Rheumatology Investigations and Management Flashcards
What is the criteria for diagnosing RA?
ACR/EULAR classification criteria
RA investigations
Blood testing (anaemia, raised platelets)
Inflammatory markers
Autoantibodies (anti-CCP)
Imaging (x-ray, US, MRI)
RA management
DMARD (1st methotrexate, 2nd sulfasalazine, 3rd hydroxychloroquine)
Steroids (for exacerbations)
Biologics (if DAS28 greater than 5.1 on 2 occasions 4 weeks apart)
Lupus diagnostic investigations
ANA Anti-dsDNA Anti-Sm Antiphospholipid ab Low complement Direct coombs test (haemolytic anaemia)
Lupus organ involvement investigations (depend on symptoms)
CXR Pulmonary function tests CT chest Urine protein quantification Renal biopsy Echocardiogram Nerve conduction studies MRI brain
SLE management
NSAIDs and simple analgesia
Hydroxychloroquine (may reduce systemic complications)
Steroids (varying dose for complications)
DMARDs
Biologics
Raynauds management
Calcium channel blockers or PDE5 inhibitors (sildefanil)
If digital ulcers - prostacyclin analogues (iloprost), botox injections, endothelin receptor antagonists (bosentan)
Systemic sclerosis management
Yearly ECHO and PFTs
Treat raynauds
Treat reflux (PPI)
Treat pulmonary fibrosis (immunosuppression)
Treat pulmonary hypertension (prostacyclin analogues, endothelin receptor antigonists, PDE5 inhibitors)
Tight blood pressure control (ACEI)
Sjogrens investigations
Antibodies (anti-ro and anti-la, ANA) Salivary gland ultrasound and biopsy (if antibodies negative) Inflammatory markers (high ESR/PV) Raised IgG Cytopaenia
Sjogrens management
Lubricants
Strong fluoride toothpaste
Hydroxychloroquine (if fatigue and arthralgia)
Immunosuppression for major organ involvement
Antiphospholipid investigations
Autoantibodies (anti-cardiolipin, lupus anticoagulant, beta 2 glycoprotein)
Thrombocytopenia
Anti-phospholipid management
Lifelong anti-coagulation IF THROMBOSIS
General principles of CTD management
Assess disease severity
Urinalysis
CXR, PFT, ECHO
Manage cardiovascular risk factors
If major organ involvement - immunosuppression
If not - hydroxychloroquine, symptomatic management
Poly/dermatomyositis investigations
Blood tests (CK, inflammatory markers, U&E, PTH, TSH) Autoantibodies (ANA, anti-Jo-1) Electromyography Muscle biopsy (definitive test) MRI
Poly/dermatomyositis management
Steroids (prednisolone)
Immunosuppressants (steroid sparing)
Temporal arteritis/polymyalgia rheumatica investigations
Inflammatory markers (raised) Temporal artery biopsy
Temporal arteritis/polymyalgia rheumatica management
Low dose steroids in just polymyalgia rheumatica
Higher dose in temporal arteritis
Gradual reduction in dose around 18 months to 2 years
Fibromyalgia management
Supportive/holistic therapy (including graded exercise therapy)
Antidepressants
Analgesia
Gabapentin/pregabalin
What is the radiographic grading scale for OA?
Kellgren-lawrence
OA management
Physiotherapy Lifestyle advice Analgesia NSAIDs Atypical pain killers Intra-articular steroids Surgery
Gout investigations
Inflammatory markers (raised)
Serum uric acid (may be raised or normal)
Synovial fluid polarised microscopy (diagnostic)
X-rays
Gout management
Acute: NSAID (colchicine second line)
Steroid
Prophylaxis: allopurinol or febuxostat (2-4 weeks after acute attack)
Need to take NSAID or colchicine as well.
Pseudogout management
NSAIDs
Colchicine
Steroids
Rehydration
Milkwaukee shoulder management
NSAIDs
Intra-articular steroid
Physiotherapy
Partial or total arthroplasty
Score for hypermobility name
Modified beighton score
Criteria for ank spon name
ASAS classification criteria
Ank spon investigations
Inflammatory markers
HLA B27
X-ray
Ank spon management
Physio/occupational therapy
NSAID
DMARDs if peripheral joint involvement
Anti-TNF/anti-IL17 if severe
Psoriatic arthritis investigations
Inflammatory markers (raised)
Negative RF
X-rays (pencil in cup, enthesitis)
Psoriatic arthritis management
NSAIDs Steroid IA DMARDs Anti-TNF (if unresponsive to DMARDs) Anti-IL17
Reactive arthritis
Inflammatory markers
FBC/U&Es
HLA B27 (rarely necessary)
Cultures
Joint fluid analysis (rule out septic arthritis)
X-ray
Ophthalmology opinion (for eye involvement)
Reactive arthritis management
NSAIDs
Corticosteroids (IA, oral, eye drops)
Antibiotics for underlying infection
DMARDs if resistant or chronic
Enteropathic arthritis management
Treat inflammatory bowel disease (controls arthritis) NO NSAID Normal analgesia Steroids DMARDs Anti-TNF
Small vessel vasculitis investigations
ANCA, PR3, MPO (varies with disease activity)
C3/4
Anca associated vasculitis management
Localised/early systemic - methotrexate and steroids
Generalised/systemic - cyclophosphamide and steroids
Refractory - IV immunoglobulins, rituximab
HSP investigation and management
Self-limiting
Urinalysis to screen for renal involvement
