Tutorial 2 - Spondyloarthropathies Flashcards
How would you ask about inflammatory back pain
Nocturnal pain - does it wake you up in the early morning?
Alternating buttock pain
Gets better with activity
Where in the spine would you get symptoms if it’s a spondyloarthropathies
Restriction in movement at all levels of the spine
What do you call the radiological sign when there are dermatophytes, joint fusion
Bamboo spine
How would you differentiate between ank spond and psoriatic arthritis
SPA = Bilateral sacroiliac joint disease
Psoriatic = unilateral
note - spa can be axial or peripheral
What do we see on a radiographic image
Widening
then narrowing
then ankylosis = bony fusion
Bamboo sign
Ank spond always starts in the SIJ and then travels up to spine
Whereas in DISH it is only the spine that is affected
Desmophyte fusion
Hot swollen joint differential in someone who has come back from a holiday
Gonorrhoea - more systemically unwell
Chlamydia
Distal joints
Asymmetrical
Similar to OA
Nail signs
synovitis on USS - in PSA not OA
Pnecilin cup
Features of rheumatoid arthritis
Symmetrical deforming polyarthropathy
MCP, PIP, spares DIP
Z deformity of thumb
Volar subluxation
Ulnar deviation
How do you differentiate between RA and OA
RA - spares finger tip DIPs
OA doesn’t spare them
SE of JAKinibs
JAKinibs - risk of shingle reactivation and DVTs
Rheumatoid arthritis features
Volar subluxation - instability of the knuckles, then ulnar deviation due to
the nodules are actually not nodules - they are the heads of the metacarpals
Features of psoriatic arthritis
Onycholysis - fungal infection that won’t get treated
Pitting
Hyperkeratosis
Ridging
What deformity do you get in the thumbs of someone with rheumatoid athritis?
Z deformity of the thumb
What do you call the condition where you get papules
Gotron’s papules - dermatomyositis - over the joints but not in between the joints.
Which is a type of inflammatory myositis, do exclude cancer because fifty percent of people have cancer.
ALT rise and CK rise in myositis as ALT
Another differential for swan neck deformity of psoriatic arthritis
Hyperextension of PIP
Mallet finger - rupture of the attachment of the distal extensor tendor, causing a straight finger without hyperextension.
Telescoping suggest
Arthritis mutilans - a form of peripheral SPA
Why would you not amputate a necrotic joint
If autotermination was going to happen - if there was a clean line
Splinter haemorrhages differential
Vasculitis disease
What deformity of the fingers do you get in RA
Boutainnire - button hole
Gout can present how? Where does it present?
Tophacious gout - macroscopic
Acute inflammatory hot swollen gout - microscopic
Kidney damage can happen with macroscopic gout
You get gout:
Elbows
Pinna of ears
Check kidney function to see if you are releasing enough urate
red swollen all fingers etc
Sclerodactyly
OA signs
Hebeden’s - DIP welling
Bouchards - PIP swelling
HD = high distinction
Red spots on periungal region
Vaculitic nail sings - nail fold infarcts
Ulnar neuropathy
Claw hand
Hypothenar muslce wasting