury.
What are 5 sub groups of tendonitis?
- Tenodynovitis
- Tendinosus
- Tendinopathy
- De Quervain’s tenosynovitis
- Rotator cuff tendonitis
What are factors of osteoarthritis?
- Commonly age associated
- Degenerative
- Cartilage loss
- Wear & tear on the joint’s
- Osteophytes
What are factors of osteoporosis?
- Commonly age associated
- Decrease in the hormone oestrogen [resulting in decrease in bone density]
Treated with calcium supplements, and HRT.
What is torticollis/wryneck?
Abnormal spasm of the neck affecting one side only.
The head is held in a bent and twisted position. Excludes quinsy, abscess local to the affected area, cervical and vertebral issues and dystonic reaction from metoclopramide.
What is plantar fasciitis?
Common form of recurrent foot pain. Generally present in foot or arch. Bony spur [osteophytes] may be on X-Ray.
What is carpal tunnel syndrome?
Neuropathy of the median nerve of the wrist. The nerve becomes trapped. Commonly caused by overuse syndrome.
List 6 alternate diagnosis’ for non-traumatic neck pain.
- Soft tissue injury [hyperextension of the muscles of the neck]
- Disc herniations
- Spondylosis
- Stenosis
- Myelopathy [compression & degeneration]
- Cancers [myelomatosis]
List of causes for non-traumatic back pain.
- Sciatica
- Disk herniation
- Spinal stenosis
- Ankylosing spondylitis
- Scoliosis
- Kyphosis
- Lordosis
- Gout & pseudogout
