Autoimmune and Systemic MSK Conditions

Question 1

What is Polymyalgia Rheumatica?

Answer 1

This is essentially a systemic vasculitis owing to inflammation of the vessels

Question 2

What type of arthritis is it?

Answer 2

Giant Cell arteritis

Question 3

What is the prevalence of this disease?

Answer 3

This affects mainly the over 50’s with a F:M of 2:1

Question 4

What is the classical presentation of the disease?

Answer 4

Sudden onset of severe pain and stiffness in the morning lasting longer than 45 minutes usually affecting the shoulder, hips and lumbar spine

Question 5

What HALLMARK symptom do the NOT show?

Answer 5

No weakness

Question 6

What systemic symptoms do people with PR have?

Answer 6

Tiredness
Apetite loss
Weight loss
Depression 
Fever
Malaise
Noctuanl sweats

Question 7

What are the main investigations of PR?

Answer 7

Raised ESR and CRP
FBC shows anaemia
temporal artery biopsy
CK is normal as the differential is myopathy

Question 8

What is the main management of PR?

Answer 8

Corticosteroids = prednisone

Question 9

What is giant cell arteritis ?

Answer 9

This is a granulomatous inflammation of the superficial femoral or occipital arteries

Question 10

How does a person present with GCA?

Answer 10

Headache over one area
Pain in the same area
Tenderness
Jaw claudication 
Painless temporary loss of vision

Question 11

What is the diagnostic test for GCA?

Answer 11

Temporal artery biopsy

Question 12

What is the treatment for GCS?

Answer 12

Start ASAP on prednisone to prevent blindness

Step dow the steroids within 2 years

Question 13

What does SLE stand for?

Answer 13

Systemic lupus erythematous

Question 14

What is SLE and what are the 4 key features of the disease?

Answer 14

This is a systemic chronic autoimmune condition which shows 4 key factors:

1. Inflammation
2. Fibrosis and scarring
3. Vasospasm
4. Vascualar thrombosis

Question 15

Who tends to present with SLE?

Answer 15

women of reproductive age

Question 16

What are the causes of SLE?

Answer 16

Genetics
UV light
Premenopausal

Question 17

What are the 11 criteria of SLE?

How many do you need to have to have the condition?

Answer 17

Mary          Macular Rash 
Did            Discoid rash
Pass          Photosensitivity 
Over          Oral ulcers
All              Arthritis 
Somewhat  Serositis
Risky          Renal issues
Now           Neuro - psychiatric/ seizures 
Having       Haematological = low platelets, WCC anaemia
Incredible  Immunology 
Adventures ANA+

Question 18

What are the key investigations in SLE?

Answer 18

ANA testing 
Urine dip
FBC
Immunological testing 
Anti-dsSNA

Question 19

What is the management of SLE?

Answer 19

Flare = IV prednisolone and cyclophosphamide
Skin issues with topic steroids 
Maintenance with NSAID's 
Immunosupressnats 
Biologica 
Check renal function

Question 20

What is systemic sclerosis otherwise known as?

Answer 20

Scleroderma

Question 21

What is scleroderma?

Answer 21

This is a chronic multi-system disorder that is autoimmune has family links

Question 22

What are the 5 clinical features of Scleroderma?

Answer 22

Calcinosis 
Reynauds
Esophageal dysmotility
SSkin thickening 
Telangiectasia

Question 23

What re some of the associated features of scleroderma?

Answer 23

Mouth ulcers 
Dry eyes
Dry mouth 
Hair loss
Ulcers

Question 24

What are the key investigations in scleroderma?

Answer 24

Autoantibodies - ANA
Anti-centromere antibodies
Anti - SCL - antibodies

Question 25

What is the management?

Answer 25

``` Very much dependant on the type of symptoms Asprin, CCB Topicals Ulcer care Coticosteroids PPI, ACEi ```

Question 26

What is Sjorgen's syndrome?

Answer 26

This is an autoimmune condition causing fibrosis and infiltration of the exocrine glands causing lack of lacrimal and salivary secretions

Question 27

What are the diagnostic features?

Answer 27

In the absence of RA, dry eyes is diagnostic, especially in females

Question 28

What are some of the features of SS?

Answer 28

``` Dry eyes, mouth and vagina Parotid gland enlargement Athralgia Reynauds Dysphagia Pulmaory fibrosis ```

Question 29

What test are you going to do in SS?

Answer 29

Schirmer test = filter paper under eyelid | Sjorgen autoantibody

Question 30

What is the treatment of Sjorgens?

Answer 30

Artificial tears | Hydroxychoroquine

Question 31

What is Dermato/polymyositis

Answer 31

this is a rare disorder of unknown cause which caused inflammation of the striated muscle causing proximal muscle weakness

Question 32

What are the 4 clinical features?

Answer 32

Skin itching Muscle weakness Dysphagia Athralgia

Question 33

What are the diagnostic tests?

Answer 33

Serum CK increase EMG Muscle biopsy

Question 34

What are you going to do for them?

Answer 34

Prednisolone IV | Suncream