Rheum II Flashcards by yeswanth AKULA

PMR demographics

It usually affects old adults (above 50 years)
More common in women
More common in caucasians

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Core features of PMR

Bilateral shoulder pain that may radiate to the elbow
Bilateral pelvic girdle pain
Worse with movement
Interferes with sleep
Stiffness for at least 45 minutes in the morning

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Other features of PMR

Systemic symptoms such as weight loss, fatigue, low grade fever and low mood
Upper arm tenderness
Carpel tunnel syndrome
Pitting oedema

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Diagnosis of PMR

Clinical presentation and response to steroids

Inflammatory markers (ESR, plasma viscosity and CRP) are usually raised however normal inflammatory markers do not exclude PMR.

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Treatment of PMR

15mg of prednisolone per day.

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Symptoms of GCA

Severe unilateral headache typically around temple and forehead
Scalp tenderness my be noticed when brushing hair
Jaw claudication
Blurred or double vision
Irreversible painless complete sight loss can occur rapidly

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Diagnosis of GCA

Clinical presentation
Raised ESR: usually 50 mm/hour or more
Temporal artery biopsy findings

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Temporal artery biopsy findings in temporal artery biopsy

: Multinucleated giant cells

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FBC in GCA

normocytic anaemia and thrombocytosis

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Mx of GCA

Steroids
Aspirin
PPI

Refer to vascular, rheum, ophthalmologist

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Late complications of GCA

Relapses of the condition are common
Steroid related side effects and complications
Cerebrovascular accident (stroke)
Aortitis leading to aortic aneurysm and aortic dissection

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Key ix for diagnosis of myositis

CK blood test

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Causes of raised CK

Rhabdomyolysis
Acute kidney injury
Myocardial infarction
Statins
Strenuous exercise

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What can polymyositis or dermatomyositis be caused by

Underlying malignancy. This makes them paraneoplastic syndromes. The most common associated cancers are:

Lung
Breast
Ovarian
Gastric

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Presentation of dermatomyositis/polymyositis

Muscle pain, fatigue and weakness
Occurs bilaterally and typically affects the proximal muscles
Mostly affects the shoulder and pelvic girdle
Develops over weeks

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Dermatomyositis skin features

Gottron lesions (scaly erythematous patches) on the knuckles, elbows and knees
Photosensitive erythematous rash on the back, shoulders and neck
Purple rash on the face and eyelids
Periorbital oedema (swelling around the eyes)
Subcutaneous calcinosis (calcium deposits in the subcutaneous tissue)

Auto-antibodies present in dermatomyositis

Anti-Jo-1 antibodies: polymyositis (but often present in dermatomyositis)
Anti-Mi-2 antibodies: dermatomyositis.
Anti-nuclear antibodies: dermatomyositis.

Definitive diagnosis of dermatomyositis

Muscle biopsy

Mx of dermatomyositis/polymyositis

Rheum referral
Corticosteroids
Rule out cancer

Immunosuppressants (such as azathioprine)
IV immunoglobulins
Biological therapy (such as infliximab or etanercept)

Autoantibodies associated with antiphospholipid syndrome

Lupus anticoagulant
Anticardiolipin antibodies
Anti-beta-2 glycoprotein I antibodies

Mx of antiphospholipid syndrome

Long term warfarin with an INR range of 2-3 is used to prevent thrombosis (3-4 may be used with recurrent thrombosis).

Pregnant women are started on low molecular weight heparin (e.g. enoxaparin) plus aspirin to reduce the risk of pregnancy complications. Warfarin is contraindicated in pregnancy.

What is sjogren’s syndrome

This is an autoimmune condition that affects the exocrine glands. It leads to the symptoms of dry mucous membranes, such as dry mouth, dry eyes and dry vagina.

Auto-antibodies associated with sjogren’s syndrome

anti-Ro and anti-La antibodies

Test used to diagnose sjogren’s syndrome

Schirmer test

Mx of sjogren's syndrome

Artificial tears Artificial saliva Vaginal lubricants Hydroxychloroquine is used to halt the progression of the disease.

Complications of sjogren's syndrome

Eye infections such as conjunctivitis and corneal ulcers Oral problems such as dental cavities and candida infections Vaginal problems such as candidiasis and sexual dysfunction

General features of all forms of vasculitis

Purpura. These are purple-coloured non-blanching spots caused by blood leaking from the vessels under the skin. Joint and muscle pain Peripheral neuropathy Renal impairment Gastrointestinal disturbance (diarrhoea, abdominal pain and bleeding) Anterior uveitis and scleritis Hypertension

What is polyarteritis nodosa

medium vessel vasculitis. It is most associated with hepatitis B but can also occur without a clear cause or with hepatitis C and HIV.

Rash associated with polyarteritis nodosa

It is associated with a rash called livedo reticularis. This is a mottled, purplish, lace like rash.

What is takayasu's arteritis

Takayasu’s arteritis is a form of large vessel vasculitis. It mainly affects the aorta and it’s branches. It also affect the pulmonary arteries. These large vessels and their branches can swell and form aneurysms or become narrowed and blocked

Presentation of takayasu's arteritis

It usually presents before the age of 40 years with non-specific systemic symptoms, such as fever, malaise and muscle aches, or with more specific symptoms of arm claudication or syncope