1B:Respiratory Flashcards
(12 cards)
X-ray findings in RA
- Narrowing of the joint space;
- soft tissue swelling, (thick halo around the bone);
- Periarticular bone erosions
- Subluxation
- Juxta-articular osteoporosis
- rarely, subchondral cysts,-sacs of hyaluronic acid that form in the subchondral bone, the layer of bone just under the cartilage.
X ray findings OA
- narrowing of the joint space
- marginal osteophytes,
- increased density of the subchondral bone or osteosclerosis,(poorly defined areas within the bone that are whiter than the surrounding bone tissue)
- subchondral cysts, -more common in OA than RA
- joint effusions or increased amount of fluid within the synovial compartment.
Lab investigations for RA
– RF- Can be positive or negative (+ in 50-80%)
– Anti-CCP (sensitivity of 95%)
- Anti-nuclear Ab (positive or negative)
- CRP and ESR (positive or negative)
Can be used to follow disease remission
- Baseline blood tests (full blood count, renal and liver function, bone profile)
Management of RA
MDT approach
steroids were the mainstay of treatment acute rx
Long term
DMARD (methotrexate) monotherapy +/- a short-course of bridging prednisolone.
is the most widely used.
Methotrexate inhibits dihydrofolate reductase, as such, folic acid supplementation is required
sulfasalazine
Leflunomide - inhibits pyrimadine synthesis and also has teratogenic side effects as well as potentially causing GI upset
hydroxychloroquine
-inadequate response to at least 2 DMARD= TNFA-inhibitor
Measure severity in RA
Measure severity: DAS 28 & CRP
What is RA
chronic, progressive, and inflammatory disorder that affects synovial joints and, sometimes, other parts of the body like the skin and the lungs.
HLA-DR1 and HLA–DR4
Joint pain swelling and erythema
Affects joint symmetrically
Morning stiffness
most common is PIP, MCP & Wrists; Later stages hips
dangerous spot is the C1-C2 joint, or the atlantoaxial joint – extension of the neck = quadriplegia ,
reduced grip strength and ROM, pain, and swelling (due to inflammation).
During flare redness
Special signs: swan-neck deformity, Boutonniere deformity, ulnar drift, Z-deformity, claw toe
Systemic sx: F, malaise
Felty syndrome (FS)
-RA, neutropenia, and splenomegaly. Severe or recurrent infection is of particular concern due to neutropenia, especially in the skin and respiratory system.
OA
breakdown of joint cartilage and underlying bone followed by inadequate repair.
swelling is secondary to bony overgrowth
<4 joints asymmetrically.
weight bearing joints DIP, knee, hip, or ankle
joint instability, limited range of motion, and crepitus,
Special signs: Bouchard nodes(pip) & Heberden nodes (dip)
Treatment for OA
- advice: weight loss, local muscle strengthening exercises and general aerobic fitness
1st ln topical NSAIDs are first-line analgesics.
2ND LN: NSAID + PPI
-intra-articular steroid injections may be tried if standard pharmacological treatment is ineffective. Only provide short-term relief (2-10 weeks) - if conservative methods fail then refer for consideration of joint replacement
medical treatment for ILD
Pirfenidon- only drug in the UK to be licensed for tx for patients with FVC of between 50-80%
Nintedanib
Causes of Upper zone fibrosis
CHARTS
C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidos
Causes of Fibrosis predominately affecting the lower zones
- idiopathic pulmonary fibrosis
- most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
- drug-induced: amiodarone, bleomycin, methotrexate, asbestosis
