Flashcards in Rheumatology Deck (212)
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.
What is ankylosing spondylitis?
-Chronic seronegative sponyloarthopathy
-Affects the axial skeleton
Who usually develops ankylosing spondylitis?
-Young males (teenage or early 20s)
-Family history present (ass. with HLA B27)
How does ankylosing spondylitis present?
-Morning stiffness/pain in the back
-Relieved with exercise and simple NSAIDs
Where does the pathology usually begin in ankylosing spondylitis?
-Usually starts at the sacroilliac joints.
-->causes diffuse non-specific buttock pain
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
How can you measure the extent of ank.spond posture?
-Occiput to wall measurement
-Lumbar spine side flexion test
What 4 extra-articular manifestations associated with ank. spond? (4As)
-Acute Achilles tendonitis
-Apical (pulmonary) fibrosis
What are the diagnostic criteria for ank. spond?
1 radiological criteria (+/- clinical criteria) OR 3 clinical criteria = DIAGNOSTIC
-->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)
--> Sacroiliitis on x ray
What classic finding is found on X ray of ank. spond?
-Bamboo spine (only seen in advanced disease)
What are some differential diagnosis of ank. spond?
-Mechanical back pain
-Inflammatory conditions ie RA, Reactive arthritis
-Degenerative conditions ie OA
What are some investigations for ank. spond?
-Blood tests: exclude other disease ie RA
-->Raised inflammatory markers
-->Xray (bamboo spine)
-->MRI/CT (Enthesitis and sacroiliitis)
*****Confirmation of clinical diagnosis -> MRI of sacroiliac joints****
What is the management for ank. spond?
What other conditions need monitoring for in a patient with ankylosing spondylitis?
-Increased risk of fractures
-Renal disease (rare)
-Neurological disease (secondary to spine fusing)
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
What is osteoporosis?
A progressive systemic skeletal disease characterised by reduced bone mass and mirco-architectural deterioration of bone tissue
What is a fragility fracture?
A fracture sustained from falling from a standing level height or less
What T score suggests osteoporosis?
What is a T score?
The standard deviations of a patient away from a healthy young adult
How is the T score measured?
How many men and women develop osteoporosis in their life time?
-1 in 2 women
-1 in 5 men
What are some risk factors for osteoporosis?
*Family history, history of parental hip fracture
What are some of the secondary causes of osteoporosis?
-RA and other inflammatory arthropathies
-Gastro disease ie Crohn's
How do patients with osteoporosis usually present?
-Usually asymptomatic until they fall and sustain a fracture
-Usually the fall is low trauma
-->Spine, neck of femur and wrist
What investigations should be done for someone with suspected osteoporosis?
-Bloods: FBC, CRP, U&E, LFT, TFT, testoserone, gonadotrophins, serum immunoglobulins and paraprotein (Bence-Jones' proteins)
What is the management for osteoporosis?
-->Weight bearing exercise
-->Smoking and alcohol cessation
-Adequate calcium and Vit D supplementation
-Analgesia and treatment for fractures
What is gout?
-An arthritis caused by deposition of MONOSODIUM URATE (MSU) crystals within joints
-->causes acute inflammation and eventual tissue damage
Who are the most likely group to develop gout?
Men. 30-60 years old. Usually overweight, drinkers
What are risk factors for developing gout?
--> increased meat and seafood consumption