Rheumatology Lec 3 Flashcards
Define fibromyalgia.
Fibromyalgia is a chronic disorder characterized by widespread pain, tenderness and stiffness of muscles and connective tissue structures. It is accompanied by fatigue, headaches, sleep disturbances.
Several co-morbidities. Sensitization of the central nervous system.
Describe the epidemiology of fibromyalgia.
It is more prevalent in women, three times more. The prevalence increases with age. It typically develops between age 25 and 55. Often have other co-morbidities. 67% has musculoskeletal disorders.
What are some of the risk factors for fibromyalgia?
Exact etiology is unknown. Risk factors: Heredity; Stressful or traumatic events; bodily injury; infection; disease.
What are some of the clinical presentations of fibromyalgia?
Morning stiffness Tingling/numbness in hands and feet Headaches/migraines Thinking and memory abnormalities Painful menstrual periods Fatigue Trouble sleeping Jaw pain Abnormal muscle pain and malaise after exercise Dizziness Skin and chemical sensitivities Deep, aching, throbbing, shooting, radiating, stabbing pain Depression.
What are some of the historical aspects needed for diagnosing fibromyalgia?
Chronic widespread pain with tenderness at 11 of the 18 specific tender points. Chronic widespread pain lasts at least three months, axial skeleton, left and right sides, above and below waist.
What are other aspect that form part of the diagnosis of fibromyalgia?
Physical examination.
Tender points according to American College of Rheumatology (ACR), at least 11 of the 18 points.
Describe the general management strategies for fibromyalgia.
Minimize stress Deep breathing exercises Relaxing techniques and massages Nutrition Exercise Sleep
What are some of the medications used to manage fibromyalgia?
Amitryptline
Pregabalin
Gabapentin
Tramadol
What are other treatment/management strategies that could be used for fibromyalgia?
Psychotherapy Physiotherapy Acupuncture Massage OT
What is gout?
Gout is a chronic heterogenous disorder of urate metabolism.
What are some of the characteristics of gout?
Hyperuricemia.
Deposition of monosodium urate monohydrate crystals in joints and periarticular tissues.
Recurrent attacks of acute synovitis, typically monoarticular.
Chronic destruction of cartilage.
Interstitial deposition of urate crystals in the kidney.
What are the different classifications of gout?
Primary gout, 95%(mostly due to hyperuricemia due to under-excretion of uric acid.
Secondary (other causes)
Describe the epidemiology of gout.
Most common in middle age men. Common is menopausal women. Can run in families.
What are the predisposing factors for gout?
Genetic Cancers and blood disorders Alcohol abuse Obesity High intake of purine containing foods. Caffeine Lead poisoning Radiation treatment Hypothyroidism Age Duration of hyperuricemia Starvation Renal failure Some drugs Trauma Infection
What are some of the triggers for gout?
Injury Surgery Consumption of large quantities of alcohol and purine rich foods. Fatigue Emotional stress Illness
What are some of the signs and symptoms of gout?
1-2 joints affected at a time. Cooler joints affected more commonly (urate crystals form at cool temperatures) Podagra (pain in the metatarsophalangeal join) Common joints (ball of big toe, feet, ankles, wrists, elbows)
What are the Hallmarks of gout?
Usually elevation of serum uric acid. Recurrent attacks Bone and joint destruction Aggregates or uric acid crystals Kidney disease and stones.
What is the clinical presentation of gout?
Asymptomatic hyperuricemia
Acute gouty arthritis
Intercritical gout-intervals between attacks of gouty arthritis are referred to as intercritical periods.
Chronic gouty arthritis.
What are the signs of acute gout?
Suddenly appears in 12-24 hours, usually overnight.
Skin is red-purplish, tight and shiny.
Joint is painful, swollen and warm.
Throbbing, crushing or excruciating pain.
Recurrent attacks develop.
Fever, chills, general sick feeling.
Rapid heartbeat.
What are the signs of chronic gout?
Progressive joint damage. More frequent attacks. Crippling deformity. Disability. Restricted joint motion. Joint pain most of the time. Hard lumps of urate crystals.
Describe tophi.
Advanced chronic tophaceous gout.
Tophi is tophaceous nodules that consist of multi-centric depositions or urate crystals and intracellular matrix and foreign body granulomatous reactions. As they enlarge in size, they calcify and can cause pressure symptoms. They are firm, yellow and occasionally discharge a chalky material. Can also occur over eyelids, nasal cartilage, cornea, tongues, vocal cords and penis.
In which ways does tophaceous gout manifest in the renal system?
Kidney stones
Urate nephropathy
Uric acid nephropathy
What are some of the factors needed to diagnose gout?
Symptoms Clinical examination of the joint High serum uric acid levels Joint aspiration Joint damage on X-rays and tophi that displaces the bone and produces cysts.
What does CPPD stand for, related to gout-type disease?
Pseudogoat Chrondrocalcinosis.
What are some of the treatment options for gout?
Diet Weight loss Current medications Add gout medications (acute-NSAIDS, colchicine, steriods; chronic-allopurinol) PT and OT
Describe ankylosing spondylitis (AS).
It is a chronic, multisystem inflammatory condition. A systemic rheumatic disease, and is one of the negative spondyloarthropaties. It affects the joints of the spine as well as the sacroilium joints. Complete fusion results in complete rigidity of the spine (bamboo spine).
Describe the epidemiology of ankylosing spondylitis.
Typical young men aged 18-30, more men (3:1), cause is unknow but genetic factors paly a big role. Rheumatoid factor negative.
Describe the aetiology of ankylosing spondylitis.
It is idiopathic. Probable factors are genetics.
Possibly bacterias like Klebsiella pneumonia and some other Enterbacterias.
Often predisposed people after exposure to infections.
Describe the pathology of ankylosing spondylitis.
Enthesis, the site of ligamentous attachment to bone, is thought to be the primary site of pathology. Enthesitis is associated with prominent oedema of the adjacent bone marrow and is characterized by erosive lesions that undergo calcification.
Sacroilitis is usually one of the first manifestations.
Axial arthritis.
Arthritis of gridle joints.
What are some of the symptoms of ankylosing spondylitis?
Pain in sacroiliac and lower back regions.
Permanent dull, worse at rest, in the morning and at night.
Relieved by motion and better in afternoon.
Buttock pain.
Lower back stiffness-in the morning.
Chest pain(mimicires intercostal neuralgia and intercostal myositis, worsens in coughing and deep breathing.
Stiffness and tenderness of back muscles.
Flattening of lumbar lordosis.
Bilateral sacroilitis.
Enthesopathies (pain in the site of ligamentous attachment to bone).
Extra-articular manifestations-usually eyes, bilateral, acute onset for about 2 -3 months.
Describe advanced Ankylosing spondylitis.
Pain in different segments of the spine.
Atrophy of back muscles.
Decrease articulation in spine.
Ankylosis of sacroiliac and intervertebral joints.
Cutaneous lesions.
Can get cardiac involvement, lung, urinary and GIT.
Describe some of the extra-articular manifestations of ankylosing spondylitis.
Acute anterior uveitis (unilateral uveitis).
Inflammatory bowel disease (asymptomatic ileal and proximal colomic mucosal ulceration).
Psoriasis (associated with more peripheral joint involvement).
Cardiovascular disease (aortic regurge due to cusp retraction; conduction disturbances).
Pulmonary disease (restrictive disease: reduces chest wall/spinal mobility; apical fibrosis with long standing disease)
What are some of the tests and measurements used for ankylosing spondylitis?
Cervical mobility. Thoracic mobility. Lumbar mobility. Lab tests-HLA B27 ESR and CRP Mild anaemia.
What are some of the other tests that can be administered to assess ankylosing spondylitis?
Pelvic compression test.
Fabere test/Patrick’s test.
Gaenslen test
What characterized changes do the spinal vertebrae show on X-ray in ankylosing spondylitis?
Sacroiliitis
What is the prescribed general treatment for ankylosing spondylitis?
Drug therapy (includes anti-inflammatory drugs, local corticosteroids injection, Disease Modifying Anti-rheumatic Drugs)
Surgery (hip arthroplasty)
Physiotherapy and occupational therapy
What are the aims of therapy?
To relieve pain.
Maintain mobility
Prevent and correct deformity
Increased chest expansion and vital capacity
Attention to posture
To maintain and improve physical endurance
Advice to patient, education
