Rhuem week 2 - joint pain and asthma Flashcards
What are the common symptoms of asthma ?
- cough
- SOB
- wheezing
- chest tightness/pains
- worst in morning/exercise/cold air
What is the Samter’s triad ?
- asthma
- nasal polyps
- aspirin allergy/sensitivity
What points should you cover when taking a Hx of joint pain ?
- joint distribution ?
- morning stiffness ?
- red, hot, swollen, tender ?
- always same joints affected ?
- movement/ADL restrictions?
- PMHx, Fx, Dx, Sx….
What differentials should be considered in joint pain with systemic symptoms ?
- sepsis
- inflammatory arthritis
- connective tissue disorders
- vasculitis
- infection
- malignancy
When does a joint aspiration need to be sent for microscopy and culture ?
when septic arthritis is suspected
What is the blood test ‘plasma viscosity’ used for in rheumatology ?
check thickness of blood to assess level of inflammation
thicker blood (higher numbers) = more inflammation occurring
similar to ESR
What special blood tests would you request in a presentation of joint pain with systemic symptoms ?
- RhF
- anti-CCP
- ANA
- ANCA
checks for inflammatory arthritis/CTDs/vasculitis
What are the features seen on XR of osteoarthritis ?
LOSS
L- loss of joint space
O- osteophytes (boney nodules)
S- subchondral cysts
S- subchondral sclerosis
What is vasculitis ?
inflammation of the blood vessels
Which systems are commonly affected in vasculitis ?
- joints
- kidneys
- lungs
- skin
- nerves
How is vasculitis classified ?
by the size of vessels affected
small, medium and large vessel vasculitis
Which systemic features are present in most patients with vasculitis ?
- weight loss
- fevers
- sweats
What is the ANCA blood test and what is is used for ?
looks for antineutrophil cytoplasmic antibodies (ANCA) in blood, suggestive of autoimmune vasculitis
what does a positive ANCA test point towards ?
small vessel vasculitis
what are the two types of ANCA test and how are they different ?
c-ANCA
p-ANCA
they target different proteins so have a different staining pattern
c- ANCA stains the cytoplasm
p-ANCA stains the perinuclear cells
Which condition is most commonly associated with a positive c-ANCA test ?
granulomatosis with polyangiitis (GPA)
Which condition is most commonly associated with a positive p-ANCA test ?
eosinophilic granulomatosis with polyangiitis (EGPA)
What criteria are used to diagnose eosinohilic granulomatosis with polyangiitis (EGPA) ?
lanham diagnostic criteria
- eosinophilia
- asthma
- multi-organ involvement
What investigations (after bloods) are best for supporting a diagnosis of vasculitis ?
urine dip - renal involvement (glomerular nephritis)
CXR - looking for lung cavities caused by vasculitis (specifically granulomatous polyangiitis)
In a query vasculitis patient, what should you do with the urine sample of blood is detected ?
send off for red cell casts
confirms glomerulonephritis
what type of glomerulonephritis can present with nephrotic and nephritic features clinically ?
crescentic glomerulonephritis
How is small vessel vasculitis treated ?
phase 1 = induction
- rapid start of strong immunosuppression via steroids in combination with a second immunosuppressant
phase 2 = maintenance
- after remission is achieved, switch Pt to methotrexate or another steroid-sparing agent
Name two examples of immunosuppressants …
- rituximab
- cyclophosphamide
which steroids are given in small vessel vasculitis ?
prednisone
methylprednisolone
