Other Conditions

Question 1

What are the types of Raynaud’s Phenomena?

Answer 1

• Primary (Raynaud’s disease)
• Secondary

Question 2

Raynaud’s disease: presentation

Answer 2

Raynaud’s disease typically presents in young women (e.g. 30 years old) with bilateral symptoms. May improve they get older and my be familial.

Question 3

What is the conservative treatment for Raynaud’s disease?

Answer 3

• Avoidance of smoking
• Keeping warm

Question 4

What is Raynaud’s Phenoma?

Answer 4

• Condition due to vasospasm of the digits.
• Painful and characterised by typical sequence of colour change in response to cold stimulus.
• Also affected by stress
  
  • White- inadequate blood flow
  • Blue - venous stasis
  • Red – rewarming hyperaemia
• Typically, in young women (30s).

Question 5

What are caueses of with Raynaud’s phenomena?

Answer 5

• Connective tissue disorders
  
  • Scleroderma (most common)
  • Rheumatoid arthritis
  • SLE
  • Sjogrens syndrome
  • Leukaemia
  • Type I cryoglobulinaemia, cold agglutinins
• Physical causes
  
  • Use of vibrating tools
  • Cervical rib
  • Drugs: oral contraceptive pill, ergot

Question 6

What factors suggest connective tissue disease in Raynaud’s phenomena?

Answer 6

• Onset after 40 years
• Unilateral symptoms
• Photosensitive rashes
• Puffy fingers
• Abnormal nail fold capillaries
• Presence of autoantibodies
• Digital ulcers
• Calcinosis
• Chilblains (very rare)

Question 7

How is Raynaud’s phenomena treated?

Answer 7

Keep warm and avoid smoking

• 1st line: Calcium channel blockers e.g. nifedipine
• 2nd line: Phospohodiesterase-5 inhibtiors
  
  • Sildenafil
• IV prostacyclin (epoprostenol) infusions

Question 8

What is Reactive Arthritis?

Answer 8

• Reactive arthritis is one of the HLA-B27 associated seronegative spondyloarthropathies.
• Presents a few days to 2 weeks post infection
• Around 25% of patients have recurrent episodes whilst 10% of patients develop chronic disease

Question 9

What is Reiter’s Syndrome?

Answer 9

Classic triad of:

• Urethritis
• Conjunctivitis
• Arthritis

Question 10

What can cause Reactive Arthritis?

Answer 10

Can be post dysenteric (equal amongst sexes) or Post-STI (more common in men)

• Post-dysenteric form:
  
  • ​Shigella flexneri
  • Salmonella typhimurium
  • Salmonella enteritidis
  • Yersinia enterocolitica
  • Campylobacter
• Post-STI form:
  
  • ​Chlamydia trachomatis

Question 11

What are features of Reactive Arthritis?

Answer 11

• Arthritis is typically an asymmetrical oligoarthritis of lower limbs
• Dactylitis
• Can’t see: conjunctivitis/uveitis)
• Can’t wee: urethritis)
• Skin: circinate balanitis (painless vesicles on the coronal margin of the prepuce), keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)
• Enthesistis

Question 12

What are investigations of Reactive Arthritis?

Answer 12

• Serology/Microbiology
• Inflammatory markers raised
• May need joint aspiration to rule out septic or crystal arthritis

Question 13

What is the management of Reactive Arthritis?

Answer 13

Symptomatic:

• Analgesia: NSAIDS
• Intra-articular steroids
• sulfasalazine and methotrexate are sometimes used for persistent disease

Most resolve within 2 years