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Flashcards in Rheumatology Deck (212)
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1

What is rheumatism?

Rheumatism or rheumatic disorder is an umbrella term for conditions causing chronic, often intermittent pain affecting the joints and/or connective tissue.

2

What is ankylosing spondylitis?

-Chronic seronegative sponyloarthopathy
-Affects the axial skeleton

3

Who usually develops ankylosing spondylitis?

-Young males (teenage or early 20s)
-Family history present (ass. with HLA B27)

4

How does ankylosing spondylitis present?

-Morning stiffness/pain in the back
-Relieved with exercise and simple NSAIDs

5

Where does the pathology usually begin in ankylosing spondylitis?

-Usually starts at the sacroilliac joints.
-->causes diffuse non-specific buttock pain

6

What is the typical posture for a patient with chronic ank. spond?

-Question mark posture
--> loss of lumbar lordosis, buttock atrophy, exaggerated thoracic kyphosis, stooped forward neck posture

7

How can you measure the extent of ank.spond posture?

-Occiput to wall measurement
-Lumbar spine side flexion test

8

What 4 extra-articular manifestations associated with ank. spond? (4As)

-Acute Achilles tendonitis
-Aortic regurgitation
-Apical (pulmonary) fibrosis
-Anterior uveitis

9

What are the diagnostic criteria for ank. spond?

1 radiological criteria (+/- clinical criteria) OR 3 clinical criteria = DIAGNOSTIC
-Clinical criteria:
-->Lower back pain >3/12 (improved with exercise, worse with rest)
-->Limitation of lumbar spine motion
-->Limitation of chest expansion (in relation to others of same sex/age)
-Radiological criteria
--> Sacroiliitis on x ray

10

What classic finding is found on X ray of ank. spond?

-Bamboo spine (only seen in advanced disease)

11

What are some differential diagnosis of ank. spond?

-Mechanical back pain
-Inflammatory conditions ie RA, Reactive arthritis
-Degenerative conditions ie OA
-Infection
-Neoplasms

12

What are some investigations for ank. spond?

-Blood tests: exclude other disease ie RA
-->Raised inflammatory markers
-Imaging
-->Xray (bamboo spine)
-->MRI/CT (Enthesitis and sacroiliitis)
*****Confirmation of clinical diagnosis -> MRI of sacroiliac joints****
-->DEXA (osteoporosis)

13

What is the management for ank. spond?

-Non-pharmacological
-->Physiotherapy (+/-hydrotherapy)
-->Firm mattress
-Drugs
-->NSAIDs
-->Biologics (adalimumab)

14

What other conditions need monitoring for in a patient with ankylosing spondylitis?

-Peripheral arthritis
-Osteoporosis
-Increased risk of fractures
-Renal disease (rare)
-Neurological disease (secondary to spine fusing)

15

What would you find on examination of the spine in a patient with ankylosing spond?

-Tenderness over the spinous processes
-Schober's test: <5cm change

16

What is osteoporosis?

A progressive systemic skeletal disease characterised by reduced bone mass and mirco-architectural deterioration of bone tissue

17

What is a fragility fracture?

A fracture sustained from falling from a standing level height or less

18

What T score suggests osteoporosis?

-2.5

19

What is a T score?

The standard deviations of a patient away from a healthy young adult

20

How is the T score measured?

DEXA scan

21

How many men and women develop osteoporosis in their life time?

-1 in 2 women
-1 in 5 men

22

What are some risk factors for osteoporosis?

ACCESS
-Alcohol use
-Corticosteroid use
-Calcium low
-oEstrogen low
-Smoking
-Sedentary lifestyle

*Family history, history of parental hip fracture

23

What are some of the secondary causes of osteoporosis?

-RA and other inflammatory arthropathies
-Diabetes
-Hyperthyroidism (thyrotoxicosis)
-CKD
-Primary parathyroidism
-Premature menopause
-Gastro disease ie Crohn's
-Primary hypogonadism

24

How do patients with osteoporosis usually present?

-Usually asymptomatic until they fall and sustain a fracture
-Usually the fall is low trauma
-Common fractures:
-->Spine, neck of femur and wrist

25

What investigations should be done for someone with suspected osteoporosis?

-X ray
-DEXA scan
-Bloods: FBC, CRP, U&E, LFT, TFT, testoserone, gonadotrophins, serum immunoglobulins and paraprotein (Bence-Jones' proteins)

26

What is the management for osteoporosis?

-Lifestyle advice
-->Adequate nutrition
-->Weight bearing exercise
-->Smoking and alcohol cessation
-Adequate calcium and Vit D supplementation
-Bisphosphonates
-Denosumab
-Analgesia and treatment for fractures

27

What is gout?

-An arthritis caused by deposition of MONOSODIUM URATE (MSU) crystals within joints
-->causes acute inflammation and eventual tissue damage

28

Who are the most likely group to develop gout?

Men. 30-60 years old. Usually overweight, drinkers

29

What are risk factors for developing gout?

-Male
-Diet
--> increased meat and seafood consumption
-Alcohol
-Diuretics
-Obesity
-Hypertension
-CHD
-DM
-Heart failure

30

How does gout present?

-Acute fast onset pain, heat, swelling, erythema in a joint
-Typically in the first metatarsal phalangeal joint at night
-Wakes patient from sleep at night