Rheumatology & MSK Flashcards
What are the characteristic symptoms of OA?
Non-inflammatory unilateral joint pain/stiffness, functional difficulties, bony deformities, limited ROM, tenderness, crepitus, haemarthrosis.
How is OA diagnosed?
X-ray (Loss of joint space, Osteophytes, Subchondral sclerosis, Subchondral cysts).
What is the primary treatment for OA?
Lifestyle modifications + paracetamol ± NSAID gel (hand or knee).
What are ‘The A’s’ associated with Ankylosing Spondylitis?
Apical fibrosis, Anterior uveitis, Achilles tendonitis, AVN block, Amyloidosis, Aortic regurgitation
How is Ankylosing Spondylitis diagnosed?
X-ray (Sacroiliitis, Bamboo spine, Syndespositis) + Schober’s test (<5cm lateral flexion) + bloods (high CRP and ESR).
How is Psoriatic Arthritis classified?
Symmetrical polyarthritis, asymmetric oligoarthritis, DIP arthritis, psoriatic spondylitis, arthritis mutilans.
What imaging is used in the diagnosis of Psoriatic Arthritis?
X-ray (pencil in cup) + bloods (high CRP and ESR).
What is the classic triad associated with Reactive Arthritis?
‘Can’t see, can’t pee, can’t climb a tree’ - Conjunctivitis, Urethritis, Inflammatory peripheral arthritis.
What is the causative agent often linked to Reactive Arthritis?
Chlamydia trachomatis.
What distinguishes RA from OA in terms of joint pain?
Inflammatory symmetrical joint pain/stiffness in RA.
How is RA diagnosed?
Bloods (RF, anti-CCP, high CRP and ESR), x-ray (juxta-articular osteopenia, soft tissue swelling, marginal erosion, subluxation), DAS28.
What is the first-line treatment for acute RA?
Prednisolone (steroid bridging treatment) + NSAID.
What is the chronic treatment approach for RA?
DMARD monotherapy (#1 Methotrexate + folic acid or SSZ or Leflunomide or Hydroxychloroquine), DMARD dual therapy, add biologic if necessary.
What is Felty’s syndrome?
RA + Splenomegaly + Leukopenia.
What are the common skin manifestations in SLE?
Malar rash associated with photosensitivity, alopecia, livedo reticularis, and Raynaud’s.
What is the primary pharmacological treatment for SLE?
Hydroxychloroquine* + lifestyle** ± NSAID ± prednisolone.
*Monitor eyes, **Diet, smoking, sun, exercise.
What are the two subtypes of Scleroderma?
Limited cutaneous (RF, ACA/anti-centromere) and Diffuse cutaneous (RF, anti-scl-70/anti-topoisomerase).
What diagnostic tests are used for Sjogren’s Syndrome?
Schirmer’s test (<5mm wetting in 5m), bloods (RF, anti-Ro, anti-La).
What diagnostic tests are used for Sjogren’s Syndrome?
Schirmer’s test (<5mm wetting in 5m), bloods (RF, anti-Ro, anti-La).
What characterizes Behcet’s syndrome?
Oral ulcers + Genital ulcers + Anterior uveitis.
What are the characteristic symptoms of gout?
Pain, swelling, and erythema of the first MTP (also ear, wrist, knee, ankle).
How is gout diagnosed?
Joint aspiration (negative birefringent needle-shaped crystals), uric acid, x-ray, USS.
What is the preferred acute treatment for gout?
NSAID (#1) or Colchicine (#2).
What are the characteristic symptoms of pseudogout?
Pain, swelling, and erythema of OA-type joints (wrist, shoulder, hip, knee).
How is pseudogout diagnosed?
Joint aspiration (positive birefringent rhomboid-shaped crystals), x-ray (chondrocalcinosis), USS.
What distinguishes Polymyalgia Rheumatica from other inflammatory conditions?
Inflammatory pain/stiffness for >1h in the morning (shoulder, hip), acute onset
What is the typical treatment for Polymyalgia Rheumatica?
Prednisolone 15mg.
What are the classic symptoms of Temporal Arteritis?
Headache, extremity/jaw claudication, tender palpable temporal artery, vision loss.
What diagnostic procedure confirms Temporal Arteritis?
Temporal artery biopsy (skip lesions).
What is seen on bloods in osteomalacia?
Low calcium, low phosphate, high PTH, raised ALP
What do we prescribe for long-term management in moderate / severe psoriatic arhritis?
Methotrexate
In bony mets, what do we use for pain control if opiates fail?
IV bisphosphonate infusion or radiotherapy
Presentation of NOF fracture
Short leg, externally rotated
Why is displaced intra-articular fracture an emergency?
Reduced blood flow to femoral head; risk of avascular necrosis
What classification system is used for intra-articular fractures?
Garden
Intervention choices in NOF fracture
Total hip replacement if patient could previously walk
Hemiarthroplasty if poor mobility before / significantly co-morbid
SE of bisphosphanates
- Reflux / oesophageal erosions
- Atypical fractures
- Osteonecrosis of the jaw
- Osteonecrosis of the external auditory canal
How do bisphosphonates work?
Reduce the activity of osteoclasts»_space; prevent bone resorption
How do we manage an extracapsular hip fracture (e.g. subtrochanteric fracture)
Intramedullary device