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3B General Care > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Signs of acute cauda equina compression

A
  • alternating or bilateral root pain in legs
  • saddle anaethesia
  • loss of anal tone on PR
  • bladder +/- bowel incontinence
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2
Q

Signs of acute cord compression

A
  • bilateral pain
  • LMN signs at level of compression
  • UMN and sensory loss below
  • Sphincter compression
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3
Q

Management of Mechanical Back Pain

A
  • education
  • self management
  • normal activities - analgesia as necessary - regular paracetamol, NSAIDs, codeine
  • consider low dose amitriptyline
  • Physio
  • accupuncture
  • exercise programme
  • psychosocial referral
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4
Q

Investigations for back pain

A
  • FBC, ESR, CRP (myeloma, infection, tumper)
  • U&Es, ALP (Pagets)
  • serum/ urine electrophoresis (myeloma)
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5
Q

Nerve Root Lesions

L2

A

Pain- Across the upper thigh

Weakness - Hip flexion and adduction

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6
Q

Nerve Root Lesions

L3

A

Pain - Across lower thigh
Weakness- hip aDducation, knee extension
Reflex- Knee jerk affected

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7
Q

Nerve Root Lesions

L4

A

Pain- Across knee to medial malleolus
Weakness- Knee Extension, Foot inversion and dorsiflexion
Reflex - Knee Jerk Affected

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8
Q

Nerve Root Lesions

L5

A

Pain- Lateral shin to dorsum of foot and great toe
Weakness- Hip extension and aBduction,
foot inversion and dorsiflexion
Reflex- Great toe jerk affected

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9
Q

Nerve Root Lesions

S1

A

Pain - Posterior calf to lateral foot and little toe
Weakness- Knee flexion, foot and toe plantar flexion, foot eversion
Reflex - Ankle jerk

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10
Q

Signs of OA

A

Pain on movement
Worse at the end of the day
Background pain at rest

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11
Q

Red Flags of Back Pain

A
  • Age <20, >55
  • acute onset in the elderly
  • constant or progressive
  • nocturnal pain
  • worse pain on being supine
  • fever, night sweats, weight loss
  • abdominal mass
  • history of malignancy
  • thoracic back pain
  • morning stiffness
  • bilateral or alternating leg pain
  • neurological disturbance
  • sphincter disturbance
  • current or recurrent infection
  • immunosuppression
  • leg claudication/ exercise related leg weakness/ numbness
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12
Q

Osteoarthritis

A

commonest joint condition
women: men 3:1
typical onset >50
usually primary, may be secondary to joint disease or other conditions - e.g. haemochromatosis, obesity, occupational

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13
Q

Signs and symptoms of osteoarthritis

Localised disease

A 
Pain on movement and crepitus 
Worse at the end of the day 
Background pain at rest 
joint gelling - stiffness after rest up to ~30 mins 
Joint instability
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14
Q

Signs & symptoms of osteoarthritis

generalised disease

A 
Commonly affected joints- DIP, thumb metocarpal joints, Knees
Joint tenderness 
Joint derrangement 
Bony swelling (Herbenden's nodes (post menopausal women) DIP, Bouchard's at PIP)
Decreased range of movement
Mild synovitis
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15
Q

Tests for osteoarthritis

A

L- loss of joint space
O- osteophytes
S - subarticular sclerosis
S- sub chondral cysts

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16
Q

Management of Osteoarthritis

A

Core - Exercise, weight loss
Analgesia - regular paracetamol ± NSAIDs
Topical capsaicin
Intra-articular steroid injections
Intra-articular hyaluronic acid injections

Physio/OT- hot /cold packs, walking aids, stretching orTENS
Surgery

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17
Q

Septic Arthritis

Risk Factors

A 
Pre-existing joint disease esp. Rheumatoid
DM 
Immunosuppression
Chronic renal failure 
Recent joint surgery 
Prosthetic joint 
IV drug use
age >80 yrs
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18
Q

Investigations

Septic Arthrtis

A

Joint aspiration - synovial MC&S
X-R and CRP may be normal
main DD = crystal arthopathies
Blood cultures for guiding abx

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19
Q

Treatment

A
  • Empirical Abx- common causes s. aureus, strep, neisseria gonococcus and gram -ve bacilli
    Abx 2/52 IV, 2-4/52 PO
    Removal of prosthetic joints
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20
Q

Rheumatoid arthritis

A

chronic systemic inflammatory disease
characterised by symmetrical deforming, peripheral polyarthritis
HLA DR4/DR1 linked

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21
Q

Presentation of RA

Typical

A

symmetrical swollen, painful and stiff small joints of the hands & feet
worse in the morning

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22
Q

Less common presentation of RA

A

Sudden onset widespread arthritis
Recurring mono/polyarthritis
Persistent monoarthritis
Systemic illness with extra-articular symptoms - fatigue, fever, weight loss, pericarditis and pleurisy
Polymyalgic onset - vague limb girdle aches
Recurrent soft tissue problems - frozen shoulder/carpal tunnel

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23
Q

Early Signs of RA

A

inflammation, no joint damage
swollen MCP, PIP, wrist or MTP joints
Look for tenosynovitis or busitits

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24
Q

Later signs of RA

A

joint damage, deformity

  • ulnar deviation
  • dorsal wrist subluxation
  • Boutonniere and swan neck deformities of the fingers
  • Z - shaped thumbs
  • hand extensor tendons my rupture
  • atlanto-axial joint subluxation may threaten spinal cord
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25
Q

Extra-articular signs of RA

A 
Nodules - elbows and lungs 
Lymphadenopathy 
Vasculitis 
Fibrosing alveolitis
Obliterative bronchiolitis 
Pleural and pericardial effusions
Raynaurds 
carpal tunnel 
peripheral neuropathy 
splenomegaly
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26
Q

Investigation in RA

A

Rheumatoid Factor positive in ~70%
ACPA/ anti- CCP antibodies
Anaemia of chronic disease
Inflammation = raised platelets, ESR & CRO
X-rays show soft tissue swelling, juxta-articular osteopenia and reduced joint space

Later may have bony erosions, subluxation or complete carpal destruction

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27
Q

Management of RA

A
  • Early use of DMARDs and biologics
  • Steroids reduce symptoms and inflammation
  • NSAIDs good for symptom relief
  • specialist physio and OT
  • Surgery - relieve pain, improve function and prevent deformity
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28
Q

Disease modifying anti-rheumatic drugs

A

start within 3 months of persistent symptoms

  • may take 6-12 weeks for symptomatic benefit
  • combination of methotrexate, sulfasalazine and hydroxychloroquine
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29
Q

SE of DMARDs

A

Immunosupression - potentially fatal
Methotrexate - pneuomonitis, ulcers, hepatotoxicity
Sulfasalazine - rash, reduced sperm count, oral ulcers

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30
Q

Biological agents and RA

A
  1. TNFa inhibitors (infliximab, enanercept)
  2. B Cell depletion e.g. rituximab with methotrexate
  3. IL-1 & Il-6 inhibition
  4. Disruption of T-cell function - abatacept
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31
Q

SE of biological agents

A 
Serious infection, reactivation of TB and hep B, 
worsening heart failure 
hypersensitivity reaction 
injection site reaction
blood disorders
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32
Q

Gout presentation

A

Acute monoarthropathy with severe joint inflammation
>50% of MTP of big toe - podagra
- may be polyarticular
- caused by the deposition of monosodium urate crstals
Precipitated by trauma, surgery, starvation, infection or diuretics
–> long term = deposits (tophi) in pina, tendons and joints- renal disease may also occur

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33
Q

Differential diagnosis of gout

A

septic arthritis
haemarthrosis
CCPD
palidromic RA

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34
Q

Causes of gout

A 
hereditary 
increased dietary purines 
alcohol excess 
diuretics
leukaemia 
cytotoxics

Associated with: CVD, HTN, DM, CKD

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35
Q

Gout investigations

A

polarised light microscopy of synovial fluids
- negatively birefringent urate crystals
X-R shows only soft tissue swelling in early stages
later–> punched out erosions in juxta-articular bone
- no sclerotic reaction and joint spaces preserved until late

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36
Q

Treatment of Gout

Acute

A

High dose NSAIDs or coxib (etoricoxib)

if CI - colchicine is effective but slower to work

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37
Q

Prevention of gout

A
  • loose weight

- avoid prolonged fasts , alcohol excess, purine rich meats and low dose aspirin

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38
Q

Prophylaxis of gout

A

allopurinol (wait 3 weeks after an acute episode to begin)

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39
Q

Calcium pyrophosphate deposition

A
  • acute CPP crystal arthritis (pseudogout)
  • chronic CPPD
  • osteoarthritis with CPPD
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40
Q

Acute CPPD crystal arthritis (pseudogout)

A

acute monoarthropathy
typically larger joints in older patients
usually spontaneous and self limiting
may be provoked by illness, surgery or trauma

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41
Q

Chronic CPPD

A

inflammatory RA-like symmetrical polyarthritis and synovitis

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42
Q

Osteoarthritis with CPPD

A

chronic polyarticular osteoarthritis with super imposed acute CPP attacks

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43
Q

Risk factors for CPPD

A

Old age
hyperparathyroidism
haemochromatosis
hypophosphataemia

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44
Q

Tests for CPPD

A

polarised light microscopy of synovial fluid shows weakly positive birefringent crystals
Associated with soft tissue calcium deposition on X-ray

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45
Q

Management of CPPD

A

acute attacks- cool packs, rest, aspiration and intra-articular steroids
NSAIDs + PPI± cochicine may prevent attacks
Methotrexate and hydroxychlorquine have a role in chronic CPPD

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46
Q

What is ankylosing spondylitis

A

chronic inflammatory disease of the spine and sacroiliac joints

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47
Q

Prevalence of ankylosing spondylitis

A

0.25-1%
men present earlier 6:1 at 16, 2:1 at 30
~90% HLA B27 positive

48
Q

Signs and symptoms of ankylosing spondylitis

A

gradual onset low back pain, worse at night
morning stiffness relieved by exercise
pain radiates from sacroiliac joints to hips/ buttocks , usually improves towards the end of the day
Progressive loss of spinal movement –> decreased thoracic expansion

49
Q

Extra-spinal presentations of ankylosing spondylitis

A

enthesitis- achilles tendonitis, plantar fascitis, tibial and ischial tuberosities
costchondritis and fatigue
acute iritis
associated with osteoporosis, aortic valve incompetence and pulmonary apical fibrosis

50
Q

Testing for ankylosing spondylitis

A

Dx is clinical and supported by imaging- bamboo spine, sacroilitis
vertebral syndesmophytes
bony proliferations

51
Q

Management of ankylosing spondylitis

A

Exercise
NSAIDs
TNF alpha blockers - etanercept, adalimumab adn golimumab
local steroid injections = temporary relief
Surgery to improve pain and mobility
Bisphosphonates - risk of osteoporotic spinal fractures

52
Q

Enteric arthropathy

A

associated with inflammatory bowel disease, GI bypass, coeliac and whipple’s disease
arthropathy improves with treatment of bowel syndromes

53
Q

Psoriatic arthritis

A

occurs in 10-40% of psoriasis- can present before skin changes

  • symmetrical polyarthritis
  • DIP joints
  • asymmetrical oligoarthritis
  • spinal due to AS

radiology -associated with nail changes, acneform rahses and palmo-plantar pustulosis

54
Q

Psoriatic arthritis radiology

A

-> erosive changes ‘pencil in cup’ deformity,

55
Q

Associated features of psoriatic arthritis

A

nail changes
acneiform rashes
palmo-plantar pustulosis

56
Q

Management of psoriatic arthritis

A 
NSAIDs
Sulfasalazine 
Methotrexate
ciclosporin 
anti-TNF agents are also effective
57
Q

Reactive arthritis

A

A sterile arthritis, typically the lower limb
1-4 weeks after urethritis or dysentry
chronic or relapsing

may have iritis, keratoderma blenorrhagica, circinate balanitis, mouth ulcers and enthesitis

58
Q

Reiter’s syndrome

A

urethritis
arthritis
conjunctivitis

59
Q

Investigations for reactive arthritis

A 
ESR &amp; CRP raised
culture stool if diarrhoea
infectious serology
sexual healthreview 
x-ray may show enthesitis with periosteal reaction
60
Q

Management of reactive arthritis

A

splint affected joints acutely
NSAIDs or local steroid injections
treating original infection may make little difference to the arthritis

61
Q

Shared features of spondyloarthropathies

A
  • seronegativity (Rheumatoid factor -ve)
  • HLA B27
  • axial arthritis- pathology in spine and sacroiliac joints
  • asymmetric large joint oligoarthritis or monoarthritis
  • enthesitis
  • dactylitis
  • extra-articular manifestation
62
Q

Systemic sclerosis

A

features scleroderma (skin fibrosis) and vascular disease

63
Q

Limited cutaneous systemic sclerosis

A 
Calcinosis (subcutaneous tissues)
Raynaud's
oEphageal and gut dysmotility
Sclerodactyly (swollen tight digits
Telangiectasia
  • skin involvement limited to hands, feet and face
  • anticentromere antibodies
  • pulmonary hypertension subclinically
    Rx- sildenafil, bosentan
64
Q

Diffuse cutaneous systemic sclerosis

A

diffuse skin involvement
early organ fibrosis - lung, cardiac, GI and renal
Anti-poisomerase 1 and anti-RNA polymerase
prognosis poor

control BP, annual ECG and spirometry

65
Q

Management of systemic sclerosis

A

no cure
immunosuppressive regimens used for organ involvement or progressive skin disease (cyclophosphamide)
try anti-fibrotic tyrosine kinase inhibitors
Monitor BP and renal function - ACE-i ±ARB

66
Q

Mixed connective tissue disease

A

combines features of systemic sclerosis, SLE and polymyositis

67
Q

Relapsing polychondritis

A

attacks cartilage

  • pinna, nasal septum, larynx (= stridor) and joints
  • aortic valve disease, polyarthritis and vasculitis
  • underlying rheumatic or autoimmune disease

Rx- steroids and immunosuppressives

68
Q

Polymyositis and dermatomyositis

A

rare conditions with insidious onset of progressive symmetrical proximal muscle weakness and autoimmune mediate striated muscle inflammation wtih myalgia ± arthralgia

69
Q

Muscle weakness in Polymyositis and dermatomyositis

A

causes

  • dysphagia
  • dysphonia (poor phonation, not dysphasia)
  • respiratory weakness

may be a paraneoplastic phenomenon- commonly from lung, pancreatic, ovarian or bowel malignancy

70
Q

Dermatomyositis

A

myositis + skin signs

  • macular rash
  • lilac-purple rash on eyelids with oedema
  • nailfold erythema
  • Gottron’s papules
  • subcutaneous calcifications
71
Q

Extramuscular signs

Polymyositis and dermatomyositis

A 
fever
arthralgia
Raynauds
interstitial lung fibrosis 
myocardial involvement (myocarditis, arrhythmias)
72
Q

Polymyositis and dermatomyositis

Tests

A

Muscle enzymes (AST, ALT, LDH, CK & aldolase) raised
electromyography - fibrillation potentials
muscle biopsy
MRI- muscle oedema in acute myositis
Anti-M2, anti-Jo1 associations

73
Q

Polymyositis and dermatomyositis

Differeentials

A 
carcinomatous myopathy
inclusion body myositis 
muscular dystrophy
PMR 
endocrine/metabolic myopathy (steroids)
rhabdomyolysis
infection 
drugs (penicillamine, colchicine, statins or chloroquine
74
Q

Polymyositis and dermatomyositis

Management

A

screen systemically for malignancy
start prednisolone 1mg/kg/day
immunosuppressives & cytotoxics

75
Q

Behcet’s Diseaes

A

Systemic inflammatory disorder of unknown origin associated with HLA B5
Common along the old silk road

76
Q

Behcet’s disease

features

A 
recurrent oral and genital ulceration 
uveitis
skin lesions- erythema nodosum, papulpustular lesions 
arthritis (non-erosive large joint oligoarthropathy)
thrombophlebitis
vasculitis
myo/pericarditis
CNS involvement (pyramidal signs 
colitis
77
Q

Treatment of Behcet’s disease

A

Cochicine for orogenital ulceration
azathioprine or cyclophosphadmie for systemic disease
infliximab

78
Q

what is SLE

A

multisystemic autoimmune disease where autoantibodies are made against a variety of autoantigens
Polyclonal B-cell secretion of pathogenic autoantibodies cause tissue damage- immune complex formation and deposition, complement activation and other direct effects

79
Q

Epidemiology of SLE

A

9:1 women to men

commoner in Afro-Carribean populations, Asian people, HLAB8, DR2 or DR3 +ve

80
Q

Clinical features of SLE

A

Relapsing and remitting
variable presentation
- non-specific constitutional symptms of malaise, fatigue, myalgia and fever

  • lymphadenopathy
  • weight loss
  • alopecia
  • nail fold infarcts
  • non-infective endocarditis (Libman-Sacks syndrome)
  • Raynaurds
  • migraine
  • Strokes
  • retinal exudate
81
Q

Revised criteria for diagnosising SLE

4/11 needed for diagnosis

A
  • malar rash
  • discoid rash
  • photosensitivity
  • oral ulcers
  • non-erosive arthritis
  • serositis- pleuritis, pericarditis
  • renal disorder- persistent proteinuria, cellular casts
  • CNS disorder- seizures or psycosis
  • haematological disorder - haemolytic anaemia, leukopenia, lymphopenia, thrombocytopenia
  • Immunological disorder - anti-dsDNA, anti-Sm antibody, antiphospholipid +ve
  • ANA +ve
82
Q

Immunology of SLE

A

> 95% ANA +ve (antinuclear antibody)

83
Q

Monitoring SLE

A
  1. Anti dsDNA antibody titres
  2. Complement (low C3, C4)
  3. ESR

Also- BP, urine for casts or proteins, FBC, U&E, LFT, CRP

84
Q

Drug induced lupus

A

incl. isoniazid, hydralazine
antihistone antibodies
- skin and lung signs prevail

85
Q

Management of SLE

severe flare

A

IV cyclophosphamide + high dose prednisolone

86
Q

Management of SLE

Cutaneous symptoms

A

treat rashes with topical steroids
prevent rashes with high factor sun block creams
sun exposure may also trigger acute systemic flare

87
Q

Management of SLE

Maintenance

A
  • NSAIDs and hydroxychloroquine- joints and skin
  • low dose steroids may be useful
  • azathioprine, methotrexate and mycophenolate are used as steroid-sparing agents
88
Q

lupus nephritis

management

A

may require more intensive immunosuppression
- steroids, cyclophosphamide or mycophenolate

–> BP must be controlled, renal replacement therapy may be needed

89
Q

managment of SLE

B-cell depletion

A

Belimuma

90
Q

Future treatments of SLE

A

interferon alpha, interleukin 6 inhibition and t-cell targets

91
Q

Antiphospholipid syndrome

A

associated with SLE
- antiphospholipid anti-bodies cause CLOTS

C- coagulation defect
L- Livedo reticularis
O- Obstetric (recurrent miscarriage)
T- THrombocytopenia

treat with low dose aspirin

92
Q

What is vasculitis?

A

inflammatory disorder of blood vessel walls, causing destruction (aneurysm/ rupture) or stenosis

  • Primary
  • Secondary to SLE, RA, Hep B/C, HIV
93
Q

Classification of Vasculitis

A

Large- GCA, Takayasu’s arteritis
Medium- Polyarteritis nodosa, Kawasaki
Small- ANCA +ve - resp & renal. incl- p-ANCA microscopic polyangitis, glomerulonephritis & Churg Strauss syndrome & Wegner’s
- ANCE -ve - Henoch-Schonlein purpura, goodpasture’s and cyroglobulinaemia

94
Q

Symptoms of Vasculitis

A
  • Systemic - fever, malaise, weight loss, arthralgia, myalgia
  • Skin - purpura, ulcers, livedo reticularis, nail bed infarcts, digital gangrene
  • Eyes - episcleritis, scleritis, visual loss
  • ENT - epistaxis, nasal crusting, stridor, deafness
  • Pulmonary - haemoptysis & dyspnoea
  • Cardiac - angina or MI, heart failure, pericarditis
  • GI - pain or perforation
  • Renal - hypertension, haematuria, proteinura, casts and renal fialure
  • Neurological - strokes, fits, chorea, psychosis, confusion, impaired cognition, altered mood
  • GU - orchiditis- testicular pain or tenderness
95
Q

Vasculitis investigations

A 
Raised ESR/CRP
ANCA may be +ve
raised creatinine in renal failure
proteinuria, haematuria, casts on microscopy
Angiography ± biopsy
96
Q

Management of vasculitis

A

Large vessel - steroids
Medium vessel - steroids + IV cyclophsophamide
Azathioprine may be used as a steroid sparing agent

97
Q

GCA- Giant Cell Arteritis

Cranial or Temporal Arteritis

A

Common in elderly
Headache, temporal artery and scalp tenderness
jaw claudication
amaurosis fugax
Dyspnoea, morning stiffness, uneuqal or weak pulses

start 60mg prednisolone ASAP

Tests- ESR & CRP very raised, high plts & ALP, low HB
Temporal artery biopsy within 7 days of starting steroids

PPI & bisphosphonate

2 year disease course then remission

98
Q

Polyarteritis nodosa

A

Necrotising vasculitis that causes aneurysms and thrombosis in medium sized vessels –> infarction

associated with Hep B
Typically systemic with skin (punched out ulcers), renal (main cause of death), cardiac, GI and GU involvement

CNS anuerysms in Kawasaki disease

WCC raised, mild eosinophilia, anaemia, raised ESR and CRP, ANCA -ve

Treatment - control BP, treat hep B. Corticosteroids and cyclophosphamide

99
Q

Microscopic polyangitis

A

necrotising vasculitis that affects small and medium sized vessels

Rapidly progressive glomerulonephritis and pulmonary haemorrhage

pANCA +ve
Treatment - control BP, treat hep B. Corticosteroids and cyclophosphamide

100
Q

Polymyalgia Rhuematica

Features

A

Age >50
Sub-acute onset (<2 weeks) of bilateral aching, tenderness and morning stiffness in the shoulders and proximal limb muscles ± polyarthritis, tenosynovitis and carpal tunnel

Weakness is not a feature

Maybe associated with fatigue, fever, weight loss, anorexia and depression

101
Q

Polymyalgia Rheumatica

Investigations

A

Raised CRP
ESR> 40
raised ALP
creatinine kinase is normal

102
Q

Polymyalgia Rheumatica

Differential diagnoses

A 
Recent onset RA
polymyositis
hypothyroidism
primary muscle disease
ocult malignancy or infection 
osteoarthritis - cervical spondylosis/ shoulder OA
neck lesion
bilateral subacromial impingement
spinal stenosis
103
Q

Polymyalgia Rheumatica

Management

A

Prednisolone 15mg OD PO
Dramatic response within one week
decrease dose slowly

104
Q

Fibromyalgia

Prevalence

A

10% of new rheumatology referrals

0.5-4%, women 10:1 men

105
Q

Fibromyalgia

Risk Factors

A

female sex
middle age
low household income
divorced
low educational status
belief that pain and activity are harmful
sickness behaviours - extended rest
social withdrawal
emotional problems such as low mood, anxiety or stress
problems or dissatisfaction at work
problems with compensation or time off work
overprotective family or lack of support
inappropriate expectations of treatment

106
Q

Features of Fibromyalgia

A
  • chronic pain >3 months
  • widespread L&R, above and below waist, axial skeleton
  • absence of inflammation
  • presence of pain on palpation at at least 11/18 tender points
  • morning stiffness
  • fatigue
  • poor concentration
  • low mood
  • sleep disturbance
107
Q

Palpation points

fibromyalgia

A
  • suboccipital insertions
  • anterior aspects of inter-transverse spaces C5-7
  • midpoint of upper border of trapezius
  • origin of supraspinatus near medial border of the scapular spine
  • costochondral junction of 2nd rib
  • 2cm lateral from lateral humeral epicondyle
  • upper outer gluteal quadrant
  • posterior to greater trochanter
  • knee at medial fat pad proximal to joint line
108
Q

Management of Fibromyalgia

A

Education of pt and family

  • Explain relapsing & remitting, no easy cure, good & bad days
  • reassure no serious underlying pathology
  • CBT
  • discuss psychosocial issues
  • low dose tricyclic antidepressants - e.g. 10mg amitriptyline and pregabalin/ venlaflaxine
109
Q

Chronic Fatigue Syndrome

A

persistant disabling fatigue lasting more than 6 months
affecting mental and physical function, present > 50% of the time + >4 of
- polyarthralgia
- decreased memory
- unrefreshing sleep
- fatigue after exertion >24h
- persistent sore throat
- tender cervical/ axillary lymph nodes
- management similar to fibromyalgia with graded exercise and CBT

110
Q

Sjorgren’s Syndrome

A

Chronic inflammatory autoimmune disorder
primary or secondary
lymphatic infiltration & fibrosis of exocrine glands- esp lacrimal and salivary

  • decreased tear production
  • decreased salivation
  • parotid swelling
  • may also have vaginal dryness, dyspareunia, dry cough and dysphagia
111
Q

Systemic signs of Sjorgren’s Syndrome

A 
polyarthritis/arthralgia
Raynaurds
Lymphadenopathy
vasculitis
lung/ liver/ kidney involvement
peripheral neuropathy 
myositis 
fatigue
112
Q

Treatment of Sjorgren’s Syndrome

A

Treat sicca symptoms

  • hypromellose (artificial tears)
  • frequent drinks/ sugar free pastilles/ gum
  • NSAIDs and hydroxychloroquine for arthralgia
113
Q

Churg-Strauss syndrome

A 
triad of 
- adult onset asthma
- eosinophilia
- vasculitis ± vasospasm ±MI ±DVT
affecting lungs, nerves, heart and skin 
septic shock picture or systemic inflammatory response syndrome with glomerulonephritis may occur
114
Q

Treatment of Churg-Strauss

A

steroids

if refractory - biologics- e.g.rituximab

115
Q

Henoch-Schonlein Purpura

A

small vessel vasculitis
presents with purpura over buttocks and extensor surfaces
typically affects young men
may be glomerulonephritis, arthritis and abdominal pain ± intussusception

3B General Care (8 decks)

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