rheumatology and bone disease I and II Flashcards
(35 cards)
rheumatoid arthritis
disease of synovial joints
autoimmune systemic infalmamtory illness
symmetrical joint inflammation and demfromity
pain history of rheumatoid arthritis
inflammatory pain
- early morning stiffness (more than 30 mins), less stiff after lunch but then stiffen in the evening
- better after movement
- stiffness after rest
- ease with use/exercise
- swelling
- may have flue like symptoms, feverish, hot etc
clinical features of rheumatoid arthritis
boggy swelling (more soft tissue than expected around the joints) knuckesl MCP joints, fingers sit lower than the level of the palm due to sub luxation Z thumb deformity ulner deviation of fingers swan neck deformity
what causes swam neck deformity
tendons move anchor points due to arthritis
flexion of distal point
extension of PIP point
extra articular features of joints
lungs - nodules lung firbosis pleural effusions cardio - pericardial infalmamtion - myocarditis - valve inflmamtion kidneys - amyloidosis skin - rheumatoid nodules secondary sjogrens syndrome
blood tests show what in rheumatoid arthrtis
anaemia
high/low platelts
high inflammatory markers (CRP and ESR)
CRP/ESR
measure of inflammation or infection in blood stream
- CRP produced in response to pro inflmamtory cytokines
ESR - found on RBCs
X ray rheumatic arthriris
osteopenia around joints
soft tissue swelling
late - erosions joint space narrow subluxation/dislocation fusion (ankylosis)
treatment of rheumatoid arthrosi
immediate relief
NSAIDS
steroids
Control of disease
- DMARDS eg methotrexate
- biological drugs eg anti TNF
DMARDS
disease modifying anti rheumatic drugs
e.g. methorexate
biologic drugs
anti TNF
B cell depletion
side effects of treatments for rheumatic fever
1) infection
- all increase risk
- for biologic drugs: reactivation of TB
2) bone marrow toxicity
- low WBC count/low platlets/pancytopenia
- pts often have lots of blood test
3) hepatotoxic
- abnormal liver tests
4) gastric upset
- nausea, diarrhoea, flatulence
5) skin rashes
methotrexate
never prescribe with trimethoprim really excreted nauseas mouth ulcers lung complications 1x weekly dose
rheumatoid neck
erosive change at C1/2
subluxation at atlanto axial level or at sunaxial levels
ligament damaged by inflammation
dens starts to move into the same leading to spinal compression
numbness/tingle of hands etc. ataxic gate
juvenila idiopathic arthritis
inflammatory arthritis occurring before 16
jaw underdevelopment, TMJ inflammation leads to alter Md growth
malocclusion
micrognathia
spondylarthropathy conditions
ankylosing spondylitis
psoriatic arthritis
enteropathic athritis
reactive arthritis
all closely related condiions
ankylosing spondylitis
inflammatory arthritis of spine and sarcophagus iliac joitns
back pain
stooped posture
neck ridge fused
common features of spondyloarthropathy
enteritis
dactylitis
skin/nail psoriasis
inflammatory bowl disease
osteoarthritis
degenerative process
exaggerated repair responce
cartilage damaged puts
pressure on bones
osteophytes
spikes of calcium
OA treatment
- physiotherapy/exercises
- weight loss (lower limb joints)
- paracetamol, co codamol
- NSAIDS
- surgery as final result (for uncontrolled pain, joint failure eg knee giving away)
what leads the response to gout
neutrophil lead inflammatory responce
why does gout occur
patient has high serum urate
c
causes of gout
- genetic predisposition (enzyme defects)
- renal impairment (kidneys)
- diuretics
- dehydration
- intercurrent illness
- high alcohol/fructose/red meat/shellfish
- part of metabolic syndrome – central obesity, diabetes, high BP, high cholesterol
