Rheum Flashcards
(15 cards)
Management of patients at risk of corticosteroid-induced osteoporosis?
The RCP guidelines essentially divide patients into two groups.
- Patients over the age of 65 years or those who’ve previously had a fragility fracture should be offered bone protection.
- Patients under the age of 65 years should be offered a bone density scan, with further management dependent;
> 0 reassure
0 to -1.5: repeat in 1-3 years
<-1.5 : offer protection
Ankolysing Spondylitis other features
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
and cauda equina syndrome
peripheral arthritis (25%, more common if female)
What valve pathology is associated with PCKD?
Mitral valve prolapse
Limited cutaneous systemic sclerosis
- Raynaud’s may be 1st sign
- Associated with anti-centromere antibodies
- Scleroderma that affects face & distal limbs predominantly
- Subtype = CREST syndrome (Calcinosis , Raynaud’s, Oesophageal dysmotility, Sclerodactly, Telengectasia
Diffuse cutaneous systemic sclerosis
- Scleroderma that affects trunk & distal limbs predominantly
- Associated with anti scl-70 antibodies
- Most common cause of death is respiratory involvement which is seen in around 80% (ILD + PAH)
- Other complications include renal disease + HTN: start on ACE-I (captopril typically) which target mechanism by reducing efferent vasoconstriction and limiting RAAS activation
- Poor Prognosis
Antibodies in systemic sclerosis?
ANA+ve (90%)
RF (30%)
Anti-centromere (limited)
Anti-scl-70 (diffuse)
Osteomalacia symptoms?
Bone pain
Bone tenderness
Fractures: especially femoral neck
Proximal myopathy (leads to waddling gait)
Osteomalacia causes?
VIT D deficiency
CKD
Liver cirrhosis
Drug-induced e.g. anticonvulsants
Coeliac
Inherited e.g. hypophosphataemic rickets
Osteomalacia investigations?
Low Vit D
Low Phosphate, Low Ca (30%)
Raised ALP (>95%)
XR - translucent bands
RA x-ray findings:
loss of joint space
juxta-articular osteoporosis
soft-tissue swelling
periarticular erosions
subluxatio
Psoriatic arthritis disease patterns
Symmetric polyarthritis
- very similar to rheumatoid arthritis
30-40% of cases, most common type
- asymmetrical oligoarthritis: typically affects hands and feet (20-30%)
historically thought to be the most common type, based on older data (e.g. 1973 Moll and Wright), though more recent studies suggest symmetric polyarthritis may now be more prevalent
- sacroiliitis
- DIP joint disease (around 10%)
- arthritis mutilans: a severe deforming form with ‘telescoping fingers’
Other signs in psoriatic arthritis
psoriatic skin lesions
periarticular disease - tenosynovitis and soft tissue inflammation resulting in:
- enthesitis: inflammation at the site of tendon and ligament insertion (e.g. Achilles tendonitis, plantar fasciitis)
- tenosynovitis: typically of the flexor tendons of the hands
- dactylitis: diffuse swelling of an entire finger or toe
nail changes
- pitting
- onycholysis
Bloods in psoriatic arthritis
CRP/ESR typically elevated due to inflammation
as a seronegative spondyloarthropathy, rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (anti-CCP) are usually negative
HLA-B27 may be positive, particularly in patients with axial involvement
XR findings in psoriatic arthritis
May show a combination of erosions and new bone formation
Periostitis
‘pencil-in-cup’ appearance in advanced disease
Paget’s disease bone profile?
Normal Ca
Normal Ph
Raised ALP
Normal PTH
