Rheumatology PassMed Flashcards
what is etanercept and what side effect is it associated with?
Anti-TNF drug
Reactivate TB
Discuss the mgt of rheumatoid arthritis
- DMARD monotherapy +/- short course of pred
how do you monitor treatment response in RA
Das28 score and CRP levels
how are flare ups of RA managed
oral or IM steroids
what do you have to regularly monitor in a patient on methotrexate and why
LFTs and FBC
risk of myelosuppression and liver cirrhosis
methotrexate and cough
side effect is pneumonitis
the current indication for a TNF-inhibitor is an inadequate response to
at least two DMARDs including methotrexate
pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended
lateral epicondylitis
which one is tennis elbow
lateral epicondylitis
how long does lateral epicondylitis last for?
6-12 weeks of acute pain but usually lasts for 6mths to 2 years
manage lateral epicondylitis
advice on avoiding muscle overload
simple analgesia
steroid injection
physiotherapy
what is ankylosing spondylitis?
HLA-B27 associated spondyloarthropathy - inflammatory disorder which also affects the joints
who gets ank spond
It typically presents in males (sex ratio 3:1) aged 20-30 years old.
what are the classical features of ank spond?
typically a young man who presents with lower back pain and stiffness of insidious onset
stiffness is usually worse in the morning and improves with exercise
the patient may experience pain at night which improves on getting up
what is the main clinical sign seen on examination with people with ank spond
shoebers test <5cm
what are the other features of ank spond (all the As)
the 'A's Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis and cauda equina syndrome peripheral arthritis (25%, more common if female)
what is the main side effect of colchicine and what do GPs use instead due to this SE
diarrhoea
NSAIDS like naproxen
what is gout
form of microcrystal synovitis caused by the deposition of monosodium urate monohydrate in the synovium. It is caused by chronic hyperuricaemia
what is classed as chronic hyperuricaemia
uric acid >450 µmol/l
what is first line mgt of gout
colchicine or naproxen
if contraindicated can give steroids
what is the criteria for offering urate lowering therapy
→ >= 2 attacks in 12 months → tophi → renal disease → uric acid renal stones → prophylaxis if on cytotoxics or diuretics
what is the first and second line urate lowering therapy
allopurinol
xanthine oxidase inhibitors such as febuxostat
what food is high in purines
Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products
what drugs can precipitate gout
thiazides
what is ehlers danlos
genetic collagen disorder, which results in widespread elasticity of tissue. There are many differing subtypes, but most commonly it is an autosomal dominant condition affecting type III collagen
what cardiac conditions are associated with ehlers danlos
valvular incompetence
what are the main features of ehlers danlos?
elastic, fragile skin
joint hypermobility: recurrent joint dislocation
easy bruising
aortic regurgitation, mitral valve prolapse and aortic dissection
subarachnoid haemorrhage
angioid retinal streaks
treat ank spond
nsaids (methotrexate doesn’t work)
second line anti tnf
what are blood calcium pth alpphos and phosphate levels like in osteoporosis
all normal
Normal calcium, normal phosphate, raised alkaline phosphatase, normal parathyroid hormone
pagets
Decreased calcium, decreased phosphate, raised alkaline phosphatase, raised parathyroid hormone
osteomalacia
Raised calcium, decreased phosphate, raised alkaline phosphatase, raised parathyroid hormone
primary hyperpapathyroidism (adenoma?)
Decreased calcium, raised phosphate, raised alkaline phosphatase, raised parathyroid hormone
secondary hyperparathyrpidism (chronic kidney disease)
what is osteoporosis in terms of bone marrow density
bone marrow density <2.5 standard deviations below the mean
risk factors for osteoporosis
corticosteroid use smoking alcohol low body mass index family history female >>age
how do you diagnose osteoporosis
DEXA of hip and lumbar spine
treat osteoporosis
bisphosphonates (alendronate)
what is temporal arteritis associated with
polymyalgia rheumatica
what are the typical features of temporal arteritis
typically patient > 60 years old
usually rapid onset (e.g. < 1 month)
headache (found in 85%)
jaw claudication (65%)
visual disturbances secondary to anterior ischemic optic neuropathy
tender, palpable temporal artery
around 50% have features of PMR: aching, morning stiffness in proximal limb muscles (not weakness)
also lethargy, depression, low-grade fever, anorexia, night sweats
diagnose temporal arteritis on
biopsy (be aware of skip lesions)
what is the treatment of temporal arteritis
should have a fast response to prednisalone
SLE is associated with low levels of
C4
how can you monitor disease progression in SLE
anti-DsDNA titres
ESR
complement levels
