mrcp Flashcards
Ankylosing Spondylitis
Clinical Features:
-Low Back Pain and Stiffness: Characterized by low back pain and back stiffness.
Stiffness is typically worse in the morning.
X-ray Findings: Subchondral erosions. , Sclerosis. ,Squaring of lumbar vertebrae.
Diagnostic Support: Best supported by sacro-ilitis observed on a pelvic X-ray.
Additional Imaging Findings: Chest X-ray:May reveal apical fibrosis in later stages
*Ankylosing spondylitis features - the ‘A’s
-Apical fibrosis -Anterior uveitis -Aortic regurgitation -Achilles tendonitis -AV node block -Amyloidosis
Additional Feature: Syndesmophytes: Ossification of outer fibres of the annulus fibrosus.
First-Line Management:
-Exercise regimes. -Nonsteroidal anti-inflammatory drugs (NSAIDs)
Osteoporosis(Decreased bone density, porous bones.)
Risk Factors:
*Post Menopausal women
*Hyperthyroidism is associated with an increased risk of osteoporosis.
*Excessive levothyroxine in hypothyroidism may also pose a risk.
*Low body mass, rather than obesity, increases the risk of osteoporosis.
-In men with osteoporosis, checking testosterone levels is important to exclude hypogonadism.
-Biochemical :normal calcium, phosphate, ALP and PTH levels
Dx DEXA scans: the T score is based on bone mass of young reference population
(T score)> -1.0 = normal if -1.0 to -2.5 = osteopaenia, if < -2.5 = osteoporosis
Treatment and Medications:(try medications after life style modification)
1-Denosumab: Inhibits RANK ligand, thereby inhibiting the maturation of osteoclasts.
2-Bisphosphonates:(inhibit osteoclasts) Consider starting bisphosphonates without waiting for a DEXA scan in individuals with osteoporosis. SE:oesophageal problems
3-Raloxifene: Potential considerations:
May worsen menopausal symptoms.
Increased risk of thromboembolic events.
May decrease the risk of breast cancer.
Osteopetrosis:
-Increased bone density, abnormally thick and dense bones.
-rare genetic due to a defect in osteoclast function.
-Normal levels of calcium, phosphate, ALP, and PTH.
Osteomalacia:
-Biochemical profile includes low calcium and phosphate, and elevated alkaline phosphatase.
-Clinical features involve bone pain, tenderness, and proximal myopathy.(waddling gait)
-Radiographic findings may include Looser’s zones.
Paget’s Disease:
-Clinical presentation includes isolated raised ALP and bone pain.
-Increased levels of hydroxyproline.
-Treatment involves bisphosphonates, such as dronate.
Rheumatoid arthritis ( TNF is key in pathophysiology)
prognostic factors - negative RF associated with a good prognosis, And Anti-CCP antibodies indicating a poor prognosis.
early X-ray feature : Juxta-articular osteoporosis/osteopenia, especially in the PIP joints and metacarpals .
Rheumatoid Factor (RF) is an IgM antibody against IgG.
Management typically involves DMARD monotherapy, commonly with methotrexate, and may short-course of prednisolone.
*methotrexate and (trimethoprim/ cotrimoxazole) cause bone marrow suppressionso avoid trimethoprim
*RA patients are at an increased risk of developing ischemic heart disease
Osteoarthritis
-Swelling of Carpometacarpal and distal interphalangeal joint involvement is characteristic of hand osteoarthritis
TTT - paracetamol + topical NSAIDs (if knee/hand) first-line
*NICE recommend co-prescribing a PPI with NSAIDs in all patients with osteoarthritis
Psoriatic arthritis : Psoraisis associated with Inflammatory arthritis involving DIP swelling and dactylitis TTT DMARDS
Reactive arthritis: develops after an infection where the organism cannot be recovered from the joint (HLA-B27)
(can’t see, pee, climb the tree)
