Rheumatology Pathology Flashcards
Describe a osteoarthritis pattern of disease
Asymmetrical, large joint, poly/oligo arthritis
Which joint is most commonly affected by osteoarthritis?
The knee, and then the hip
Which joint in the hand is most commonly affected by osteoarthritis?
Carpal - meta carpal joint in the thumb
Which sign in the hands are seen in osteo arthritis
Hebedens nodes - DIP joint
Bouchards nodes - PIP joint
Squaring of the thumb
Treatment of osteoarthritis
Symptomatic;
C - Conservative ; weight loss, physio
A - analgesia
S - Surgery is required
What signs will you commonly see on x ray of osteoarthritis
L - Loss of joint space
O - Osteophytes (little out puchings of bone)
S - Subchondral cysts - darkening circles
S - Sub articular sclerosis - white marks
Describe a rheumatoid arthritis pattern of disease
Symmetrical, small joint, polyarthritis
Which joints in the hand are commonly affected by rheumatoid arthritis?
Proximal inter phalangeal joints
carpal meta carpal joints
radial joint of the wrist
Distil inter phalangeal joints spared
What are the extra articular features of rheumatoid arthritis?
RAYNAUDS DISEASE
SCLERITIS , EPISCLERITIS
RESPIRATORY COMPLICATIONS - pulmonary sclerosis, lung nodules and pleural effusions
What signs can you see on the hand in rheumatoid arthritis?
Swan neck deformity - fixed extension of the pip joint and flexion of the dip joint
Boutoneire deformity - fixed flexion of the pip joint and extension of the dip joint
Ulnar deviation
When investigating a swollen , red joint what must be ruled out?
Septic arthritis (do obs, take a good history, take a full blood count)
When investigation a swollen joint what tests would you do and why?
Obs FBC - infection / aneamia of chronic disease Rheumatoid factor Anti CCP CRP and ESR
THYROID FUNCTION - hyperthyroidism can present as joint pain
What criteria must a patient fit in order to be diagnosed with rheumatoid arthritis?
- Synovitis in many small joints
- Serology
- CRP and ESR raised
- Duration - over 6 weeks
What is the immediate management of rheumatoid arthritis?
- Steroid injection as bridge before DMARDS take affect
or - Short course prednisolone to induce remission
** gastritis **
What are the treatment steps in rheumatoid arthritis?
- Analgesia - NSAIDS - must prescribe with a PPI
- DMARDS - methotrexate plus one other
- When two combinations of DMARDS have been tried over 6 months, biologics can be given*
3. Biologics - infliximab, retuximab
