Rheumatology History taking and Pharmacology Flashcards
name three inflammatory arthrides that start acutely
crystal arthropathies
infectious athritis
reactive arthritis
what is the additive pattern
one which more and more joints are affected over time
what arthritis involves the MCPs, wrists, elbows, shoulder, ankles or second to fifth MTPs
secondary arthritis (previous trauma or infection) or inflammatory arthritis
what type of arthritis begins as monoarthritis
oestoarthritis- one weight bearing joint
can also be inflammatory
what is oligoarthritis
involving 1-4 joints
what is polyarthritis usually associated with
inflammatory arthritis
is psoriatic arthritis symmetrical or asymmetrical
asymmetrical
how does anklylosing spondylitis affects the joint
affects axial skeleton and large peripheral joints in an asymmetrical fashion
what joints does osteoarhritis affect
DIP, base of thumb, knees, hips, lumbar and cervical spine
what type of arthritis commonly doesn’t affect other joints- just the one affected
degenerative- primary osteoarthritis
what type of arthritis spreads to other joints (additive)
inflammatory- rheumatoid
what is palindromic pattern of joint involvement
The begins with a joint becoming involved and reaching peak intensity over 24 hours and then resolving just as quickly as it came on
what type of arthritis has an intermittent pattern (on and off)
inflammatory
what are the inflammatory features of arthritis
joint swelling
redness (septic, gout, reactive arthritis, psoriatic)
morning stiffness (longer than 30mins)
gets better with movement (no inactivity gelling like in osteo)
disturbed sleep
fever (septic arthritis, gout, vasculitis, SLE)
weight loss (vasculitis, inflam arthritis, CTD)
how does smoking affect arthitis
less likely to respond to medications
more progressive disease in RA
increased risk of cardiovascular disease
how does alcohol affect arthritis
reacts badly with drugs e.g. methotrexate
can cause gout
what suggests a bacterial infectious arthritis
monoarticular- very red and warm
associated with fevers and chills
portal of entry
prior underlying joint abnormality (prosthetic, arthritis)
what suggests a viral infectious arthritis
acute polyarticular onset may have associated rash (parovirus) duration less than 6 weeks other people sick at home hepatitis and HIV
what associated symptoms would suggest rheumatoid arthritis
rheumatoid nodules sicca features (dry eyes and mouth) raynauds phenomenon occular inflammation pulmonary involvement (dry cough, SOB)
what associated mucocutaneous symptoms would suggest a CTD
alopecia, oral/ nasal ulceration, nosebleeds, chronic sinusitis, malar rash, photosensitivity, subcutaneous lupus, urticaria, dry mouth, sclerodactyly (systemic sclerosis)
what associated occular symptoms would suggest a CTD
sicca symptoms (sjogrens) red, inflamed eye
what associated pulmonary symptoms would suggest a CTD
pleuritic chest pain
SOB
cough
what associated cardio symptoms would suggest a CTD
pericardial chest pain
raynauds syndrome
what associated CNS symptoms would suggest a CTD
headaches and migrarines psychiatric illness peripheral neuropathy mononeuritis mulitplex seizures
what associated lymph symptoms would suggest a CTD
lymphadenopathy
what associated renal symptoms would suggest a CTD
new onset hypertension
haematuria
proteinuria
what would suggest ant-phospholipid syndrome
recurrent miscarriages blood clots (arterial or venous)
what symptoms would suggest a vasculitis
ENT problems (nasal stuffiness/sinusitis, crusting, nose bleeds, acute hearing loss)
non blanching rash
CNS problems (acute nerve palsy, acute temporal headache with scalp tenderness (GCA))
occular problems- red inflamed eye, sudden vision loss (GCA)
pulmonary problems (asthma (EGPA), polyangitis (churg strauss), cough, SOB, haemoptysis
renal problems- new onset hypertension, haematuria, proteinuria
what symptoms would suggest seronegative spondyloarthritides
psorias symptoms/ FH of psoriasis FH of spin problems (AS) recent STI/ urethral discharge recent gastroenteitis IBD symptoms enthesitis dactylitis eye inflammation
what drug can cause gout
diuretic use
what medical conditions is gout associated with
hypertension, obesity, insulin resistance, hypercholesterolemia
why might peptic ulcer disease be a problem
risk is higher in RA, concurrent use of anticoagulants (GI bleed)
why might liver or kidney disease be a problem
many rheumatological medications hepatoxic (methotrexate) or nephrotoxic or metabolised in the liver
why might pulmonary disease be a problem
Some rheumatological medications may cause pneumonitis (eg methotrexate and anti-TNF drugs) and pre-existing lung disease might affect choice of treatment. NSAIDs are contraindicated in patients with NSAID / aspirin sensitive asthma
what rheumatological drugs do you not give in pregnancy
methotrexate and leflunomide
what are bouchards nodes
swelling of PIPs- seen in osteoarthritis
what is the most specific inflammatory marker
CRP
what can be seen in x rays of rheumatoid arthritis
loss of joint space, erosions, osteopenia
what happens to the pannus during inflammation
become hypervascular and/ or hypertrophic
what can show a hypertrophic or hypervascular pannus
MRI
what joints does psoriatic arthritis affect in hand
DIPs and PIPs
what is the dosage of methotrexate
starts 15 mg then increased to 20mg weekly
what must methotrexate be prescribed in combination with and why
folic acid (taken everyday)- as methotrexate is a folate antagonist, if not will get: nausea, alopecia, mouth ulcers
what condition is monitored by the DAS28 score
RA only
what is the lowest titre of serum ANA
1:80
why is creatine raised in renal conditions
as is excreted through the kidneys
what does protein in the urine show
kidneys not working
in systemic sclerosis what organs can be affected and how
lung and kidneys
pulmonary artery hypertension
interstitial lung disease
what imaging for pulmonary artery hypertension
transthoracic echocardiogram- shows tricuspid valve to see if back pressure causing regurgitation and how strong ejection is
