Week 6: Rheumatology (4) (quiz) Flashcards
which important condition may be the cause of her swollen knee and list 2 risk factors
septic arthritis
immuosuppression treatment- methotrexate and prednisolone
RA
prosthetic joint
IV joint use
diabetes
pathophysiology of septic arthritis
Infection in the joint (can be cultured), infection starts somewhere else in the body (haematogenous spread e.g. infected leg ulcer), by joint aspiration or RTA. Microorganisms becomes seeded into joint, causing erosion of the cartilage and bone (bony erosions). S. aureus most common.
- knee is most common joint
- may be poly articular- very poor prognosis
- axial sites affected in IVDU
- usually staph or strep
- <40 - gonococcal
complications of septic arthritis
OA, osteomyelitits, full blown sepsiss
diagnosing septic arthritis
- Aspirate the joint and send off the fluid for a gram stain and culture. Also blood culture.
management of septic arthritis
Sepsis 6. IV antibiotics- vancomycin. Repeated aspiration of the joint and clean out with saline. Analgesia.
differential diagnosis
- Rheumatoid arthritis (young age and widespread joint swelling), Psoriatic arthritis or reactive arthritis
psoriatric arhtritis presentation
- Insidious
- Comes and goes until gradually it stops going away
- Asymmetrical
- Polyarticular
- ‘sausage-like’ swelling
- Enthesitis- more diffuse swelling that also affects tendinitis
- history of arthritis
- extensor surfaces, nails, scalp, trunk,
reactive arthritis
- inflammation in the joint after infection e.g. GI infection
- Tends to be mild and disappear
- Asymmetrical
- Common to have enthesitis e.g. Achilles tendinitis
treatment of psoriatic arthritis
methotrexate and dmards, anti-tnf (infliximab)
what could the feature of this hand x-ray be diagnostic of
pencil cup deformity
good bone density
fluffy periosteal reaction
central ill-define erosion
Typical psoriatic arthritis- pencil in cup deformities (pencil= phalynx , joint is subluxed, sitting inside of the expanded base of the distal phalynx = the cup)
features of inflammatory features
Inflammatory problems relieved with movement and early morning stiffness, improvement with non-steroidal anti-inflammatory medication. (Mechanical= worse with movement)
baseline tests required before starting methotrexate
U and E and LFTS
pregnancy tests (methotrexate is an antifolate)
warn not to drink much alcohol due to risk of liver cirrhosis
rash found in SLE
Malar rash (top left)- photosensitive, sparing area under the node.
- Must wear factor 50 + and take vitamin D. Sunlight also causes systemic features e.g. damage to the cell due to light cause the release of autoantibodies.
- Discoid lupus (top right)- can cause a lot of scaring and treated with topical steroids- most people wont get systemic lupus.
- Bullus lupus (on the right)
most likely diagnosis
Polymyalgia rheumatica (PMR)
- Bursitis- no inflammation in joints or muscle
treatment and prognosis of polymyalgia rheumatica
- 18 months- 2 years. Will improve rapidly with treatment (Prolonged treatment)
- Oral prednisolone (15mg), alendronic acid, calcium and vitamin D, PPI
what condition related to polymyalgia rheumatica may arise
giant cell arteritis - jaw claudication, sudden onset headache, change in sight
→ treated with high dose steroids
diagnose
- Rheumatoid arthritis
- Rheumatoid nodules- found in later stage of the disease (rarer now with better treatment)
- Swan neck deformity
- Ulnar deviation
- Palmar deviation of MCPJs
- Carpophalangeal swelling
- Wasting of hand muscle
- Deformity of the wrist
name given tot he swellings seen on this patients DIP joints
Heberdens nodes- swellings on either side of the DIP
what is this diagnosis
- Raynaud’s phenomenon (disease)- primary
- White due to vasospasm
- Secondary due to connective tissue disease e.g. lupus
what is this clinical sign
- Digital ulcer
- Skin is very tight- due to sclerodactyly
- Scleroderma
- Limited- diffuse skin tightness below knees and below elbows
- Diffuse- anywhere
what skin condition would you expect this patient to have
- Oncolitis- nail sign
- Psoriasis
- Sausage fingers
- Psoriatic arthritis
what signs do you see and what is the diagnosis?
- Gottrons papules
- Dermatomyositis – skin involvement of the hands and eyes with polymyositis which involves proximal weakness of the hips and shoulders
- Raised CK
this man has a painful foot what is the diagnosis
- gout
- test for uric acid levels
- treatment: NSAIDs/ colchicine
- allopurinol long term
what is the name of the rash on the sole of this foot and what is the syndrome linked to
- History: red eye, swollen knee + rash
- Keratoderma blennorrhagia
- Reactive arthritis
what is the abnormality and what is the DD
- Abnormal capillary folds
- Due to vasculitis or lupus
what is the purpose of this test
- Schobers test- Measuring for how much flexion in the spine
- For ankylosing spondylitis
what are these called and what would be seen under the microscope if these swellings were aspirated
gouty tophi
- Crystals of uric acid- gout
- Negatively bifrigent crystals
- Treat with allopurinal
these deformities disappear when the patient rests her hands flat-→ what is the explanation
- Swan neck deformity
- In RA these will not disappear when hands flat
- Due to hypermobility- will disappear when hands flat
what is observed here and what else would be examined for
- Hyper elasticity of the skin
- Ehlers Danlos syndrome
- Would also have hypermobility
what is the differential diagnosis
- Thoracic kyphosis and subsequent hyperextension at the neck. Loss of lumbar lordosis
- Ankylosing spondylitis (bamboo sign)
- Thoracic kyphosis can also be caused by osteoporotic collapse of thoracic vertebra
