Inflammatory Conditions Flashcards
(30 cards)
What other condition can polymyalgia rheumatica be linked with?
Giant Cell Arteritis
What are the Sx of Polymyalgia Rheumatica?
Subacute or rapid onset Proximal joints: SHOULDERS & PELVIC GIRDLE B/L aching & tenderness Morning stiffness Tenosynovitis Fatigue Fever & weight loss
How is Polymyalgia Rheumatica investigated?
Bloods: ↑CRP, ↑ESR > 40, CK (N), ↑ALP
How is Polymyalgia Rheumatica managed?
Prednisolone: 15mg OD PO for >2years
PPI & Bisphosphonate
IV Methylpred for rapid relief
What are the types of Large vessel vasculitis?
GCA
Takayasu’s
What are the types of Medium vessel vasculitis?
Kawasaki
Polyarteritis Nodosa
What are the types of Small vessel vasculitis?
ANCA +ve: Churg-Strauss, Microscopic polyangitis
ANCA -ve: HSP, Goodpasture’s
What are the types of variable vessel vasculitis?
Bechet’s
How does the Chapel Hill Consensus Conference classify vasculitides?
- Infective: Direct invasion of pathogens into vascular wall = inflammation
- Non-infective: Autoimmune
How does small vessel vasculitis present?
Palpable purpura- may become confluent → plaques +/- ulcers Papules Urticaria Vesicles Splinter haemorrhages
How does medium vessel vasculitis present?
Nodules Ulcers Digital infarcts Lived Reticularis (mottled purplish lace-like discolouration of skin) Papulo-necrotic lesions HTN- damaged renal vessels
How does large vessel vasculitis present?
End organ damage: TIA, CVA, HTN, CVD
Aneurysm
Dissection +/- haemorrhage
How is vasculitis investigated?
Imaging: ANGIOGRAPHY +/- BIOPSY
Bloods: ↑ESR, ↑CRP, ANCA, RF, Hepatitis serology
Urine: MSC
How is vasculitis managed?
Steroids:
ImmunoS: Cyclophosphamide for s/m vessel disease
ANCA +ve: Mycophenolate
What are the complications of vasculitis?
CNS infarct LT steroid use AV thrombosis Gangrene of digits Pulm haemorrhage
What is dermatomyositis?
AI mediated inflammation of striated muscle causing symmetrical proximal muscle weakness & skin lesions
What are the causes of dermatomyositis?
Idiopathic OR Associated: CT disease Malignancy (Ovarian, breast, lung)
How does dermatomyositis present?
Proximal muscle weakness & tenderness
Photosensitivity
Macular rash: Itchy/burning Back + shoulders = SHAWL sign
Heliotrope rash: Lilac periorbital region w/oedema
Gottron’s papule: Rough, red papules over extensor surfaces of fingers/elbows/knees
Nail fold capillary dilatation
How is dermatomyositis investigated?
Bloods: ANA +ve, Anti-Mi2, ↑↑CK, ↑AST ↑LDH
Biopsy: Skin & smooth muscle
How is dermatomyositis managed?
Prednisolone
Photosensitivity: Hyroxychloroquine
How is dermatomyositis differentiated from polymyositis?
Poly = ↑Anti-Jo1
Same as dermatomyositis but NO rash
What is the pathophysiology of gout?
Renal re-absorption of urate & poor excretion = supersaturation
Deposition of monosodium urate crystals in & near joints
Crystals interact w/phagocytes & trigger inflammatory response
Over time forms tophi
Leads to acute monoarthropathy & severe joint inflammation
What are the RFs for gout?
↑Purine diet OH- Surgery Starvation CKD Diuretics Infection Male
Where does gout commonly affect?
MTP OF BIG TOE Ankle Foot Wrist Knee Elbow Hand
