Rheumatology Essentials: BW 2 Flashcards
Todays lecture:
When can rheumatologist help?
List inflammatory arthritis -
Define them: A traumatic joint swelling “soft mushy swelling”.
OA: Hard bony swelling, more for GPs, physio, orthopaedic surgeons
1) reactive arthritis - Chylamdia postive, or Camplybacter
2) Tenosynovitis- Psoriatric arthritis, DIP, sausage, boggy joints
3) Gouty Tophus - Maori pacific islanders- more common
4) Early Rheumatoid: Early, you dont see deformities - Present 2 months pain, morning predominant in hands
Classically: Aspiration of knees or other joints
>WCC>2000 x 106 = infammatory arthritis
What are major connective tissue disorders?
- Scleroderma
- SLE
- Sjorens
- Polymosistis
Vasculitis:
- GCA
- PMR
- ANCA positive-
Key questions is to ask in vasculitis or CT disorder, is there any organ threatening disease (kidneys, eyes, lungs)
ALWAYS check Urine for blood etc, when seeing any of these conditions
How are Vasculitis(s) catergorized? - By vessel size effected
Different types of Vasculitis?
Know basics: EMQ?
- Henoch Schlonein Purpura
- Polymyositis
- GCA
- Raynauds
- Scleroderma - Fibrosis, thickening of hands (sclerodactyl)
What is ANCA vasculitis? (small vessel Vasculitis)
(rarer)
3 Major types
All have ability to cause severe glomerularnephritis,
3 major types of small vessel Vasculitis (ANCA positive)
Case
ANCA vasculitis
What is most common causes of GN over >50 - Haematuria
What are Basic Prinicples of Rheumatology
What are the common conditions
What are the common medications used? DMARDS, Pred (try limit steroids, use DMARDS)
Gout:
Clinical features
Signs: XRAY: erosive deformites
Investigations: Gold standard (fluid aspirate) -
Management
- Also increases kidney stones, uric acid stones
What are the biggest risk factor for GOUT?
High Urate, Uric acid. (hyper-uricaemia)
- Increases with age, diet, genetics
Prevalence of gout throughout the ages?
Gout management
Acute:
Chronic:
(NEED to know for exams)
What is a Gout action plan? (what to do in flares)
TREAT to target Urate - potentially curable with a pill - Urate lowering therapy (allopurinol) (lifelong medications)
What drug interactions are important in Allopurinol?
Allopurinol - But in first 6 months may make condition worse - thus need to explain it to the patient, that the next 6 months may have attacks, but after will reduce dramatically.
Increase monthly 100mg
What are the key to RA?
What joints are commonly affected in RA?
X ray features?
UNtreated or poorly treated RA results in what?
Treatment for RA:
What are conventional DMARDS?
What are biological DMARDS?
What role do corticosteroids have in RA?
Management of RA - Specific factors (MEthotrexate)
Methotrexate: MOA, once per week+ folic acid
Common myths about methotrexate
Biological DMARD
MOA
What is treatment for RA
Know Psoriatic artritis: Same treatment as RA almost
What is Ankylosing Spondylitis?
Male more common then female
Key features:
RULE OUT RED FLAGS - e.g waking at night? weight loss? IVDU?
Morning stiffness, improves with excercise, nocturnal waking
HLAB 27 positve!
What is associated with AS?
—> Psoriasis, crohns, IBD, Uveitis. (painful red eye ddx)
X ray features of ankylosing spondylitis?
What joints are involved?
Spectrum of illness
What is the criteria for diagnosis of Axial spondylitis?
What is the management of AS?
Medications for AS
What are their MOA?
What are major consideration when giving Biological Disease modifying agents?
What do you need to consider with ALL patient on Biological agents?
What do you need to consider for their management?
What are the 4 cardinal signs on X ray of OA?
Need to know
Management of OA?
Non-pharmacological major?
Symptomatic treatment
Key points about CT tissue disease:
SLE, Scleroderma, polymyositis, Sjogrens.
- DS DNA tests are specific, Anti Smith, Anti RNP, very
LUPUS! need to know Blood tests which are most
Whats in the urine? Kidney biopsy?
What are the various rashes associated with SLE? Lupus
What are clincial and labs associated with Scleroderma
What are the long term risks with Scleroderma (PAH)
What can
What are the key things to know about Scleroderma?
What are the key bloods
Clinical features of GCA?
Bloods?
Associated conditions? Morning stiffness
Diagnosis?
Treatment?
Summary:
