Rheumotology Flashcards
What association is RA?
HLADR4
Joint pain in RA?
Early morning stiffness/pain >30 mins
EASES with use
sinovial joint inflammation.
Joint pain in OA?
less than 30 in early moring. degenerative . worse with use. articular cartilage erosion. non inflammatory pain
Signs of RA?
LESS on x-ray Boitonierre's swan neck, ulnar deviation, z thumb nodules rarely affects DIP symmetrical joints. hot red and swollen
Signs of OA?
Herbens (DIP)
Buchards (PIP)
asymmetrical
thumb and big toe, hip and knees.
Treatment for RA?
2 x DMARDs (one being Methotrexate).
Analgesia
treatment for OA?
Nsaids, paracetamol, surgery replacment of joints,
Extra articular manifestations of RA?
NODULES Carpal tunnel syndrome Anaemia (chronic disease/autoimm.) Lungs - caplan’s, nodules Eyes – sjogren’s, scleritis, episcleritis Felty’s syndrome
What thiazide should be replaced when treating gout?
bendrofluromethiazide should be replaced with cosartan
what prevents gout from occuring?
allopurinol (inhibitor of xanthine oxidase)
Name two Nsaids. which one is used in gout? which is used in OA?
OA - diclofenac
Gout- colchicine
What are synovial bursae?
fluid filled sacs in synovial joints to cushion a joint more
Which synovial bursae are important in the shouldeR?
subscapular, subacromial synovial bursae
What does the subacromial bursae do?
subacromial bursa reduces friction beneath the deltoid, promoting free motion of the rotator cuff tendons
What are the ligaments of the shoulder joint?
glenohumeral (middle, inferior, superior), coracohumeral ligament, transverse humeral, coraco-clavilcular (composed of conoid and trapezoid ligaments)
what nerve injury can cause deltoid muscle wasting?
axillary nerve injury
what muscles extend shoulder joint?
posterior deltoid, latissimus dorsi and teres major
What muscles flex the shoulder joint?
pectoralis major, anterior deltoid and coracobrachialis. Biceps brachii weakly assists in forward flexion
Muscles repsonsible for abduction of shoulder joint?
The first 0-15 degrees of abduction is produced by the supraspinatus.
The middle fibres of the deltoid are responsible for the next 15-90 degrees.
Past 90 degrees, the scapula needs to be rotated to achieve abduction – that is carried out by the trapezius and serratus anterior
Adduction of shoulder joint muscles?
contraction of pectoralis major, latissimus dorsi and teres major
internal roation of shoulder joint?
contraction of subscapularis, pectoralis major, latissimus dorsi, teres major and anterior deltoid
external rotation of shoulder joint?
contraction of the infraspinatus and teres minor
what contributes to stability of shoulder joint?
rotator cuff, glenoid labrum, ligaments, biceps tendon
What contributes to mobility of shoulder joint?
ball and socket joint. glenoid cavity small in relation to large humeral head. 1:4 disproportion
