Rheum Flashcards
(33 cards)
Gout
Investigations
treatment
causes of hyperuricaemia
chronic- tophi in skin around joints- ear, fingers, achilles
Bloods + ESR + urate
Joint aspiration in acute if concern re diagnosis- negatively birefringent and needle shaped
Clinical diagnosis reasonable
XR- punched out erosions in junta-articular bone
Treatment:
- NSAID (colchicine second line)
- if 2 or more episodes then allopurinol prophylaxis (inhibits xanthine oxidase)- start 2 weeks after acute
- alternative is febuxostat
causes of hyperuricaemia
increased production: alcohol, tumour lysis/ lymphoproliferative
reduced excretions: CKD, thiazide diuretics, ciclosporin, hypothyroid, hyperparathyroid
CPPD
different types- monoarthropathy or symmetrical polyarthritis (pseudo rheumatoid)
on joint asp see weakly positive birefringement crystals which are rhomboid
RF: haemochromatosis
treatment: NSAIDs, inrtarticular steroids
seronegative spondyloarthropathies
A-E
•Asymmetrical large joint oligoarthritis (<5 joints) or monoarthritis
•HLA B27 (dont test for this though- 88% in AS, in all at least 50%)
•Certain joints- Axial (spinal and sacroiliac) inflammation
•Dactylitis- inflammation of entire digit (sausage digit due to soft tissue oedema and tenosynovial and joint inflammation
•Enthesitis- inflammation of site of insertion of tendon or ligament in to bone e.g. plantar fascitis, achilles tendonitis, costrochondritis
•Factor- no rheumatoid factor- i.e. seronegative
•Extra-articular-
o Anterior uveitis
o Psoriaform rashes
o Oral ulcers
o Aortic valve incompetence
o IBD
seronegative spondyloarthropathies-what are they?
1- ank spond
2- enteric arthropathy
3- psoriatic arthropathy
4- reactive (Reuters)
ank stond
Treatment
88% HLA B27
affects spine and sacroiliac
worst in morning, relieved by exercise
treat: exercises, NSAIDs, TNF alpha if persistent disease activity
ank spond associated
6 As apical fibrosis anterior uveitis aortic regurgitation achilles tendonitis AV node block amyloidosis
enteropathic arthritis
large joint mono/asymmetrical oligoarthritis
10-15% of UC and crohns
improves with bowel symptoms
reactive arthritis
after GI or STI- due to crossreactivity
3 key symptoms:
- arthritis (knees, ankles, toes)
- urinary sx
- conjunctivitis
cause: chlamydia
occurs a few weeks after acute infection
signs:
- enthesitis
- keratoderma blenorrhagica
- dactylitis
psoriatic arthritis
20% of patients with psoriasis - esp if nail involvement
asymmetric involvement of small joints of hand INCLUDING DIP/ symmetrical seronegative/ arthritis mutilans/ sacroilitis
XR- pencil in cup deformity by bone erosion
NSAIDS, intraarticualr steroids, DMARDS as per RA
osteoarthritis XR findings
Only abnormal in advanced disease – LOSS • Loss of joint space • Osteophytes- see hand pic • Subarticular sclerosis • Subchrondral cysts
Heberdens
DIP
- think OA
differential of DIP affected:
chronic gout
psoriatic arthritis
bouchards
PIPJ
- think OA
- can be seen in RA
Differentials of hand joint swellings
- RA
- OA
- CPPD (pseudo OA)
- chronic gout
psoriatic arthritis
septic arthritis
most common cause staph aureus
single joint + systemic features
urgent joint aspiration for MCS
treat with flucloxacillin
Acute monoarthritis
Differentials
Septic arthritis
Seronegative spondyloarthopathies- enteropathic and reactive
Crystal arthropathies- gout and CPPD
Trauma
Investigations acute mono arthritis
FBC, ESR, CRP, blood cultures
joint aspiration
consider XR if concern re fracture/ as baseline
If urinary symptoms MCS/ swab for chlamydia
back pain red flags
<20 or >55 constant/ nocturnal worse lying down fever/ sweats/ weight loss hx of malignancy immunosuppression prolonged steroid use thoracic back pain morning stiffness neurological signs bilateral
vasculitis types
large: GCA, Takayasau
medium: PAN, kawasaki
Small
ANCA pos: microscopic polyangitis, GPA, churn strauss
ANCA neg: HSP, cryoglobulinaemia
vasculitis signs
- purpura
- ulcers
- livedo reticular
- eye symptoms - episcleritis/scleritis
- haemoptysis
- nasal crusting + epistaxis
wegeners- saddle nose
charge strauss- asthma
behcets
multisystem disorder recurrent ulceration
- oral ulcers
- genital ulcers
- eye lesions- uveitis
- skin lesions e.g. erythema nodosum
- skin pathergy
DMARD
METHOTREXATE
- lung, liver
- folic acid
- trimethoprim and septrin CI
SULFASALAZINE
-rash, ulcers
LEFLUNOMIDE
- ulcers, liver, BP
HYDROXYCHLOROQUINE
- retinopathy
- NB continue in illness (only one)
sarcoid sx and signs
erythema nodosum polyarthralgia lupus pernio resp signs- SOB, cough fever
lofgrens
BHL + erythema nodosum + fever + polyarthralgia
excellent prognosis
marfans features
- tall stature with arm span to height ratio > 1.05
- high-arched palate
- arachnodactyly
- pectus excavatum
- pes planus
- scoliosis of > 20 degrees
- heart: dilation of the aortic sinuses (seen in 90%) which may lead to aortic aneurysm, aortic dissection, aortic regurgitation, mitral valve prolapse (75%),
- lungs: repeated pneumothoraces
- eyes: upwards lens dislocation (superotemporal ectopia lentis), blue sclera, myopia
- dural ectasia (ballooning of the dural sac at the lumbosacral level)
