Summary Book Rheumatology Flashcards
Movements initiated by radial nerve. Associate with C6 and 7.
C6 - elbow flexion and brachioradialis. C6/7 - wrist extension. C7 - triceps, elbow extension and finger extension.
Movements initiated by median nerve. Associate with C8 and T1.
C8 - 1st and 2nd DIP flexion, and thumb flexion. T1 - thumb abduction.
Movements initiated by ulnar nerve. Associate with C8 and T1.
C8 - 3rd and 4th finger flexion. C8 and T1 - finger 4 abduction. T1 - 1st finger abduction and finger adduction.
Compare crystals of gout and pseudogout
Gout - monosodium urate, needle shaped, negative birefringence. Pseudogout - calcium pyrophosphate, rhomboid shaped, positive birefringence.
Compare xray findings of gout and pseudogout
Gout - erosive arthritis with soft tissue swelling. Pseudogout - chondrocalcinosis. Both are asymmetrical deforming peripheral oligoarthritis
Management of gout. Acute, prophylaxis and urate lowering.
Acute: 1. NSAID or colchicine. 2. Prednisolone - aim uric acid level <0.4. Prophylaxis: colchicine, weight loss, diet modification. Urate Lowering: allopurinol (xanthine oxidase inhibitor) or IL-1 blocker for refractory gout (anakinm).
Systems involved in rheumatoid arthritis
Cushingoid, joints, eyes, cardio, resp, splenomegaly, vasculitis
Describe key features of rheumatoid arthritis
Symmetrical deforming, small joint predominant peripheral arthropathy; with morning stiffness, joint pain/swelling, fatigue and possible paraesthesia.
Signs of rheumatoid arthritis
elbow subcutaneous nodules, sicca, ILD, pleural effusion, possible anaemia, peripheral neuropathy, splenomegaly, pericarditis, raynauds
Risk factors for rheumatoid arthritis
smoking, FHx (HLA-DR4)
Poor prognostic factors for rheumatoid arthritis
increased number of joints, extra-articular involvement, high rheumatoid factor and anti-ccp, erosions on xray, HLA-DR4 positive
Serum findings for rheumatoid arthritis
rheumatoid factor sensitive, anti-ccp specific and bad prognosis, FBC - anaemia, CRP
5 xray findings for rheumatoid arthritis
- marginal subchondral erosions. 2. symmetrical narrowing of joint space. 3. juxta-articular osteopenia. 4. periarticular soft tissue swelling. 5. deformities.
MRI findings for rheumatoid arthritis
synovitis, effusions, oedema
Management of rheumatoid arthritis
Non-pharmacological: exercise, braces, smoking cessation, OT/PT. Pharmacological: NSAID, steroids to bridge, DMARD (start early = 1. methotrexate, 2. leflunomide / sulfasalazine / hydroxychloroquine), biologic - anti TNF alpha (if methotrexate and DMARD fail after 6 months). Also manage cardiovascular and osteoporosis risk factors.
Risk factors of osteoarthritis
obesity, family history, joint trauma
Describe osteoarthritis
asymmetrical deforming peripheral oligoarthritis (knees, DIP (heberden), PIP (bouchard) and 1st CMC). With joint effusions, bony swelling, not warm, tender, crepitations and decreased ROM. Involves progressive loss of synovial cartilage.
Serum findings of osteoarthritis
normal inflammatory markers, negative RF/anti-ccp to exclude RA
Synovial findings of osteoarthritis
yellow, increased viscous, decreased cell count
4 xray findings of osteoarthritis
- joint space narrowing. 2. osteophytes. 3. subchondral sclerosis. 4. subchondral cysts
Management of osteoarthritis
exercise, weight loss, NSAIDs, intra-articular corticosteroids, surgery
Examination of psoriatic arthritis (HLA B27)
hands and cardio
Signs of psoriatic arthritis
Dactylitis, enthesitis, nail changes (pitting, onycholysis, ridging), functional limitation, anterior uveitis, aortic regurgitation, apical lung fibrosis, psoriatic skin disease (limb extensor, behind the ears, scalp line)
Serum findings for psoriatic arthritis
CRP, negative autoantibody
4 xray findings of psoriatic arthritis
- erosive arthropathy. 2. pencil in cup. 3. rays not rows. 4. juxta-articular new bone
Management of psoriatic arthritis
exercise, UV for skin, NSAIDs and intra-articular steroids, methotrexate, anti-TNF alpha (infliximab)
Presentation and management of giant cell arteritis
Headache, loss of vision, jaw claudication. Steroids.
Associations of polyarteritis nodosa
peripheral neuropathy, mononeuritis multiplex and clots (chest or abdo pain)
Organ involvement and management of microscopic polyangiitis
Lung and cyclophosphamide
Organ involvement and management of granulomatosis with polyangiitis
Lung (dyspnoea, haemoptysis, cough, congestion) and renal. Rituximab, possibly cyclophosphamide or MMF.
Organ involvement and management of eosinophilic granulomatosis with polyangiitis.
Renal, atopic conditions, mononeuritis multiplex and peripheral neuropathy. Cyclophosphamide vs mycophenolate.
For management of renal and / or respiratory involvement of vasculitis which agents should be considered
Cyclophosphamide for lung or renal. MMF for renal.
Investigations for vasculitis
ANCA, ESR, UEC, LFT, renal biopsy, imaging
Risk factors for vasculitis
Other autoimmune conditions, drug reaction (hydralazine, allopurinol, propylthiouracil), leukaemia / lymphoma, hep B/C
Presentation for mixed cryoglobulinemia
raynauds, arthrtis, Hep C
Which organ is associated with microscopic polyangiitis
lung
General presentation symptoms for vasculitis
fatigue, myalgia, arthralgia, rash
Good questions for steroid and opioid use
Exposure over time, changes in dose, complications, weaning
What to examine when determining activity of disease for a rheumatological condition
Nodules, eyes, anaemia, fibrosis, skin
Administration of methotrexate
Weekly, monitor for toxicity, give folic acid
Potential risk factors of methotrexate
Lung fibrosis, liver cirrhosis, skin malignancy, teratogenicity, infection, mouth ulcers, alopecia, pneumonitis
Potential risk factors of leflunomide
Lung fibrosis, liver cirrhosis, skin malignancy, teratogenicity, infection, mouth ulcers, alopecia, pneumonitis, neuropathy
What should be monitored for plaquenil (hydroxychloroquine)
Eyes and skin pigmentation
Risk factors of sulfasalazine
Neutropenia and rash
Risk factors of TNF inhibitors
TB, infection, skin malignancy, drug induced lupus, MS
Give two examples of a JAK Kinase Inhibitor
Tofacitinib and Ruxolitinib
Risk factors of JAK kinase inhibitors
Lipid dysfunction, CVS event, bowel perforation, diverticulitis, clots, shingles, skin malignancy
Name a IL 6 drug
Tocilizumab
Risk factors of IL 6 drugs
Bowel perforation, diverticulitis, lipid dysfunction, cytoplasm
Important management when taking Rituximab
Vaccination against COVID and strep.
