Rheumatology Flashcards
(37 cards)
What disease is pseudogout associated with?
- hyperparathyroidism
- hypothyroidism
- haemochromatosis
- acromegaly
- low magnesium, low phosphate
- Wilson’s disease
what is keratoderma blenorrhagica associated with and what is it?
pustular lesions on palms, soles - seen in reactive arthritis; indistinguishable from palmarplantar pustulosis (bad psoriasis)
risk of developing psoriatic arthritis if have psoriasis
15%; more often skin disease occurs first; 30% have a family hx of psoriasis
HLAc26 a/w psoriasis alone
HLA Dr7 a/w psoriatic arthritis
HLA B27 a/w psoriatic arthritis with spondylitis
MICA-A allele strongly a/w with Psoriatic arthritis
clinical patterns in PsA (joint disease - 6)
predominantly DIP (a/w nail disease) asymmetrical oligoarticular polyarticular small c/w rheumatoid arthritis with spondylitis arthritis mutilans SAPHO syndrome
PsA arthritis treatment
NSAIDs
DMARDs (sulphasalazine MTX - skin only (more irreversible liver fibrosis), ciclosporin, leflunomide) peripheral joints only
anti TNF - skin and all joint (again more liver tox)
ustekinumab IL12/23
SAPHO syndrome
synovitis - sternoclavicular, manubrium acne palmarplantar pustulosis hyperostosis osteitis
HLA B27 in 13%
gonococcal arthritis
dermatitis - pustules esp on hands
tenosynovitis
migratory polyarthritis
NOT a/w HLA B27; due to disseminated gonoccal infx
behcets disease (silk road)
recurrent oral ulceration PLUS 2 of: recurrent genital ulceration eye lesions - panuveitis -> blindness skin lesions - EN, PG, Sweets positive pathergy test (inflammatory response to scratch etc)
ALSO a/w arthritis, thrombosis, vasculitis, CNS (dural sinus thrombosis)
acute rheumatic fever diagnostic criteria
2 major or 1 major; 2 minor
major: carditis, polyarthritis, chorea, erythema marginatum, subcut nodules
minor: fever, arthralgia, PHx rheum fever, raised ESR, CRP, prolonged PR, evidence of GAS infix (ASOT, strep Abs)
antiphospholipid syndrome
aPL X 2 > 12/52 apart AND > 1 thrombosis OR 3 consecutive mc < 10/40 1 mc > 10/40 pre eclampsia < 34/40
aPL = anticardiolipin, lupus anticoagulant, beta2microglobulin
typical EMG findings in myositis
EMG – increased insertional activity, spontaneous fibrillations, abnormal myopathic low amplitude and polyphasic motor potentials, complex repetitive discharges
typical muscle biopsy findings in myositis
muscle degeneration a/w macrophages, internalised nuclei, pale, hyalinised, split fibres, marked variation in fibre size
Anti synthetase syndrome features
- Jo1 antibodies
- Myositis, ILD, arthritis, fever, raynauds, mechanics hands
APS treatment
aPL alone - RFx rx; heparin for travel
> 1 thrombosis + aPL - warfarin
recurrent thrombosis on warfarin - add DMARD
pregnant: no events - aspirin (cease at 34/40)
events - add clexane
avoid warfarin in pregnancy
methotrexate
antimetabolite
SEs: GI, ulcers, hair loss, liver fibrosis (more in PsA), bone marrow suppression, renal toxicity at high dose
AEs: accelerated rheumatoid nodule formation
acute pneumonitis - reversible
B cell lymphomas - regress off MTX
hydroxychloroquine (plaquenil)
retinal toxicity - need 3-5 yearly ophthal review
otherwise well tolerated
OK in pregnancy
sulfasalazine
SEs: rash, headache, BM suppression, hepatotoxicity, haemolysis in G6PD def, reversible oligospermia
Leflunomide
- inhibits pyrimidine synthesis (which are required for T cell proliferation)
- need to wash out with cholestyramine for 11 days pre conception
- SEs: diarrhoea, peripheral neuropathy, LFTs
- CI in pregnancy
cyclosporin
renal toxicity
Azathioprine
- purine analogue
- use in SLE for maintenance
- screen for homozygous deficiency of TMPT enzyme which metabolises 6MP product of azathioprine as these people are at higher risk of bone marrow suppression
- pregnancy cat D
Cyclophosphamide
- alkylating agent
- induction in lupus nephritis
- risk haemorrhagic cystitis, bladder CA
- increases risk of CIN X 3
- age dependent decrease in fertility
- pregnancy cat D
gout
2-60,000 leuks in aspirate
negatively birefringent crystals (in cells at time; can be aspirated between attacks)
aim urate < 0.36mmol/L
xray: -cystic changes, well-defined erosions with sclerotic margins with overhanging bony edges; soft tissue masses
medications affecting urate levels
- allopurinol
- uricosuric agents
- thiazide or loop diuretics
- low-dose aspirin
beer > spirits (wine not a factor)
long term hypouricaemic therapy indicated for gout if:
> 2 attacks; uric acid stones; uric acid > 535umol/L, tophi, chronic gouty arthritis
