disease profiles MSK Flashcards
(356 cards)
1
Q
what is osteoporosis
A
reduced bone mineral density and increased porosity
2
Q
what comes as a result of osteoporosis
A
increased fragility and fracture risk
3
Q
normal quality of bone just not enough of it
A
osteoporosis
4
Q
risk factors of osteoporosis
A
smoking, poor diet, female, inactivity, increased alcohol intake and lack of sunlight exposure
5
Q
what is the intermediate stage of osteoporosis
A
osteopenia
6
Q
what is type 1 osteoporosis
A
post menopausal
7
Q
what is type 2 osteoporosis
A
osteoporosis of old age
8
Q
what type of fractures dominate osteoporosis type 2
A
neck and vertebral fractures
9
Q
how to diagnose osteoporosis
A
DEXA scanning
10
Q
how to treat (slow process) of osteoporosis
A
calcium and vit D supplements
11
Q
abnormal softening of bone due to deficient minerilisation of osteoid secondary to inadequate amounts of calcium and phosphorus
A
osteomalacia
12
Q
what is an osteoid
A
immature bone
13
Q
what is osteomalacia in children known as
A
rickets
14
Q
what are the causes of osteomalacia and rickets
A
insufficinet calcium and phosphate deficiency
15
Q
how can there by a lack of calcium
A
lack of absorption in intestine or resistance to action of vit D
16
Q
how does phosphate deficiency happen
A
increased renal losses
17
Q
what is the presentation of osteomalacia and rickets
A
pain, deformities from soft bone, pathological fractures, symptoms of hypocalcaemia
18
Q
how to treat osteomalacia and rickets
A
vit D therapy with calcium and phosphate supplementation
19
Q
what is hyperparathyroidism
A
over activity of parathyroid glands with high levels of PTH
20
Q
what is primary hyperparathyroidism due to
A
benign adenoma, hyperplasia or rarely a malignant neoplasia
21
Q
labs of someone with primary hyperparathyroidism
A
raised serum PTH, raised Ca, phosphate low or normla
22
Q
what is secondary hyperparathyroidism due to
A
physiologial overproduction of PTH secondary to hypocalceamia
23
Q
what is secondary hyperparathyroidism caused by
A
vit D deficincy or chronic kidney disease
24
Q
what is tertiary hyperparathyroidism due to
A
people with chronic secondary who develop adenoma which continues to produce PTH despite biochemical correction
25
what is renal dystrophy
reduced phosphate excretion and inactive activation of Vitamin D
26
what does renal dystrophy lead to
secondary hyperparathyroidism with subsequent osteomalacia, sclerosis of bone and calcification of soft tissues
27
what is pagets disease
a chronic disorder resulting in thickened britter and misshapen bones
28
labs of pagets disease
serum alk phos is raised whilsy calcium and phsphorus are usually normal
29
how to treat pagets disease
with biphosphonates or calitonin
30
what is rheumatoid arthritis
symmetrical inflammatory polyarthtritis affecting mainly the peripheral joints which if untreated can potentially lead to joint damage and irreversible deformities and increased morbidity and mortality
31
prevalence of RA in men and women
3x more common in women
32
prevalence of RA in the UK
1%
33
what is RA mediated by
HLA -DR4
34
cause of RA
unknown
35
trigger of RA
infections, stress, cigarette smoking
36
severity of RA depends on
genetic factors, presence of auto antibodies
37
what is the main structure involved in RA
synovium
38
what does the synovium line
the inside of the synovial joint capsules and tendon sheaths
39
what joints in the spine are synovial fluid lined
C1/C2
40
what joints are usually affected by RA
hand joints, wrists, elbows, shoulders, TMJs, knees, hips, ankles, feet
41
difference between osteoarthritis and RA
osteoarthritis is when bone ends rub together and RA is when a swollen inflamed synovial membrane causes bone erosion
42
inflamed synovial is called
pannus
43
what happens when panes is in contact with bone
osteoclast is activated causing bone erosion
44
what is released from macrophage in RA
TNFa, IL1 and IL6
45
what is released from B cells in RA
RF and IL 6
46
what do the activation of pro inflammatory cytokines lead to in RA
- activation of synoviocytes to cause the hypertrophic synovium / pannus
- activation of osteoclasts
- inhibition of chondrocytes
- stimulation of angiogenesis
47
what drugs inhibit TNFa
infliximab, etanercept, adalimumab, certolizumab, golimumab
48
what drugs inhibit iL1-
anakinra
49
what drugs inhibit the IL6 receptor
tocilizumab
50
presentation of RA
pain and swelling in symmetrical fashion affecting peripheral synovial joints, typically small joints of hands and feet, prolonged morning stiffness, monoarthritis (rare), tenosynovitis, trigger finger, carpal tunnel, palindromic, systemic symptoms, poor grip strength
51
what test can be used of the detection of synovitis in RA
squeeze test
52
what is tenosynovitis
inflammation of the tendon sheath
53
what is trigger finger
fingers lock
54
palindromic
episodic RA
55
lung manifestations of RA
Plueral effusion, rheumatoid nodules
56
heart manifestations of RA
pericarditis, pericardial effusions
57
neurological manifestations of RA
peripheral neuropathy, carpal tunnel syndrome
58
leg ulcers associated with RA
arterial
59
diagnosis of RA
mainly clinical, peripheral symmetrical polyarthtritis affecting hands and feet, raised inflammatory markers, antibody testing not always positive, imaging
60
autoantibodies in RA
rheumatoid factor (rheumatoid IgM), antiCCP antibodies
61
what autoantibody in RA is more specific
Anti CCP
62
what autoantibody has low sensitivity in RA
anti CCP
63
score for disease activity in RA
DAS 28
64
management of RA
early diagnosis, disease modifying anti rheumatic drugs, NSAIDs and steroids, education
65
what is early RA defined as
less than 2 years since symptom onset
66
therapeutic window of opportunity in RA
first 3 months
67
first line for RA
education, rest, exercise, social services, salicylates, NSAIDs
68
second line for RA
gold salts, hydroxychloroquine
69
third line for RA
MTX, penicillin amine, AZA
70
last line for RA
cytotoxic agents and experimental drugs
71
examples of DMARD
methotrexate, sufasalazine, hydrochloroquine, leflunomide, steroids
72
what can methotrexate cause in the lungs
pneumonitis
73
who to avoid methotrexate with
people with lung disease
74
less than 2.6 DAS28 scoring
remission
75
2.6-3.2 DAS28 scoring
low disease activity
76
3.2-5.1 DAS28 scoring
moderate disease activity
77
more than 5.1 DAS28 scoring
active disease
78
what DAS28 score qualifies for biologic therapy
3.2 inspite of 2 DMARDs
79
what is osteoarthritis
a chronic disease characterised by cartilage loss and accompanying periarticular damage
80
what are the most affected joints in osteoarthritis
knees, hands and hips
81
what is the pathophysiology of OA
metabolically active dynamic process that involves all joint tissues
82
what are the key pathological changes in OA
localised loss of hyaline cartilage and remodelling of adjacent bone with new bone formation at joint margins
83
what indicates a repair process of synovial joints
combination of tissue loss and new tissue synthesis
84
risk factors of OA
genetic, ageing, female, obesity, biomechanics
85
features of a OA joint
subchondral bone cyst, thickened joint capsule, episodic synovitis, fibrillated cartilage, osteophyte, degenerative cartilage loss, subchondral bone sclerosis
86
localised OA
can effect hips, knees, finger interphalangeal joints, facet joins of lower cervical and lower lumbar spines
87
generalised OA
defined as OA at either the spinal or hand joints and in atleast 2 other joint regions
88
what does the presence of multiple heberdens nodes indicate
a subset of OA involving DIP joints, thumb bases, first MTP joints, lower lumbar and cervical facet joints, knees and hips
89
joints most affected by OA
neck, lower back, hips, base of thumb, finger joints, knee, base of toe
90
examination features of OA
joint line tenderness, crepitus, joint effusion, bony swelling, deformity, limitation of motion
91
where is heberdens node found
top of fingers
92
where is bouchards node found
bottom of fingers
93
presentation of knee OA
osteophytes, effusions, crepitus, restriction in movement, genuflects varies and valgus deformities, bakers cysts
94
distribution of hip OA
pain felt radiating to knee or groin, pain in hip can be radiating from lower back, hip movement restricted
95
distribution of spine OA
cervical - pain and restriction of movement , occipital headaches, osteophytes may impinge on nerve roots
lumbar - osteophytes can cause spinal stenosis if they encroach on the spinal canal q
96
diagnosis of spinal OA
clinical, imaging
97
what would u see on a OA x ray
marginal osteophytes, joint space narrowing, subchondral sclerosis, subchondral cysts
98
management of OA
education, lifestyle, physiotherapy, occupation therapy, analgesia, local intra articular steroid infections
99
surgical management of OA
joint replacements arthroscopic surgery to remove loose bodies
100
what are crystal arthropathies
a diverse group of disorders characterised by the deposition of various minerals in joints and soft tissues leading to inflammation
101
types of crystal arthropathies
gout monosodium urate crystals, pseudogount calcium pyrophosphate crystal deposition, hydroxyapatite - basic calcium phosphate deposition
102
define gout
a potentially disabling and erosive inflammatory arthritis caused by deposition of monosodium urate crystals into joints and soft tissues
103
prevalence of gout
2.49%
104
prevalence of gout in men vs women
more common in men
105
causes of hyperuricaemia
increased urate production and reduced urate excretion
106
what causes increase urate production
inherited enzyme defects, myeloproliferative / lymphoproliferative disorders, psoriasis, alcohol, high dietary purine intake
107
what causes reduced urate excretion
chronic renal impairment, volume depletion, hypothyroidism, diuretics, cytotoxic
108
how long does acute gout usually last
3 days with treatment, 10 days without
109
what is chronic tophaceous gout associated with
diuretics
110
investigations of gout
serum uric acid is raised, raised inflammatory markers, polarised microscopy synovial fluid, renal impairment, x rays
111
treatment of acute gout
NSAIDs, cohcicine, steroids, lifestyle modification
112
preventative measures for gout
Xanthine oxidase inhibitors - allopurinolm febuxostat, uricosuirc drugs - sulfinpyrzone, prodenecid, benzbromarone,
113
when should you start preventive treatment for gout
1 week after acute attack
114
WHO target for serum uric acid
300-360 mol/L
115
indications for prophylactic treatment of gout
one or more attacks of gout in a year inspite of lifestyle modifications, presence of gouty tophi or signs of gouty arthritis, uric acid calculi, chronic renal impairment, heart failure where unable to stop diuretics, chemo therapy patients who develop gout
116
who is pseudo gout most common in
elderly
117
what is pseudo gout also known as
calcium pyrophosphate deposition disease
118
treatment of pseudo gout
NSAIDS, cochincine, steroids rehydration
119
what is hydroxyapatite
crystal deposition in or around the joint
120
treatment of hyrocyapaitie
NSAIDs, intra articular steroid injection, physiotherapy, partial or total arthroplasty
121
what does hydroxyapatite lead to the release of
collagenases, serine proteinases and IL-1
122
what is soft tissue rheumatism
pain that is caused by inflammation/damage to ligaments, tendons, muscles or nerve near a joint rather than bone or cartilage
123
generalised soft tissue pain
fibromyalgia
124
what is the most common area for soft tissue pain
shoulder
125
investigation of soft tissue rheumatism
clinical history and examination, Xray, US, MRI, identify precipitating factors
126
treatment of soft tissue rheumatism
pain control, rest and ice compression, PT, steroid injections surgery
127
prevalence of joint hyper mobility syndrome in men and women
women more than men
128
genetic syndromes leading to joint hypermobility syndrome
marfans, Ehlers danlos syndrome
129
when does joint hyper mobility syndrome tend to present
childhood or 3rd decade
130
signs and symptoms of jointer hypermobility syndrome
joint pains, joint stiffness, foot and ankle pain, neck and backaches frequent sprains and dislocations, thin stretchy skin
131
what scoring system is used for hypermobility syndrome
beighton score
132
what score on the Brighton score constitutes a diagnosis
>4/9
133
treatment of joint hypermobility syndrome
patient education, physiotherapy, analgesiA
134
what are connective tissue diseases
conditions associated with spontaenous overactivity of the immune system
135
what is present in connective tissue disease
auto antibodies
136
types of CTD
SLE, sjogrens syndrome, systemic scleoriss, dermatomyositis, polymyositis, anti phospholipid syndrome
137
what is SLE
an auto immune condition that can affect most organ systems
138
pathophysiology of SLE
immune system attcks cells causing inflammation and tissue damage
139
ratio of female to male prevelance of SLE
9:1
140
when does SLE present
at child bearing women
141
pathogenesis of SLE
defective apoptosis leading to cell contents float about for longer than normal allowing the immune system to start to develop a reaction against them so the cell contents are seen as antigens (autoantigens), immune cells trigger a response which means over time there are antbodies against these antigens which then start to recognise antigens within normal cells and attack them this causes immune complexes to form and they get deposited in skin, blood vessel walls of kidneys and that deposition activates the complement cascade causing focused inflammation in certain areas causing necrosis and fibrosis causing organ damage
142
SLE score
EULAR/ACR
143
what must be positive in SLE
ANA
144
what score constitutes SLE
10
145
skin manidestatins of SLE
discoid lupus, cutaneous lupus, alopecia, oral ulceration, buttterly facial rash
146
types of arthritis in SLE
synovitis, jaccouds arthropathy
147
x ray of jaccouds athropathy
normal
148
neorological manifestations of SLE
delirium, psychosis, seizure, headache, cranial nerve disorders
149
serositis in SLE
pleurisy, pericarditis, pericardial effusions
150
heamotological manifestations of SLE
leukpenia, thrombocytopenia, haemolytic anaemia, lymphadenopathy
151
renal manifestatiosn of SLE
proteinuria, biopsy proven nephritus, red cell casts
152
what is specific in SLE
dsDNA
153
what is highly specific for lupus
anti Sm
154
management of lupus (mild)
sun protection, vaccinations, lifestyle, HCQ, short courses of steroids, MTX/AZA
155
treatment for patients with anti phosphilipd syndrome
antiplatelets and anti coagulants
156
management of moderate lupus
HCQ,MTX/AZA, GC.PO/IV
157
treatment of severe lupus
cyclic phosphilide
158
how to monotor lupus
SLEDAI score
159
symptoms of sjogrens
drye eyes, gritty feeling, dry mouth, dry throat, vagina dryness, bilateral parotid gland enlargement, joint pains, fatigue,, unexplained increase in dental caries
160
immunology of sjogrens
anti Ro, anti La
161
what does sjogrens put people at risk of
lymphoma
162
what is systemic scleorisis
a multisystem autoimmune disease characterised by vasculopathy, autoimmunity and fibrosis
163
sympyoms of systemic scleorisis
raynauds, skin thickenng, difficulty swallowing, GORD, telangiectasia, calcinosis, +/- SOB, digital ulcers or ischeamia, skin tightness/loss of dexterity of hands
164
diffuse cutaneous systemic sclerosis
skin involvement above and below elbows and knees
165
limited systemic sclerosis
skin involvement on extermities below the elbows and knees - sparing the torsu
166
key antibodies in systemic sclerosis
anti centromere - limited , anti STL70 - diffuse, anti RNA polymerase 3
167
facial changes in systemic sclerosis
small mouth with puckering, beaked nose, tigh skin - no wrinkles and telangiasia
168
GI complications of systemic sclorisis
dysphagia, GORD, GAVE, small intestinal bacterial overgrowth, malabsorption, fluctuating bowel habiy, faecal incontinance
169
cardio plmonary complications of systemic sclerosis
interstitial lung disease, pulmonary arterial hypertension, myocardial disease
170
renal complications of systemic sclerosis
sclerodrma renal crisis, non specific progressive renal dysfunction
171
what is raynauds phenomenon
blanching, acrocyanosis, reactive hypereamia
172
how to treat rynauds
nifedipine - first line, PDE-5 inhibitor- sildenafil, proyacyclin infisiom - iloprots, endothelin recepyor antagonst - basentan
173
pulmonary hypertension classified by
>25mmhg at rest by right heart catheterisation
174
symtoms of pulmonary hypertension
SOB on exertion
175
treatment for pulmonary hypertension
PDE5 inhibitor, ERA, eproprotinol infusions, oxgen
176
examples of PDE5 inibitor
sildenafil
177
example of ERA
bosentan
178
treatment of interstitial lung disease
MYCOPHEMOLATE, rarely cyclophosphamide, rituximab, nintedanib
179
what is systemic sclerosis renal disease assoiated with
anti RNA polymerase 111 antibody
180
what puts people at risk of enal disease
steroids
181
how to treat renal crisis
ace inhibitors
182
treatment of skin fibrosis
methotrexate, mycophenolate
183
what is spndyloarthropathy
family of inflammatory arthritides characterised by involvement of both spine and joints, principally in genetically predisposed individuals
184
genetic predisposition of spondyloarthropathies
HLA-B27
185
what is HLA-B27 associated with
ankylosing sponylitis, reactive arthritis, crohns disease, uveitis
186
spondyloarthrtitis sub groups
ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritic
187
mechanical back pain
worsened by activity, typically worst at end of the day, better with rest
188
inflammatory back pain
worse with rest, better with activity, significant early morning stiffness
189
what is enthesitis
inflammation at isertion of tendons into bones
190
what is anklylosing sponylitis
chronic systemic inflammatory disorder that primarily affects the spine
191
when does ankylosing spondylitis present
late adolescence or early childhood
192
who is ankylosing spondylitis more common in
men
193
sacrolitis on imaging
active acute inflammation on MRI suggestive of sacroilitis associated with SpA
194
clinical features of ankylosing spondylitis
back pain, enthesitis, peripheral arthritis, uveitis, cardiovascular involvement, enetric mucosal inflammation, neurological involvement, amyloidosis
195
diagosis of ankylosing spondylitis
history, examination, bloods, x ray
196
examination of ankylosing spondylitis
tragus/occiput to wall, chest expansion, modified schober test
197
bloods for ankylosing spondylitis
inflammatory parameters, HLAB27
198
x rays for ankylosing spondylitis
sacroiliitis, syndesmophytes, bamboo spine
199
difference between AS and OS on imaging
bone density is normal in early AS but reduced in late disease, shiny corners in AS and bamboo spine but in OA there is normal bne density and reduced joint space
200
what is psoriasitic arthritis
inflammatory arthritis asscoated with psoriasis
201
clinical features of psoriasitic arthritis
nail pitting, onycholysis, dactylitis, enthesitis, extra articular features
202
bloods of psoriasitic arthtritis
raised inflammatory parameters, negative RF
203
xray findings of psoriasitic arthritis
marginal erosions and whiskering, pencil in cut deformity, osteolysis, enthesitis
204
what is reactive arthritis
infection induced systemic illness characterised primarily by an inflammatory synovitis from which viable microorganisms cannot be cultures
205
when do symptoms of reactive arthritis occur
1-4 weeks after infection
206
common infections for reactive arthritis
urogenital eg chlamydia, enterogenic eg salmonella, shigella and yersinia
207
who does reactive arthritis typically affect
young adults
208
HLA B27 in reactive arthritis
positive
209
what is reiters syndrome
triad and a form of reactive arthritis
210
what is the triad of reiters syndrome
urethritis, conjutivitis, arthritis
211
clinical features of reither syndrome
general symptoms, asymmetrical monarthritis or oligoarthritis, enthesitis, mucocutaneous lesions, ocular lesions and visceral manifestations
212
bloods of reiters syndrme
inflammatory parameters, FBC, U +Es, HLA B27
213
what is enteropathic arthritis associated with
IBS
214
clinical symptoms of enteropathic arthritis
loose watery stool with mucous and blood, weeightloos and low grade fever, eveitis, pyoderma gangrenosum, enthesitis and oral apthous ulcers
215
management of spondyloarthropathies
NSAIDs, corticosteorids, topical steroid eyedrops, MTX, anti TNF
216
when can you ise secukinumab
only for PsA and AS
217
what is secunumab
anti IL 17
218
what is SLE
a chronic auto immune disease
219
what does SLE incidence increase with
high oestrogen exposue
220
pathogenesis of SLE
developmemnt of autoantibodies as a result of a defect in apoptosis that causes increased cell death and a disturbance of immine tolerance
221
what does increased apoptosis release
nuclear material
222
what produces autoantibodies inSLE
B cell adn T cells
223
epidemiology of SLE
high prevelance in back people in the uS but not black people in africa
224
prognosis of SLE
10 year survival of >90%
225
presentation of SLE
fever, fatigue, weight loss, athralgia, myalgia, inflammatory arthrtitis, avascular necrosis, jacouds arthritis
226
what is jaccouds arthritis
lateral shift on metacarpal = parangeal joint
227
skin manifestations of SLE
malar rash, photosensitiviy, discoid lupus, alopecia, subacute cutaenous lupus, oral/nasal ulceration (painless), reynaids phenomenon
228
what is raynauds phenominon
white/blue extremities in cold
229
renal manifestation of SLE
lupus nephritis
230
respiratory manifestation of SLE
pleurisy, pleural effusion, pnuemonitis, PE, pH and ILD
231
haemolytic manifestations of SLE
leukopenia, lymphopenia, anaemia, thrombocytopenia
232
neuropsychiatric manifestations of SLE
seizures, psychosis, headache, aseptic meningitis
233
cardiac manifestations of SLE
pericarditis, pericardial effusion, PH, sterile endocardiris, and accelerated ischeamic heart disease
234
neurological manifestations of SLE
migraines, seizures, cranial or peripheral neuropathy, mononeuritis complex
235
GI manifestations of SLE
autoimmune hepatitis, pancreatitis, mesenteric vasculitis
236
serositis
inflammation of serous membranes
237
investigations of SLE
immunology, FBC, urinalysis, imaging
238
ANA positive in what % of SLE patients
>95%
239
is ANA specific to SLE
no also in RA, HIV and hepC
240
what antibody is specific to SLE
anti-dsDNA
241
what antibody is spefic to SLE but has low sensitivity
anti-sm
242
what is low when SLE is activity
C3/4 levels
243
what may FBC of SLE show
anaemia, leucopenia, thrombocytopenia
244
what may urinalysis show
glomerulonephritis
245
if glomerulonephritis is positive what should you do
kidney biopsy
246
management of SLE - non pharmacological
Counselling, regular monitoring, avoid sun,
247
what does every lupus get
hydrochloroquine
248
how to treat skin disease and arthralgia in SLE
hydrochloroquine, topical steroids and NSAIDs
249
how to treat inflammatory arthritis or evidnee of some types of organ involvement in SLE
immunosuppresion, moderate corticosteroids
250
how to treat severe organ disease in SLE
Iv steroids, cyclophosphamide
251
how to treat unresponsive SLE
Iv immunoglobin and rituximab
252
mild SLE management
HCQ, topical steroids NSAIDs
253
moderate SLE management
oral steroids, azatioprine/methotrexate
254
severe SLE management
IV steroids cyclophosphamide rituximab
255
what is sjogrens syndrome
autoimmune condition characterised by lymphocyte infiltrates in exocrine organs
256
presentations of sjogrens syndrome
dryness of eyes and mouth, arthralgia, fatigue and vagina dryness and parotid gland swelling
257
what does sjorgens syndrome put people at risk of
lymphoma
258
what can sjorgens syndrome be secondary to
RA or SLE
259
diagnosis of sjorgens syndrome
confirmation of ocular dryness (schirmers test)< +anti-ro and anti-la antibodies and typical features on a lip gland biopsy
260
management of sjorgens syndrome
symptomatic, lubricating eye drops, saliva replacement, dental care, HCQ for athragia and faatigue, immunosuppression in organ involvement
261
what is systemic sclerosis
systemic connective tissue disease
262
what constitutes systemic sclerosis
vasomotor disturbances (raynauds), fibrosis and subsequent atrophy of the skin and subcutaneous tissue, excessive collagen deposition causes skin and internal oragn chnages
263
what causes death in systemic sclerosis
renal and lung changes
264
what % of petinets with systemic sclerosis have pulmonary hypertesion
12%
265
major features of systemic sclerosis
centrally located skin sclerosis that affects the arms, face or neck
266
minor features of systemic sclerosis
includes sclerodactyl and atrophy of the fingertips and bilateral lung fibrosis
267
diagnosis of systemic sclerosis
1 major and 2 minor features
268
organ involvement in systemic sclerosis
pulmonary hypertension, pulmonary fibrosis and accelerated hypersion causing renal crisis, gut involvement may cause dysphagia, malabsorption and bacterial overgrowth of small bowel inflammatory arthritus and myositis
269
limited systemic sclerosis
skin affected confined ti face, hands, forearms and feet
270
antibody in systemic sclerosis limited
anti centromere
271
antibody in diffuse systemic sclerosis
anti - acl- 70
272
what is diffuse systemic sclerosis
organ involvement, rapid skin changes, may involve trunk
273
investigations of systemic sclerosis
anti centromere and anti scl-70, organ screening
274
management of raynauds
raynauds - CCB
275
management of renal crisis
ACEi
276
management of GI symptoms in systemic sclerosis
PPI
277
management of interstitial lung disease
immunosuppression, usually cyclophophamide
278
what is MCTD
raynauds, arthraligia, myositis, slcerodactyl, PH and ILD
279
what is MCTD associated with
anti RNP antibodies
280
managements of MCTD
regular echos, screen of ILD
281
whats is anti phosphilipd syndrome
recurrent venous or arterial thrombosis and / or fetal loss, may not have associated disease but often occurs in conjunction with SLE
282
presentation of APS
increased frequency of stroke or MI, multiorgan infarctions, migraines
283
invesitations of APS
thrombocytopenia and prolongaton of APTT, lupus anticoagulant, ant cardioliin antibodies and anti beta 2 glycoprotein may be positive
284
management of APS
anticoagulation - LMWH in pregnancy as warfarin is teratogenic
285
acute attack of crystal arthropathies duration
upto 2 weeks
286
cause of gout is
monosodium urate
287
how many people have gout in the world
1-2%
288
what gender is gout more common in
men
289
when does prevelance of gout increase
with age
290
what is hyperuricemia
serum uric acid >7mg/dL
291
diagnosis of gout
radiograohic identification of crystals and hyperuricemia
292
when should you meaure serum urate
2 weeks after attack
293
how can hyperuricaemia occur
renal underxcretion or excessive intake of alcohol, red meat and seafood
294
where can uric acid crytals precipitate
in joints which can be triggered by dehydration traima or surgery
295
what can renal underexcretion be exacerbated by
diuretics or renal failure
296
most affected joints in gout
1st MTP, ankle and knee are most affected joints
297
clinical presentation of gout
rapid onset, red, hot joint, severe pain - mimics spetic arthritis symptoms last for 7-10 days
298
what is gouty tophi
painless accumulations of uric acid which can occur in soft tissue and occasuonally erput through skin
299
what. ischronic polyarticular gout
chronic joint inflammation, usually after having recureent acut attacks >10 years. Often diuretic associated. may get acute attacks can alos cause erosive arthritis
300
investigations of gout
inflammatory markers raised, WCC may be raised, X ray, joint aspirate with polarised microscopu
301
what should you see in gout joint aspirate and polarised microscopy
needle shaped crystals yellow to blue
302
management of acute gout
NSAIDs, colchoncne or corticosterods
303
lifestyle modifications in gout
less red meat, beans, shellfish, reduve alcohol,wgt loss, fluids
304
how should you treat people who suffer from recuurent attacks of gout
urate lowering therapy - allopurinal
305
when to start allopurinal in gout
AFTER FLARE HAS CLEARED
306
what is pseudogot caused by
CPPD
307
who mainly gets pseudogout
elderly
308
what is pseudogout related to
OA
309
what does pseudogout tend to affect
knee wrist and ankle
310
crystals seen in pseudogout
rhomboid / envelop shaped crystals
311
treatment of pseudogout
NSAIDs, colchincine, corticosteroids, rehydration
312
what is hydroxyapatite
crystal deposiy in shoulder, acute and rapid deterioration
313
who gets hydroapatite
females 50-60 years old
314
what is hydroxyapatite also known as
milwaukee shoulder
315
what are inflammatory myopathies
polymyositis and dermatomyositis
316
prevelnace of muscle disease by gender
2x more common in females
317
peak age for inflammatory myopathies
40-50 years
318
what does inflammatory myopathies come with
increased incidence of malignancy
319
increase in malignancy in dermatomyositis
15%
320
increase in malignancy in polymyositis
9%
321
pathophysiology of inflammatory myopathies
muscle fibre necrosis, degneration, regeneration, inflammatory cell infitrate
322
clinical features of inflammatory myopathies
muscle weakness (neck, shoulder, hips), worsening onset, usually symmetrical and proximal muscles, often difficulty doing specific tasks myalgia
323
signs of demratomyositis
gottrons sign, heliostrope rash, shawl sign
324
what is gottrons sign
pink rash over MCPJ
325
what is shawl sign
rash accross back of shoulders
326
other manifestations of inflammatory myoapthies
ILD, resp muscle weakness, dysphagia, myocarditis, also fever weight loss, raynauds, non erosive, polyarthritis
327
what to ask about in patients with inflammatory myopaties
diabetes, thyroid disease, steroids, statins, alcohol and illicit drugs
328
diagnosis of inflammatory myopathies
confrontational testing, isotonic testing, blood test, auto antibodies, EMG, muscle biopsy, MRI
329
auto antibodies in inflammatory myopathies
ANA, anti jo 1
330
treatment of inflammatory myopathies
high dose steroid to suppress initially and then decease dose, 20 mg of prednisolone + methotrexate or azathioprine
331
who is body myositis more common in
men and older people
332
what muscles does inclusion body myositis effect
distal muscles
333
what des polymyalgia rheumatica present as
ache in shoulder and hip girdle, morning stiddness, symmetrical, fatigue, anorexia, weight loss, fever, reduced movement, muscle strength is normal
334
who does polymyalgia present in
over 50s
335
incidence of polymyalgia
1%
336
what is polymyalgia associated iwth
temporal arteritis/giant cell arteritis
337
what is termpal arteritis /giant cell arteritis
granulomas arteis of large vessels
338
presentation of temporal/giant cell arthritis
headaches, scalp tenderness, jaw claudication, visual loss and tender enlarged non pulstile temporal arteries
339
diagnosis of polymyaligia rheumatica
exclude other diagnosis, raised ESR, plasma viscosity, CRP, temperoal artery biopsy
340
treatment of polymyalgia rheumatica
treat with low dose steroids, gradually reduce over 18 months to 2 years
341
what is fibromyalgia
oversensitised pain stimulus
342
prevelance of fibromyalgia
2.5%
343
who does fibromyalgia present in
women 22-50
344
presentation of fibromyalgia
pain in neck, shoulders, lower back, chest wall, pins and needles, ibs, poor concentration and memroy
345
examination of fibromyalgia
excessive tenderness on palpation of soft tissues
346
treatment of firbomyalgia
pain control - atypical analgesia - amitriptyline, gabapentin, pregbalin, graded excersise programme, cbt
347
what. is vasculitis
presence of leukocytes / immune complexes in vessel wall damaging structure
348
how to classify vasculiti
by size of vessel or ANCA +
349
example of ANCA + vasculitis
wegeners, microscopic polyangitis, churg strauss
350
presentation of vasculitis
myalgia, arthralgia, fever, wgt loss, skin infarct, bloody nasal discharge, ulcers, paranasl sinus involvement, gangrene, subglottic stenosis, conductive deafness, sensorineural, hearing loss, pulse loss, valve disease, pericarditis, cardiomyopathy, congestive HF, peritonitis, bloody diarrhoea, ischeamic abdominal pain
351
test for vasculitis
ANCA
352
score for vasculitis
BVAS
353
untreated vasculitis prognosis
fatal
354
prognosis of treated vasculitis
5 yr survival is 90%
355
least common small cell
microscopic polyangitis
356
what does small cell microscopic polyangitis affect
kidneys
