MSK Flashcards
1
Q
What are the different types of bone ultrastructure of bone?
A
- woven/primary bone
2. lamellar/secondary bone - contact and spongy bone
2
Q
what are the ECM components of bone?
A
- Collagen (type 1 mainly, and type 5)
2. Mineral salts -calcium hydroxyapatite
3
Q
what are osteoclasts derived from?
A
monocytes
4
Q
describe the 2 ways in which bones undergo ossification
A
Endochondral - provides length
Intramembranous - provide
width
5
Q
what is a fracture?
A
a discontinuity of bone
6
Q
How could you describe a fracture to a person? What do you need to think about?
A
Orientation - transverse, oblique, spiral, comminuted
Location - epiphysis, metaphysis, diaphysis OR Proximal ⅓, Middle ⅓, Distal 1/3
Displacement - displaced or undisplaced
Skin penetration - open or closed
7
Q
What are the 2 types of fracture healing?
A
Direct - Intramembranous healing. Minimal fracture gap. No movement.
secondary/indirect - Results in callous formation (fibrocartilage). It is endochondral healing
8
Q
what are some risks that affect fracture healing?
A
Age
Diabetic
Smoker
9
Q
Bones adapt to forces placed upon it by remodelling. This is ___ law
A
wolfs
10
Q
what are the two main types of fracture healing complications?
A
Non union - bone does not heal within expected time frame
Malunion - bone healing occurs but outside the normal parameters of alignment
11
Q
State and describe the different types of Non-union fracture healing complications.
A
Atrophic - healing completely stopped with no XR changes
Hypertrophic - too much movement causing callus healing - horse hoof vs elephant hoof
Oligotrophic
12
Q
how do you manage a fracture?
A
Resuscitation
Reduction of fracture - casts
Rest - hold the fracture in a position
Rehabilitation
13
Q
state 3 types of conservative management of fractures
A
Rest and ice
Casts
Traction
14
Q
state types of surgical management of fractures.
A
Internal fixation - MUA + K-wire, ORIF, IM nail
External fixation - mono/biplanar, multiplanar(ring)
Arthroplasty
15
Q
__ is a condition where there is a decrease in bone density. Types include post-menopausal, senile and secondary.
A
osteoporosis
16
Q
Rickets/osteomalacia results from _ or _ deficiency
A
- vitamin D
- calcium
17
Q
____ ___ is a disorder that results from abnormal collagen synthesis. fragile bones, bone deformities and blue sclera are common signs/symptoms.
A
osteogenesis imperfecta
18
Q
how do you diagnose a fracture
A
History and examination – tenderness/limb pain/swelling
Obtain X-ray of affected region, ensure in at least two planes
19
Q
what are the symptoms and signs of shoulder dislocation?
A
loss of normal shoulder contour, pain, restricted movement.
20
Q
how do you manage a shoulder dislocation?
A
asses to see if there is axillary nerve damage. Vigorous manipulation or twisting should be avoided.
Use traction-counter traction +/- gentle internal rotation. Ensure patient relaxation (benzodiazepines)
If alone could use stimson’s method.
21
Q
3 types of shoulder dislocation are?
A
Anterior
Posterior
Inferior
22
Q
A _ shoulder dislocation is associated with seizures/shocks and has a light bulb sign on XR
A
posterior
23
Q
A __ shoulder dislocation results from arm being held abducted above head
A
inferior
24
Q
A __ shoulder dislocation is the most common type.
A
anterior
25
Damage to humeral head in shoulder dislocation is known as a __ lesion
Hill-Sachs
26
Damage to the labrum and/or glenoid in shoulder dislocation is known as a __ lesion
Bankart
27
what is a common cause of a proximal humerus fracture?
Fall onto an outstretched hand. Typically in elderly with osteoporosis
28
describe how proximal humerus fractures are classified
2 part - neck vs greater tuberosity fracture
3 part
4 part
29
what are the different management options for a proximal humerus fracture?
- Collar and cuff - 2-part fracture, minimally displaced, high surgical risk
- ORIF - fracture with displacement but not highly comminuted
- Arthroplasty - fracture with large displacement and high risk of non-union
- Reverse arthroplasty
30
describe how distal radius fractures are classified
Extra articular:
- Dorsal angulation - colles fracture
- Volar angulation - smith fracture
Intra articular:
- Dorsal angulation - dorsal barton
- Volar angulation - Volar/reverse barton
31
how do you manage a distal radius fracture?
cast/splint - minimally displaced
MUA & K-WIRE - extra-articular but with instability
ORIF- fractures not suitable for K-wires or with intra-articular involvement.
32
What 3 things does management of a distal radius fracture aim to restore?
Radial inclination
Radial height
Volar tilt
33
label the carpal bones of the wrist
refer to notes
34
what is the most common carpal bone injury?
scaphoid fracture
35
what examinations and investigations are required if a scaphoid fracture is suspected?
Scaphoid exam + scaphoid view X-ray
| Always check if carpal bones are articulating well and if they have fractures
36
how is a scaphoid fracture managed?
undisplaced - cast
| displaced - ORIF
37
what is the difference between a lunate and perilunate dislocation?
Perilunate = disruption of articulation of lunate with capitate only
Lunate = disruption of articulation with capitate AND radius
38
how is perilunate instability managed?
- Acute injury (<8 weeks): Open reduction, ligament repair and fixation
- Non-acute (>8 weeks): Proximal row carpectomy (converts wrist into simple hinge type)
39
Other than imaging X rays and radiographs, what other investigation is important if a pelvic fracture is suspected?
urethrogram
40
AN _____ exam and ATLS protocol is important in pelvic fractures and femoral shaft fractures
ABCDE
41
what are the 3 types of pelvic fractures
Lateral compression
Anterior-posterior compression
Vertical shear
42
how do you manage a NOF fracture?
```
Pain relief
Catheterise
Blood tests
ECG/Chest X-ray if >55
Rule out other injury/pathology causing fall
```
43
how can you treat a femoral shaft fracture?
intramedullary nail
44
state 3 different types of lower back pain
Non-specific
Mechanical
Nerve root pain (sciatica) - pain radiating to lower limb with or without neuralgic symptoms
45
what are some general causes of lower back pain?
```
Tumour including myeloma
Infection -> e.g. due to tuberculosis
Spondyloarthropathy
Pars interarticularis injury
Compression fracture
Visceral
```
46
Give 2 examples of lower back MECHANICAL pain
```
Disc degeneration
Disc herniation
Annular tears
Facet joint OA
Instability
```
47
what are indicators for sciatica?
Unilateral leg pain greater than low back pain
Pain radiating to foot or toes
Numbness and paraesthesia in the same distribution
Straight leg raising test induces more leg pain
Localised neurology—that is, limited to one nerve root
48
Do you offer imaging in a non-specialist setting for people with low pack pain with or without sciatica?
No. treat first, if pain doesn't go away, imaging
| Or do specialist referral if needed
49
name some treatments for lower back pain
```
Paracetamol, NSAIDS
Manipulation
Acupuncture
TNS
Disc replacement
```
50
What are some red flags for malignancy in patients with lower back pain?
Weight loss
Fever
Night pain
Under 19 years
51
What are some red flags for spinal cord compression in patients with leg pain?
Bowel or bladder dysfunction
Saddle anaesthesia
Profound neurological deficit
52
what is the primary investigation for lower back pain?
MRI
| Radiographs can miss lesions
53
identify some lower back conditions from the MRIs provided.
what condition can cause shiny corners on vertebral bodies of MRI
what condition can cause collapse of vertebral bodies?
1. inflammatory arthropathy
| 2. tuberculosis of spine
54
what are the different types of epidural anaesthetic?
Interlaminar
Transforaminal
Caudal
55
state a non-surgical treatment for a slipped disc
nerve root block
56
The ankle joint is composed of the _ articulating with tibia and fibula.
talus
57
what are the 3 classes for ankle fractures?
Weber A - below the level of the syndesmosis, ligament disruption and joint stability unlikely
Weber B - at the level of the syndesmosis, ligament disruption and joint stability possible
Weber C - fractures occur above the level of the syndesmosis, therefore ligament disruption and joint instability likely
58
With ankle fractures, always check for ____ tenderness as a high fibula fracture may be present
proximal
59
___ refers to a combination of a fracture of the proximal fibula together with an unstable ankle injury (widening of the ankle mortise on x-ray), often comprising ligamentous injury (distal tibiofibular syndesmosis, deltoid ligament) and/or fracture of the medial malleolus.
Maisonneuve fracture
60
How is compact/cortical bone organised?
Osteons - lamellae surrounding haversians canals
Volksman canals - transverse perforating canal
lacunae - small spaces containing osteocytes
61
What is the connective tissue covering bone called?
periosteum
62
describe the steps in fracture healing
Hematoma formation -> soft callus -> hard callus -> remodeling
63
3 mechanisms of bone fracture?
Trauma
Stress
Pathological - abnormal bone
64
different pathological causes of bone fracture?
```
Osteoporosis
Malignancy
Vit D deficiency
Osteomyelitis
Osteogenesis imperfecta
Pagets disease
```
65
which type of test checks for metastases?
bone scan
66
what key things do you consider when describing a fracture radiograph?
Location: which bone and which part of bone?
Pieces: simple/multifragmentary?
Pattern: transverse/oblique/spiral
Displaced/undisplaced?
Describing displacement: Translation (proximal vs distal, medial vs lateral, anterior vs posterior) and angulation (internal vs external rotation, dorsal vs volar, varus vs valgum) including X/Y/Z plane for both
67
how would you manage a fracture?
Reduce/ hold /rehabilitate
68
under hold, what options are there for fixation of a fracture?
Internal fixation - internal intra/extramedullary
| External fixation - monoplanar, multiplanar
69
how would you reduce an open vs closed fracture?
Closed - manipulation, traction
| Open - mini incision/full exposure
70
what are some general fracture complications?
```
Fat embolus - hours
DVT - days-weeks
PE
Infection/sepsis
Prolonged immobility - UTI, chest infections, sores
```
71
what are some urgent local fracture complications?
```
visceral, vascular or nerve injury
compartment syndrome
hemarthrosis
infection
gas gangrene
```
72
what are some less urgent local fracture complications?
```
sores
fracture blisters
nerve entrapment
myosistis ossificans
joint stiffness
algodystrophy
ligament injury, tendon lesions
```
73
what are some late local fracture complications?
```
union problems
avascular necrosis
muscle contracture
joint instability
osteoathritis
```
74
what are the main causes of NOF fracture?
Osteoporosis - older
| Trauma - younger
75
When would a NOF fracture require total hip replacement?
Intracapsular fracture that is displaced and patient >65 years
76
how do you classify joints?
Fibrous- e.g. sutures
Cartilaginous - e.g. spine, pubic symphysis
Synovial
77
what are the key differences in X-ray findings in osteoarthritis vs RA
differences:
- OA has subchondral sclerosis
- OA has ostophytes
- MCP is spared. involvement of DIP (and PIP and 1st CMC)
- RA has osteopenia
- RA has bony erosions
- RA can have ulnar finger deviation
- involvement of MCP, wrist, (and PIP)
78
what condition is degenerative. and starts in articular cartilage
OA
79
which condition starts in synovium and an example is RA
Inflammatory Arthritis
80
what are the risk factors for OA?
how does OA typically present?
Age
Weight
Menopause/estrogen deficiency
Trauma - e.g meniscus removal
pain in weight bearing joint with use -> improves after rest.
asymmetric joint involvement
no systemic symptoms
81
how do you examine a patient in orthopeadics?
Look - e.g. scars, valgus alignment
Feel - e.g. for effusions
Move - range of movement possible e.g. knee flexion
Special tests - e.g. anterior drawer tes
82
What 4 radiographic changes in knee are common in OA?
Loss of space
Osteophytes - new bone production
Sclerosis
Subchondral cysts
83
how do you manage osteoarthritis?
Conservative - analgesic, steroid injections
| Operation - e.g. knee replacement, ankle fusion
84
What causes septic arthritis? What are the risk factors?
Bacterial infection of joint
| Immunosuppressed, pre-existing damage, IV drug use
85
What are the symptoms of septic arthritis? How do you diagnose it?
Acute painful, Red, hot, swollen joint, fever, usually only one joint involved
Diagnosis - joint aspiration -> gram stain and culture
86
How do you treat Septic arthritis?
surgical wash out and IV antibiotics
87
What organisms are usually responsible for septic arthritis?
Staphylococcus aureus, streptococci, gonococcus
88
How do you treat osteomyelitis? (bacteria not in the joint, they are on the shaft of bones)
antibiotics
| Surgical drainage
89
distinguish between the 2 ways in which bones grow
Intramembranous: mesenchymal cells -> bone (flat bones)
Endochondral: mesenchymal -> cartilage -> bone (long bones)
90
There are more bones in a __ skeleton, with __ bones
child
| 270
91
Primary ossification centres occur ____ and form the ____ part of the bone. Secondary ossification centres are _____. There are often several and they are ____.
Prenatally
Central
Post-natal
Physes
92
state 3 differences between children and adult bones
More elastic - can bend more due to increased density of haversian canals
They have physes - growth
Speed of healing and remodelling
93
state 3 presentations you can get in children due to elasticity of bones
Plastic deformity - bends before breaking
Buckle fracture - taurus like column
Greenstick - one side snaps but other side buckles
94
state some presentations you can get in children due to physeal injuries
Growth arrest
| Deformity
95
state locations where physis grows quickly in children
extreme upper limb
| knee
96
state 4 common congenital orthopedic conditions
1. Developmental dysplasia of hip
2. Club foot/ congenital Talipes Equinovarus
3. Achondroplasia
4. Osteogenesis
imperfecta
97
what is DDH?
Spectrum with dysplasia - subluxation - dislocation
98
what are the risk factors for DDH?
```
Female
First born
Breech
FH
Oligohydramnios
Native american
```
99
how do you investigate and treat DDH?
Ultrasound up until 4 months
X ray after 4 months
Treatment = pavlik harness
100
how does club foot present?
C avus- high arch
A dductus of foot
V arus
E quinous
101
risk factors for club foot?
Male
Hawaiin
PITX1 gene
102
treatment for club foot
Ponseti method - sequential casts
May require operative treatment - soft tissue release
Foot orthosis brace
103
___ is the most common skeletal dysplasia
achondroplasia
104
what causes achondroplasia?
- G380 mutation of FGFR3
| - Inhibition of chondrocyte proliferation in the physis -> defect in endochondral bone formation
105
how does achondroplasia present?
1. Rhizomelic dwarfism:
- Humerus shorter than forearm
- Femur shorter than tibia
- Normal trunk
2. Normal cognitive
development
3. Significant spinal issues
106
what causes OI?
Decreased secretion of OR abnormal collagen production -> insufficient osteoid production
107
effects of OI?
1. Bones - fragility fracture, short stature, scoliosis
2. Non orthopedic:
- Heart
- Blue sclera
- Dentiogenesis imperfecta - brown soft teeth
- Wormian skull
- Hypermetabolism
108
If a fracture affects the physis in children, the fracture description must include the _____ classification.
Slater-harris
109
In primary bone healing, there is no ___ formation.
callus
110
how would you describe a pediatric fracture x ray?
P attern - transverse, oblique, spiral, comminuted, avulsion
A natomy - location
I ntra/extra articular
D displacement - displaced, angulated, shortened, rotated
S alter-Harris
111
describe the Salter-Harris classification system
Type 1 - physeal Separation
Type 2 - fracture traverses physis and exits metaphysis Above
Type 3 - fracture traverses physis and exits physis Lower
Type 4 - fractire passses Through epiphysis, physis and metaphysis
Type 5 - crush injury to physis
Risk of growth arrest increases from type 1-5
Type 2 is the most common
112
How would a whole physeal injury differ from partial?
Whole physis - limb length discrepancy
Partial - angulation
113
how do you treat growth arrest?
Limb length correction - shorten long side, lengthen short side
Angular deformity correction - stop growth of unaffected side OR reform the bone (osteotomy)
114
Pediatric fractures are often managed by ___ reduction. An example of a traction method used is ___ traction
closed
| Gallows
115
state 4 causes of a limp in a child
1. Septic arthritis - kocher's classification can help diagnose - requires surgical washout
2. Transient synovitis - diagnosis of exclusion after ruling out septic arthritis - can be managed with antibiotics
3. Perthes
4. SUFE (slipped upper femoral epiphysis)
116
To diagnose limp in a child, you must always rule out __ ___ first
septic arthritis
117
what is perthes?
Idiopathic necrosis of the proximal femoral epiphysis
| More common in men
118
how do you diagnose perthes?
Won't see temp or inflammatory markers
| Plain film radiograph
119
risk factors for SUFE?
Obese adolescent male
12-13 during rapid growth
Associated with hypothyroidism/hypopituitarism
120
How do you treat SUFE?
Fixation with screw
121
Describe 3 causes of joint inflammation and give examples of related diseases
1) Crystal arthritis
Gout
Pseudogout
2) Immune-mediated(“autoimmune”)
- Rheumatoid arthritis
- Seronegative spondyloarthropathies
- Connective tissue diseases
3) Infection
Septic arthritis
Tuberculosis
122
what is gout?
syndrome caused by deposition of urate (uric acid) crystals -> inflammation
123
risk factors for gout?
- Genetic tendency
- Increased intake of purine rich foods
- Reduced excretion (kidney failure)
- Hyperuriceamia
124
what is pseudogout?
a syndrome caused by deposition of calcium pyrophosphate dihydrate (CPPD) crystal deposition crystals -> inflammation
125
risk factors for psuedogout?
background osteoarthritis, elderly patients, intercurrent infection
126
Acute arthritis occurs as a result of _____. It can lead to ___ and gouty arthritis
```
hyperuricemia
tophy (external ear, olecranon bursa, achilles tendon)
```
127
Gouty arthritis commonly affects the 1 MTP joint. This can be described as ____. X-ray shows “rat bite’ ___.
podagra
| erosions
128
What investigations and management is carried out for crystal arthritis?
Joint aspiration
- synovial fluid analysis
Management
- Acute attack – colcihine, NSAIDs, Steroids
- Chronic – allopurinol
129
Distinguish between the shape and birefringence in gout and pseudogout
gout - needle shaped, negative
Pseudogout - brick-shaped, -Positive
130
describe how RA (rheumatoid arthritis) presents
Polyarthritis
Symmetrical joint involvement
Early morning pain and stiffness -> improves with use
systemic symptoms -> fever fatigue, weight loss.
131
State some extra-articular manifestations that occur in RA
Rheumatoid nodules - common on elbow
Rare: vasculitis (can cause digital ischemia), occular inflammation e.g. episcleritis, neuropathies, Amyloidosis, Lung disease, Felty’s syndrome (triad of splenomegaly, leukopenia and RA)
132
What is the Rheumatoid ‘factor’ that may be detected in the blood in RA.
IgM antibody against IgG Fc region
133
The primary site of pathology in RA is the ____ . It becomes a mass of tissue due to Neovascularisation, Lymphangiogenesis and inflammatory cells. ______ is a key inflammatory cytokine in this condition.
Synovium (can also get bursitis, extensor tenosynovitis)
TNF-alpha
134
What are the treatment options for RA?
1st line - methotrexate (DMARD. folic acid analog that inhibits DHFR and decreases DNA synthesis) in combination with hydroxychloroquine or sulfasalazine
2nd line - biologics:
- anti TNFs antibodies - infliximab, adalimumab, golimumab
- antibodies against B cell CD20 - Rituximab
- receptor fusion proteins - entanercept - binds TNF and prevents it from binding to IgG
- interleukin 6 receptor antagonists (tocilizumab, sarilumab)
glucocorticoids (prednisolone)
135
What are some key features of seronegative spondyloarthritis?
Arthritis without Rheumatoid factor
Strong association with HLA-B27
Subtypes show variable inflammatory back pain(early morning, IMPROVES with exercise), peripheral arthritis, enthesitis, dactylitis, uveitis.
ASSYMETRICAL arthritis
136
Name the 4 subtypes of seronegative spondyloarthritis
P - psoriatic arthritis
A - ankylosing spondylitis
I - Inflammatory bowel disease
R - reactive arthritis
137
Ankylosing spondylitis is inflammation of spine and ___ ___. It results in ___ __. Typical finding on imaging is ___ ____. Patients may have loss of lumbar lordosis and hyperextended neck.
```
Sacroiliac joint. (can narrow)
Spinal fusion
Bamboo spine (vertebral fusion)
```
138
What are the features and findings in psoriatic arthritis?
how do you treat it?
ASYMMETRICAL arthritis involving IPJs
Pencil in cup deformity of DIP on X-Ray
Psoriasis association
dactylitis
treat with methotrexate, avoid steroids
139
What are the features of reactive arthritis?
Sterile inflammation in joints following infection
GI infections - salmonella, shigella, campylobacter
Urogenital - chlamydia
Triad; conjunctivitis, urethritis, arthritis
self limiting
140
____ is an example of a connective tissue disease that causes joint inflammation. Clinical tests show ANA (highly sensitive but not specific) and anti-dsDNA (specific).
SLE
141
What 3 investigations are usually carried out in rheumatology?
- blood tests
- joint (synovial) fluid analysis
- Imaging tests - X-rays,etc
142
when looking at the full blood count. what would the WCC be in:
1. inflammatory arthritis
2. osteoathritis (degenerative arthritis)
3. septic arthritis
inflammatory arthritis - usually normal
osteoathritis - normal
septic arthritis - leucocytosis
143
A patient complains of painful joints in front of you.
go through this long list to see the order in which you should order tests.
May not need if diagnosis is clear from history and examination e.g. osteoarthritis of knee
```
Start with basic blood tests:
FBC
U&E
LFT
Bone profile
ESR
CRP
```
If ESR/CRP elevated then move on to do specialist tests for conditions causing inflammatory arthritis:
1. RF - non-specific. anti -CPP - more specific for RA
2. ANA - non-specific. In combination with correct clinical features may indicate an autoimmune connective tissue disease (SLE, Sjrogren’s syndrome, scleroderma, polymyositis)
If ANA is positive, do an ENA test(panel of 5 autoantibodies)
1. Ro - lupus or sjogrens syndrome
2. La - lupus or sjogrens syndrome
3. RNP - lupus or mixed connective tissue disease
4. Smith - lupus
5. Jo-1 - polymyositis
If ANA is positive, also order dsDNA - highly specific for lupus. Associates with renal involvement, useful for tracking lupus activity. Can also look at C3 and C4 with decrease in active lupus
144
Give examples of how rheumatological diseases can impair kidney function
SLE - lupus nephritis
Vasculitis - nephritis
Poorly controlled chronic inflammatory disease -> high
SAA protein -> SAA deposits in organs (AA amyloidosis)
NSAIDS can impair kidney
145
Why are LFTs important in rheumatology?
DMARDs e.g. methotrexate can cause liver damage.
Regular blood tests required
Low albumin can reflect liver synthesis problem or problem of leak from kidney (e..g in lupus nephritis)
146
What is pagets disease and what will a bone profile show?
Abnormality of high bone turnover
bone pain, excessive bony growth, fracture through abnormal bone
ELEVATED ALP
147
What does a bone profile show for ostoeomalacia?
Elevated calcium
| Others usually normal
148
What does a bone profile show for osteoporosis
Normal values usually
| Diagnosis made with DEXA scan
149
ESR and CRP are useful markers of _____. However ___ can be up for other reasons. ___ more specific.
Inflammation
ESR
CRP
150
What do ESR and CRP values show in SLE?
ESR usually high. CRP usually normal
| High CRP - first suspect infection
151
How do you interpret an ANA test?
1:80 means it is the furthest dilution at which the ANA was still detectable. It is weak
Therefore 1:1280 is strong
Negative test rules out SLE
Positive test doesn't mean SLE. only if other clinical and lab features
152
State 2 reasons for joint aspiration
Diagnostic - septic arthritis, crystal arthritis
Therapeutic to relieve symptoms +/- steroid injection
153
State 3 key differences between septic and reactive arthritis
Synovial fluid culture is negative in reactive arthritis
No antibiotic therapy is given in reactive arthritis
No joint lavage in reactive arthritis
154
State the types of imaging used in rheumatology and when they will be appropriate
X rays - first line
CT scans - more detailed bony imaging
MRI - visualization of soft tissues like tendons and ligaments. Best for spinal imaging
Ultrasound - can visualise soft tissues. Good for small joints
155
early RA is best detected with ___ imaging. what might you see?
Ultrasound
- synovial hypertrophy
- increased blood flow -> doppler signal
*a normal x-ray doesnt rule out RA
156
What is the key antibody in systemic vasculitis?
ANCA
157
What antibodies are associated with RA?
Rheumatoid factor- not specific
| Anti-cyclic citrullinated peptide (CCP) antibodies - more specific
158
Where are the key sites of inflammation in SLE?
joints, skin, kidney
159
What antibodies are associated with SLE? How do you interpret their findings?
Antinuclear antibodies - always seen, not specific for SLE
Anti-double stranded DNA antibodies- specific, level correlated with disease activity
Antiphospholipid antibodies - associated with risk of venous and arterial thrombosis. Can occur in absence of SLE
anti-SM - specific
Also Low C3 and C4 (they are not antibodies)
160
How do you treat SLE?
Ibuprofen
Hydroxychloroquine
persistently active or severe disease -> B cell targeted therapies (rituximab and belimumab)
161
what are the connective tissue disorders?
Systemic Lupus Erythematosus (SLE)
Sjögren’s syndrome
Autoimmune inflammatory muscle disease: Polymyositis, Dermatomyositis
Systemic sclerosis (scleroderma): Diffuse cutaneous, Limited cutaneous
Overlap syndromes
162
what are the key features of connective tissue disorders
Arthralgia and arthritis is typically non-erosive
| Raynaud's phenomenon may be present
163
What is sjogrens syndrome? What are the features? what antibodies are associated with it?
```
Autoimmune exocrinopathy (lymphocytic infiltration)
Non-erosive arthritis
Dry eyes
Dry mouth
Parotid gland enlargement
Raynaud's phenomenon
```
anti-Ro and/or anti-La antibodies (can also be seen in SLE)
164
what is inflammatory muscle disease?
Progressive symmetric proximal muscle weakness
With rash = dermatomyositis
Without rash = polymyositis
165
Which antibody is specific for dermato or polymyositis?
anti-tRNA transferase e.g anti-Jo-1
166
what are the findings in inflammatory muscle disease?
Elevated CK
anti-Jo-1 antibodies
CD8+ T cells in muscle biopsy = polymyositis
CD4+ T cells in muscle biopsy = dermatomyositis
```
Dermatomyositis:
Gottron's papules
Heliotrope rash on eyelids
Malar rash
Mechanics hands
Shawl sign
```
167
state 2 conditions associated with dermatomyositis
Malignancy
| Interstitial lung disease
168
What antibody is specific for a mixed connective tissue disease?
anti-U1 RNP
169
what is systemic sclerosis/scleroderma
Noninflammatory vasculopathy and collagen deposition with fibrosis
key findings:
- Sclerosis of skin - puffy taught skin, thickened skin without wrinkles, fingertip pitting
- Raynauds phenomena
May involve other body systems
Diffuse and limited type
170
what are the features of limited systemic sclerosis?
Limited skin involvement - fingers and face
Anticentromere antibodies
CREST syndrome: Calcinosis cutis(calcium deposits on elbows knees and fingers that leak white fluid), Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly (claw like hands), Telangiectasia (dilated capillaries beneath skin of face and lips)
Raynauds
Severe complication -> pulmonary disease-> Hypertension, fibrosis
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What are the features of diffuse systemic sclerosis?
Widespread skin involvement
anti-SCL-70 antibody
Visceral involvement - pulmonary disease, renal, GI,
raynauds
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How do you treat gout?
Acute = NSAIDS (not including aspirin) glucocorticoids, colchicine (inhibits microtuble polymerisation impairing neutrophil chemotaxis)
Chronic = allopurinol (Xanthine oxidase inhibitor)
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swan neck and boutonniere are findings in what arthritic condition?
Rheumatoid arthritis
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state 3 conditions in rheumatoid arthritis that can develop from synovial inflammation
1. Extensor tenosynovitis - due to inflammation of tenosynovium surrounding tendons
2. bursitis e.g. olecranon bursitis
3. joint synovitis
