MSRA Flashcards
(113 cards)
What is osteoarthritis and what does it commonly effect?
Clinical syndrome of joint pain accompanied by varying degrees of functional limitation. It is characterised pathologically by localised loss of cartilage, remodelling of adjacent bone and associated inflammation and reduced quality of life. Osteoarthritis includes a slow but efficient repair process that often compensates for the initial trauma, resulting in a structurally altered but symptom-free joint
Hips, knees, hands
How do you diagnose osteoarthritis clinically?
Diagnose osteoarthritis clinically without investigations if a person:
is 45 or over and
has activity-related joint pain and
has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes
What is first lime treatment for osteoarthritis?
NSAID cream
What are the radiological features of osteoarthritis and when do you.get each sign?
Joint space narrowing - focal cartilage loss
subchondral sclerosis - increased trabecular thickness
bone cysts
osteophytes about the joint margins - central, marginal, periosteal
osteochondral “loose” bodies - islands of chondral metaplasia that have ossified
In the initial stages of OA, the first three features are restricted to the load-bearing part of the osteoarthritic joint. In more advanced disease all five features are present on non-weight-bearing and weight-bearing parts of the joint.
What is the commonest jointinflammatory condition and how is it characterised
Rheumatoid arthritis (RA) is the most common inflammatory arthritis in adults, characterised by progressive joint destruction and deformity, usually of peripheral joints.
Typically affects the small joints of the hands and the feet, and usually both sides equally and symmetrically, although any synovial joint can be affected
a systemic disease and so can affect the whole body, including the heart, lungs and eyes
How is rheumatoid arthritis managed
Treat active RA in adults with the aim of achieving a target of remission or low disease activity if remission cannot be achieved (treat-to-target)
Achieving the target may involve trying multiple conventional disease-modifying anti-rheumatic drugs (cDMARDs) and biological DMARDs with different mechanisms of action, one after the other
Consider making the target remission rather than low disease activity for people with an increased risk of radiological progression (presence of anti-CCP antibodies or erosions on X-ray at baseline assessment)
In adults with active RA, measure C-reactive protein (CRP) and disease activity (using a composite score such as DAS28) monthly in specialist care until the target of remission or low disease activity is achieved.
What are the main symptoms of rheumatoid arthritis
RA usually presents as a gradual-onset, symmetrical arthritis. The main symptoms present in RA are:
Pain, swelling and stiffness of the joints – commonly seen in wrists, proximal interphalangeal, metacarpophalangeal, and metatarsophalangeal joints.
Early morning stiffness that lasts over 30 minutes - sensitivity 74-77%, specificity 48-52%
systemic symptoms
weight loss
fatigue
malaise (1)
What are the main symptoms of rheumatoid arthritis
RA usually presents as a gradual-onset, symmetrical arthritis. The main symptoms present in RA are:
Pain, swelling and stiffness of the joints – commonly seen in wrists, proximal interphalangeal, metacarpophalangeal, and metatarsophalangeal joints.
Early morning stiffness that lasts over 30 minutes - sensitivity 74-77%, specificity 48-52%
systemic symptoms
weight loss
fatigue
malaise (1)
What is the journey of RA and what are the hand signs
The clinical course of RA is extremely variable. In most patients, the disease begins insidiously with malaise, fatigue, non-localised musculoskeletal pain, and sometimes low grade fever.
Only later do joints become involved, sometimes monarticular, at other times oligoarticular, and in some instances polyarticular (usually symmetrically). Often the disease begins in the proximal finger joints and wrists and later spreads to the elbows, shoulders, knees, ankles and feet. Characteristic deformities occur and include, in the hands, ulnar deviation of the fingers due to subluxation at the metacarpophalangeal joints, loss of finger function due to hyperextension of the PIP joints with fixed flexion of the DIP joints ‘swan neck deformity’, or fixed flexion of the PIP joints with hyperextension of the DIP joints ‘boutonniere’ or Z deformity of the thumb.
Are nsaids OK I’m pregnancy?
non-steroidal anti-inflammatory drugs can be used during pregnancy but there use is not recommended during the third trimester. This is because they may cause premature closure of the ductus arteriosus. The use of non-steroidal anti-inflammatories during late pregnancy has also been associated with renal impairment in the newborn
Is methotrexate OK in conception?
the use of methotrexate during pregnancy is contraindicated (teratogenic); manufacturer advises the use of effective contraception during and for at least 6 months after administration to men or women
How do you investigate RA
offer to carry out a blood test for rheumatoid factor in adults with suspected rheumatoid arthritis (RA) who are found to have synovitis on clinical examination
consider measuring anti-CCP antibodies in adults with suspected RA if they are negative for rheumatoid factor
X-ray the hands and feet in adults with suspected RA and persistent synovitis
When would you refer RA and why?
Refer all urgently even if results are negative as treatment must be started asap
How long does it take for methotrexate to work in RA
Response to treatment cannot be expected before 2 months and may not occur until after 6 months treatment.
What are the RA drugs?
MHLS
Methotrexate, Hydroxychloraquine, leflunomide, sulfasalazine
Give the toxic effects of methotrexate
toxic effects include:
pneumonitis in 3% of patients
bone marrow suppression in approximately 3%
opportunistic infections
accelerated nodulosis of the hands
cirrhosis and liver failure - very rarely
How do you monitor methotrexate
Monitor every 2 weeks for 2 months, then monthly thereafter.
Monitor:
haemoglobin
total white cell count
neutrophil count
lymphocyte count
platelet count
liver function tests
What are the side effects of methotrexate and how do you manage them
mouth ulcers
stomatitis
Stop if severe, reduce dose if mild/moderate. Consider carbenoxalone or difflam mouth washes. Consider other causes.
cough or dyspnoea
Stop drug. Seek advice. Chest X-ray and pulmonary function tests.
nausea/anorexia
Split dose, reduce dose. Take with food. Try anti-emetic. Stop if unacceptable
increased nodule formation
Reassure. Stop if unacceptable
Why is Hydroxychloraquine and clarithromycin/erythromycin and azathioprine bad together
QT prolongation a d bad for the heart
What are the common side effects of azathioprine
The most common side-effects of azathioprine are myelosuppression and hepatotoxicity.
How do you monitor azathioprine
Check full blood count before starting treatment, once weekly for the first four weeks, then at least every 3 months throughout treatment. Check:
Haemoglobin
Total white cell count
Neutrophil count
Platelet count
also check liver function tests
Patients should immediately have a full blood count if they develop any symptoms suggestive of marrow depression.
Untreated asthma is characterised by:
greater than 10% diurnal variability in PEFR
lowest values in the morning
How do you work up a diagnosis of COPD
identifying early disease
perform spirometry in people who are over 35, current or ex-smokers, and have a chronic cough
consider spirometry in people with chronic bronchitis. A significant proportion of these people will go on to develop airflow limitation
How os airflow obstruction defined on spirometry
airflow obstruction is defined as (1):
FEV1 < 80% predicted
and FEV1/FVC < 0.7
