Rheumatology (that isn't covered in M&M) Flashcards
Systemic sclerosis (scleroderma)
A: Systemic tissue disease causing fibrosis, associated with malignancy.
S: Limited cutaneous: skin affected early, but systemic symptoms occur late. CREST syndrome (Calcinosis, Raynaud’s syndrome, Esophageal dysmotility, Sclerodactyly, Telangiectasia).
Diffuse cutaneous: Rapidly progressing, early systemic involvement.
Dysphagia, nausea, vomiting, weight loss, abdominal cramps, bloating, diarrhoea, SOBS, cough, palpotations, joint/muscle pain.
D: Clinical. But often are ANA posotive, ACA posotive, and SCL-70 posotive
T: Depends on organ involved
Fibromyalgia
A: Environmental and genetic.
S: Chronic widespread pain lasting more than 3 months, associated with fatigue, poor sleep, stiffness, cognitive difficulties, anxiety and/or depression.
D: Criteria for diagnosis: pain in all 4 body quadrants, 3 months +, 11 out of 18 tender points.
T: Graded exercise, relaxation techniques. Tricyclics, antidepressants, muscle relaxants, gabapentin.
Osteomalacia
A: Defective bone mineralisation of new bone, childhood form is known as rickets. From vitamin D deficiency: malnutrition, malabsoption, coeliac disease, hypophosphataemia, renal failure, Fanconi syndrome (kidneys don’t reabsord properly), anti-convulsant therapy.
S: Proximal myopathy (waddling gate), bone pain and deformity, hypocalcaemia, dental problems.
D: Low vitamin D, calcium and phosphate. High ALP and PTH.
x-ray shows pseudofractures/looser zones.
T: Vitamin D replacement
Paget’s disease
A: Elderly, male > female. Chronic disorder of bone remodelling with excessive breakdown and formation of bone causing painful, misshapen bone and fractures.
S: Increased head size, sabre tibia, warmth over affected area, bone pain, hearing loss (from CN 8 compression)
D: Urine (increased hydroxyproline - indicates bone turnover), raised ALP, x-ray (mixed areas of osteolytic and sclerotic areas). Calcium and phosphate normal.
T: Biphosphonates, calcitonin, surgery for fractures.
