Arthritis in Preg

Question 1

Hx/Exam/Ix of polyarthritis in preg
- 28yo G3P2, 25/40, acute polyarthritis

Answer 1

DDx (arthritis)
- Inflammatory - RA, SLE
- Reactive - Rheumatic (GAS), Chlamydia
- Septic - Gono
- Viral- EBV/HSV/VZV/CMV/Parvo/Hep

Hx
Mother
- migratory pain (rheumatic fever)
- fever/anorexia/weight loss (sepsis)
- coryzal/hematuria/dysuria/PV dc
- sick contacts (kids, chickenpox)
- risky sexual exposure
- PHx - RA/SLE…
- Med - hydroxychlo, aza, pred, NSAIDs
- SHx - smoke/etoh/illicit…toddlers

Baby
- FMF/APH/SROM/TPL
- AN course….

Exam
- weight/height/vitals
- appearance - rash/jaundice/rheumatoid nodules
- cardio-resp (murmurs, pleurisy)
- abdo-pelvic - hepatosplenomegaly
- external - lesions
- internal - spec - CST/STI screen
- joints - effusion/hot/redness
- RTS +/- CTG

Ix
- FBE/UEC/LFT/ESR/CRP
- RF, anti-CPP, ANA, anti-DS DNA, aPLs
- anti-Ro/La (risk of neonatal lupus)
- urine - MCS, uPCR
- serology/PCR, STI screen
- +/- joint aspiration - crystals/MCS
- USS (wellbeing/FGR)
- Fetal echo (if anti-Ro/La) - CHB
- screen for GDM if on pred

Mx (depends on cause)
- MDI - MFM/Obs med/ID/Paeds

Question 2

Clinical features of SLE

Answer 2

• joint pain
• skin rash (malar)
• chest pain (pericarditis, pleurisy)
• urine (proteinuria + casts)
• hematological (hemolytic anemia, thrombocytopenia)
• neurological (seizure, psychosis)

Question 3

Clinical features of RA

Answer 3

• joint pain
• hx of on DMARDS
• vasculitis
• aneamia of chronic disease
• pulmonary fibrosis
• scleritis/dry eys/mouth = Sjgroen’s (assoc anti-Ro/La)

Question 4

Key Mx points for SLE

Answer 4

• MDI - MFM/Obs Med
• ? IUGR & PET - BP/uPCR/G/S
• ? flares - high ds-DNA, low C3/4
• flare rx - pred & azathioprine
• PET - hyperuricaemia/LFT derange
• renal bx gold std in diff PET vs flare
• deliver earlier if IUGR & PET
• aim 39-40 if stable
• hydrocort if been on pred

Question 5

Key mx points for RA

Answer 5

• MDI - MFM/Obs Med
• ? IUGR (? aPLs)
• ? CHB/Neo lupus (? anti-Lo/Ra)
• early OGTT if on pred
• atlanto-axial disease - GA risk - ano rv
• hip disease - delivery position
• cease teratogenic - NSAID, mycophenolate, MTX

some improve in preg
most have postpartum flare

Question 6

Key mx points for infective cause

Answer 6

• MDI - ID +/- MFM
• Confirm +/- screen for other
• Treatment APP
• Education - written info, intercourse
• Contact tracing +/- notification
• Follow-up & TOC
• Foetal transmission risk…

Chlam - 1g PO azithro
Gono - 500mg IM Ceft + 1g PO Azithro