Block 9: gout, osteoarthritits, osteoporosis, PMR, Psoriasis Flashcards

Question

Osteoporosis treatment

Answer 1

- Conservative: quit smoking, reduced alcohol, regular exercise, Balanced diet - Medical: Bisphosphonates (oral alendronic acid, IV zoledronate), Teripartide, Denosumab. Calcium and vitamin D replacement - Surgical: bony fractures

Answer 2

- Do FRAX score in women >65 and men >75 - OR - In women <65 and men <75 with risk factors

Answer 3

- Offer DEXA scan without initial FRAX score to anyone >50 with history of fragility fracture - Consider starting treatment without DEXA scan in people with a vertebral fracture - For patients with risk factors for osteoporosis do a FRAX score first. High risk patient should have DEXA

Answer 4

- An inflammatory condition causing pain and stiffness in the shoulder and pelvic girdle - More common in women >50 and caucasian - Respond well to steroids, treatment tends to be over 2-3 months - 15% develop GCA

Answer 5

- Shoulder and/or pelvic girdle pain and morning stiffness lasting at least 45 minutes (may be initially unilateral but then becomes bilateral). Worse in the morning and after rest, interferes with sleep - Improvement in symptoms one week after a trial of corticosteroids (usually prednisolone) - Systemic features: low grade fever, fatigue, anorexia, weight loss and depression - Peripheral oligoarticular arthritis (wrist, knee and metacarpophalangeal joint) - Associated features: muscle tenderness, carpel tunnel syndrome, peripheral oedema

Answer 6

- Have red flags of serious pathology (including weight loss. night pain or neurological features) and don’t have a identifiable cause - Younger than 60 - Do not have the core symptoms of PMR: Bilateral shoulder/pelvic girdle pain, >45 minutes of morning stiffness - Have unusual features of PMR: Normal, or very high inflammatory markers, Chronic onset of symptoms, Limited response to steroids

Answer 7

- CRP/ESR: normally elevated. CRP is more sensitive but ESR is associated with higher risk of relapse - Bloods: FBC, U&E, LFT, TSH, Calcium, Creatine kinase, Serum protein electrophoresis, RF, anti-CCP - Urine dip - Chest x-ray: before commencing methotrexate - US: subacromial bursitis is associated with PMR

Answer 8

- Age >50 - Acute or subacute bilateral pelvic and/or shoulder girdle aching, morning stiffness lasting >45 minutes - A good response to corticosteroids - Acute phase response: elevated CRP or ESR - Exclusion of other conditions that mimic PMR: infection, active cancer and GCA

Answer 9

- Oral corticosteroids and gradually weaned off with dose adjustments being every 4-8 weeks and reviews one week after each dose adjustment - If symptoms begin again after dose reduction then dose may need to be increased. Don’t need routine bloods can rely on reported symptoms

Answer 10

- Chronic relapsing course- symptoms exacerbate frequently when reducing the corticosteroid dose - Risks of corticosteroids: osteoporosis, increased infection risk, T2D, hypertension, cataracts, glaucoma, skin changes (thinning or bruising) - GCA

Answer 11

- 15mg until the symptoms are fully controlled, then - 12.5mg for 3 weeks, then - 10mg for 4-6 weeks, then - Reducing by 1mg every 4-8 weeks

Answer 12

- Don’t – steroid dependence occurs after 3 weeks of treatment, and abruptly stopping risks adrenal crisis - S – Sick day rules (steroid doses may need to be increased if the patient becomes unwell) - T – Treatment card – patients should carry a steroid treatment card to alert others that they are steroid-dependent - O – Osteoporosis prevention may be required (e.g., bisphosphonates and calcium and vitamin D) - P – Proton pump inhibitors are considered for gastro-protection (e.g., omeprazole)

Answer 13

A type of systemic vasculitis affecting the medium and large arteries. Key complication is visual loss which can be irreversible

Answer 14

- Unilateral headache: severe and around the temple and forehead - Temple artery is tender and thickened to palpation with reduced or absent pulsation - Scalp tenderness (e.g., noticed when brushing the hair) - Jaw claudication - Blurred or double vision - Loss of vision if untreated

Answer 15

- Clinical presentation - Raised inflammatory markers, particularly ESR (usually more than 50 mm/hour) - Temporal artery biopsy (showing multinucleated giant cells) - Duplex ultrasound (showing the hypoechoic “halo” sign and stenosis of the temporal artery)

Answer 16

- Steroids: started immediately before confirming diagnosis. 40-60mg prednisolone daily with no visual symptoms or jaw claudication. 500mg-1000mg methylprednisolone daily with visual symptoms or jaw claudication - Once condition is controlled steroid dose is weaned over 1-2 years - Aspirin 75mg daily decreases vision loss and strokes - Proton pump inhibitor (e.g., omeprazole) for gastroprotection while on steroids - Bisphosphonates and calcium and vitamin D for bone protection while on steroids

Answer 17

- Steroid-related complications (e.g., weight gain, diabetes and osteoporosis) - Visual loss - Cerebrovascular accident (stroke)

Answer 18

- 85-90% - Well defined patches of redness with a thick silver scale - Typically on extensor surfaces like elbows and knees - Increased itch

Answer 19

- Intense proliferation and abnormal keratinocytes proliferation, triggered by an active cellular immune system - Role for T cells, dendritic cells and cytokines - Genetic factors: HLA-B13, -B17 and Cw6 - Type 1 psoriasis (young onset) most strongly associated with CW0602 (PSORS1) - Environmental triggers i.e. trauma, infection, drugs, EtOH. Improved by sunlight

Answer 20

- Psoriatic epidermis contains scattered neutrophils - Neutrophil microabcesses can form - Psoriasis may be pustular

Answer 21

- Guttate psoriasis - Erythrodermic psoriasis - Scalp psoriasis - Flexural psoriasis Features of psoriasis: nail pitting, onycholysis

Answer 22

- First line treatment of Psoriasis: Calcipotriol, Tar, Dithranol (anthralin) for chronic plaque psoriasis, topical steroids - Photo: PUVA, UVB - Systemic: biologics, ciclosporin, methotrexate, retinoids - The systemic treatment is more toxic then first line

Answer 23

- Erythematous plaque covered in silvery white scale - Clear delineation between normal and affected skin - Typically effects extensor surfaces like elbows and knees - Plaques 1 to 10cm in size - If the scale is removed, a red membrane with pinpoint bleeding points may be seen (Auspitz's sign)

Answer 24

- Regular emollients to reduce scale loss and pruritis - First line: potent corticosteroids once daily plus vitamin D analogue applied once daily for up to 4 weeks - Second line: if no improvements after 8 weeks then a vitamin D analogue twice daily - Third line: if no improvements after 8-12 weeks then either a potent corticosteroid twice daily up to 4 weeks or a coal tar preparation OD or BD. Short acting dithranol can be used.

Answer 25

- Psoriatic arthropathy - Increased incidence of metabolic syndrome - Increased incidence of cardiovascular disease - Increased incidence of venous thromboembolism - Psychological distress

Answer 26

- More common in children and adolescents. - May be precipitated by a streptococcal infection 2-4 weeks prior to the lesions appearing. - Tear drop papules on the trunk and limbs. Pink scaly patches or plaques of psoriasis - Tends to be acute over days - Tends to resolve spontaneously within 2-3 months. Use topical agents as per psoriasis, UVB phototherapy. Tonsillectomy might be necessary with recurrent episodes

Block 9: gout, osteoarthritits, osteoporosis, PMR, Psoriasis Flashcards

(50 cards)