Rheumatology Flashcards Preview

Year 5 Notes > Rheumatology > Flashcards

Flashcards in Rheumatology Deck (34):
1

Polymyalgia Rheumatica

Generalised ache, tenderness, morning stiffness in shoulders/proximal limbs, mild poly arthritis, tenosynovitis, carpal tunnel, fatigue, weight loss, depression
Ix: CRP, ESR, plasma viscosity
Tx: pred 10-15mg -dramatic respond in 4days, reduce dose + gastric and bone protection for long term steroid use

2

Causes of monoarthritis

Septic arthritis
Gout/pesudogout
OA
Trauma eg haemarthrosis

3

Symmetrical polyarthropathies

RA
OA
viral

4

Asymmetrical polyarthropathies

Reactive arthritis
Psoriatic arthritis

5

X-RAY features of OA

LOSS
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

6

X-RAY features of RA

Justa-articular osteopaenia
Soft tissue swelling
Joint deformity
Loss of joint space

7

X-RAY features of gout

Peri articular erosions
Normal joint space
Soft tissue swelling

8

Features of OA

Affects larger joint eg hip, knee
Crepitus, worse and end of day
Stiffness after rest, joint instability
Pain at rest

9

Features of OA hand

Heberedens nodes at DIP
Bouchards nodes at PIP
Mainly affected DIP

10

OA management

Exercise and weight loss
Paracetamol and topical NSAIDS
Oral NSAID/ codeine +PPI
Topical capsaicin
Intra articular steroids/hylauronic acid injections
Heat/cold patches, TENS
Joint replacement

11

Septic arthritis

Acute inflamed joint
Often in pre-existing joint disease eg OA, or DM, immunosupressed
Needs urgent synovial fluid microscopy and culture
Start empirical ABx after aspiration
Commonly staph
If v bad may have to refer to ortho for lava get and debridement

12

Features of RA

Symmetrical
Swollen, stiff, painful small joints, worse in morning
MCP/MTP, PIP, wrist
Tenosynovitis or bursitis
Atlanta-axial subluxation

13

Features of RA hand

Ulnar deviation
Dorsal wrist subluxation
Boutonnière and swan neck deformity
Z thumb
Extensor tendon rupture

14

Extra articular features of RA

Nodule - lungs and elbows
Lymphadenopathy
Vasculitis
Lungs: fibrosising alveolitis, obliterative bronchiolitis, pleural/pericardial effusion
Raynauds/carpal tunnel
Peripheral neuropathy
Splenomegaly
(Epi)scleritis
Keratocnojunctivitis Wicca
Osteoporosis

15

RA Ix

RF - higher title=worse disease
ACPA/antiCCP
Anaemia of chronic diseas
X-RAY
USS/MRI

16

RA treatment

Calculate DAS28
early DMARDS/biologicals

17

Gout presentation and features

Acute monoarthropathy
MTP of big toe, ankle, foot, hand, wrist, elbow
Monosodium urate crystals
Precipitated by trauma, starvation, infection, duirecfics
Ax with renal disease

18

Causes of gout

Diabetes
Diuretics
Leukemia
Chemo
Dietary routines
Alcohol excess

19

Gout Ix

Microscopy of synovial fluid - negatively bifringent urate crystals
Raised serum urate but can be normal

20

Treatment of acute gout

High dose NSAID eg diclofenac
If CI Cochicine
Steroids

21

Gout prevention

Address lifestyle

Start prophylaxis if >1 attack/year or tophi, renal stones
Allopurinol at least 3w after acute episode. Titration against plasma urate
Cover with 6w NSAID or 6m colchicine when starting
Don't stop in acute gout attack
Febuxosta is alternative

22

Pesudogout

Calcium pyrophosphate
Tends to be larger joints than gout
Usually self limiting
Ax w/ hyperparathyroidism, haemochromatosis
Microscopy - positive bifringent
Rest, NSAIDs or steroids

23

Ankylosing Spondyltiis

30yr old man
Low back pain, morning stiffness, worse at night, better with exercise
Radiates to hips/buttocks
Loss of spinal movement
Question mark spine - neck hyperextension+kyphosis

24

Extra articular features of ank spond

Enthusiastic eg Achilles tendonitis, plantar fasciitis
Acute iritis
Osteoporosis
Aortic valve incompetence
Pulmonary fibrosis

25

Ankylosing spondylitis Ix

Clinical diagnosis
X-ray - sacroilitis, bamboo spine
Normocytic anaemia
Raised ESR, CRP
HLA B27

26

Ankylosing Spondylitis Tx

Exercise
Physic
NSAIDS
TNF alpha blockers
Steroid injection
Bisphosphonates

27

Psoriatic arthritis

DIP, spinal (like AS)
X-RAY - erosive pencil in cup
Synovial sand nail changes
Can present before skin psoriasis

28

Reactive arthritis

Sterile arthritis
Lower limbs 1-4weeks after chlamdyia, campylobacter, shigella
+- iritis, keratoderma, brown patches on soles and palms, balanitis, mouth ulcers, enethesis
No specific treatment, just manage joints and treat cause

29

CREST syndrome/ limited cutaneous systemic sclerosis

Limited to face, hands and feet
ACA (anti centromere)
Pulmonary hypertension

ACE, cyclophosphamide

30

Diffuse cutaneous systemic sclerosis

All skin
Organ fibrosis
Scl70 antibodies/anti RNA
Needs regular echo and spirometeery
Terrible prognosis

ACE, cyclophosphamide

31

Polymyositis/dermatomyositis

Proximal muscle weakness and striated muscle inflammation
Myalgia and arthralgia
Dysphagia, dysphonia
Autoimmune but can be paraneoplastic
Purple rash on eyelids (heliotrope)
Macular 'shawl' rash
Test muscle enzymes
Prednisolone

32

SLE

Anti ANA, anti dsDNA
Low C3, C4
Lymphadenopathy
Fatigue
Malagia
Fever
Rash - discoid/malar

Cyclophosphamide, prednisolone

33

Anti phospholipid syndrome

Ax with SLE
CLOTS: coagulation, livedo recticularis, obstetric, thrombocytopenia

Give low dose aspirin/warfarin

34

Polyarteritis nodosa

Necrotising vasculitis causes aneurysms and thrombosis
Ulcers and rash
Causes significant renal impairment

Cyclophosphamide