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YEAR 2 FCM Revision > Rheumatology Revision > Flashcards

Rheumatology Revision Flashcards

(57 cards)

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1
Q

chronic pain in specific areas or pain all over

  • worse when stress, with activity or in cold weather
  • associated with morning stiffness

lethargy, cognitive impairment,
sleep disturbance, headaches, dizziness

women in 30-50yrs

A

fibromyalgia

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2
Q

Ix and dx of fibromyalgia?

A

typically clinical diagnosis
blood tests to r/o other ddx = TFTs, ESR/CRP, RF and CCP

11/18 trigger points

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3
Q

Management of fibromyalgia?

A

non-pharm = educate, exercise and CBT

first line pharm tx = amitriptyline

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4
Q 
sudden onset pain (can last 1-2wks)
spontaneous but can also be triggered 
big toe affected 
joint - warm, shiny, swollen and red 
very painful - cannot touch bedsheets
A

gout

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5
Q

what causes gout?

A

uric crystal deposition into joint space

can be mono or oligoarthritis

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6
Q

Ix in gout?

A

GOLD standard = joint aspiration and crystal analysis
= -ve birefringent crystals

serum uric conc may drop in acute attack
- often checkes around 2/52 after attack

leucocytosis, raised ESR/CRP

XR = effusion, punched out erosions, eccentric erosions and soft tissue trophi

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7
Q

Acute management of gout?

A

NSAIDs + colchicine 500mg BD
can give prednisolone

resolves within 2wks
need to exclude septic joint, RICE protocol

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8
Q

Prophylactic management of gout?

A

allopurinol - OD to prevent frequent attacks

  • main S/E is diarrhoea
  • can continue use if already on during acute attack, but cannot be initiated in acute attack
  • indicated if 2+ attacks in 1 yr, renal disseas/uric stones and on diuretics
  • lower dose in reduced eGFR

second-line = febuxostat

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9
Q

commonly knee affected
painful, swollen , warm , erythematous
acute onset

A

pseudogout

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10
Q

Ix for pseudogout?

A

aspirate joint & crystal analysis
- +vely birefringent crystals

XR = chondrocalcinosis - linear calcifications

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11
Q

management of pseudogout?

A

IA steroids

NSAIDs for pain mx

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12
Q

older pt (>60) for the past month has been having…

morning stiffness, achy pain in the shoulders and hips
- can affect proximal limbs
lethargy
depression
low grade fevers, night sweats and anorexia

A

polymyalgia rheumatica

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13
Q

What is PMR associated with?

A

temporal arteritis and GCA

often seen in older pts, and mainly females

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14
Q

Investigations and diagnosis of PMR?

A

raised inflammatory markers - ESR>40
CK normal
EMG normal

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15
Q

Management of polymyalgia rheumatica?

A

prednisolone 15mg OD

usually rapid response to steroids, if any failure to effectively respond - consider alternative dx

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16
Q

stiffness in peripheral joints

hands and fingers commonly affected - joints may be swollen
multiple joints are affected
symmetrical

may have ulnar deviation, swan neck deformity, hyperextended PIP and flexed DIP (Boutonniere) , thumb deformity
hyperextension of interphalangeal joint

A

Rheumatoid arthritis

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17
Q

How is Rheumatoid arthritis investigated?

A

bloods - FBC, ESR/CRP, anti-CCP, RF, ANA

XR = bone erosions

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18
Q

Which blood test is the most specific for Rheumatoid arthritis?

A

anti-CCP

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19
Q

What criterion used for diagnosis of rheumatoid arthritis? What score is needed for a diagnosis?

A

American college of rheumatology criterion

6/10 = diagnosis

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20
Q

Management of Rheumatoid Arthritis?

A

usually initiated in 2° care

  • DMARD = methotrexate (or sulfasalazine)
  • short term bridging steroids on initiation of tx
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21
Q

what is methotrexate regime? What is monitored? How is monitoring assessed?

A

methotrexate is given on a weekly basis
- co-prescribed with folic acid which is given 24hrs after methotrexate dose

monitor LFTs (hepatoxic drug), monitor FBC (WCC), monitor ESR/CRP

monitoring based on DAS28 score

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22
Q

methotrexate - side effects?

A 
mucositis = inflamed mouth and gut 
pulmonary fibrosis 
liver cirrhosis 
myelosuppression 
pneumonitis
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23
Q

Methotrexate - contraindications? things to avoid?

Study These Flashcards
A

contras = pregnancy (tetragenic)

avoid prescribing alongside trimethoprim and co- trimaxazole
avoid prescribing with aspirin

24
Q 
mono/oligoarthritis 
non-symterical joints 
common affecting knee and DIPs 
dactylitis - swollen digit 
enthesitis = swollen tendon 
pitting nails

known to have psoriasis

Study These Flashcards
A

Reactive arthritis

25
What are the investigations for psoriatic arthritis?
XR = pencil cup deformity - often later stage sign but very characteristic Elevated CRP & ESR often CCP neg
26
Management for psoriatic arthritis
mild cases - treated with NSAIDs DMARDs - methotrxate = helps skin and joint manifestations if methotrexate provides an inadequate response = TNFa inhibitors (immunosupressant)
27
``` male Hx of GU/GI infection fever joint pain - oligoarthritis/asymmetrical uveitis - red/sore eye urethritis = dysuria ```
reactive arthritis / reiter's syndrome
28
What other features can be seen in reactive arthritis
skin lesions circinate balantis keratoderma blennorrhagica
29
what is Reactive arthritis associated with
HLA-B27
30
what is reactive arthritis triad?
uveitis urethritis arthritis can't see, can't pee and can't climb a tree
31
Ix for reactive arthritis?
clinical diagnosis - not need for any Ix can do tests to rule out other causes
32
Management for reactive arthritis
NSAIDs IA steroids for joints if persistent disease (>6/12) consider DMARD (methotrexate or sulfasalazine)
33
What is Polyarteritis Nodosa?
``` rare form of vasculitis affecting medium/small arteries causing aneurysms (microaneurysms) ```
34
``` men, 40-60yrs arthralgia malaise, fevers, weight loss peripheral painful neuropathy ulcers/pupuric rash/mottled skin testicular pain/haematuria ```
Polyarteritis nodosa
35
Ix and Dx for Polyarteritis nodosa?
elevated CRP/ESR FBC = normocytic, normochromic anaemia renal involvement = raised creatinine affected skin/tissue = necrotizing inflammation
36
Management of Polyarteritis nodosa?
steroids | DMARDs if needed
37
what can increase risk/closely associated with Polyarteritis nodosa ?
Hep B virus infection
38
proximal muscle weakness - common complaint = can't brush my hair - symmetrical chronic/subacute onset dysphagia/phonia resp muscle weakness/dyspnoea raynaud's phenomenon
Polymyositis
39
What is associated with Polymyositis?
associated with malignancy
40
Investigations and diagnosis for Polymyositis ?
massively elevated CK - elevated LDH, adolase, AST/ALT EMG antisynthetase/anti-Jo antibodies Definitive dx = muscle biopsy
41
Management of Polymyositis?
steroids Other options include = immunosuppressants, IVIG and biologics
42
What is scleroderma?
multi-system autoimmune disease via production of autoantibodies structural & functional abnormalities - small blood vessels - fibrosis of skin/internal organs
43
RFs for scleroderma?
family history | autoimmune disease
44
sclerodactyly/claw like hand skin thickening swelling of hands and feet severe raynaud's phenomenon esophageal dysmotility/dysphagia telangiectasia
Scleroderma
45
Ix and Dx of Scleroderma?
Bloods - ANA usually positive, Scl-70 positive and also anti-topoisomerase I
46
Management of scleroderma?
NSAIDs and steroids
47
severe dry eyes severe dry mouth - associated poor dentition Fatigue Pre-exisiting RA or SLE
Sjogren's syndrome
48
Ix or dx of Sjogren's syndrome ?
bloods - +ANA diagnostic = +SSA/Ro, +SSB/La antibodies Gold standard = salivary gland biopsy
49
Management of Sjogren's syndrome?
symptomatic tx - eye drops, sialogues and punctal plugs
50
what is the dry eyes and dry mouth also referred to
sicca complex
51
``` females, <16yrs 6weeks + hx of.... joint pain and swelling in knee intermittent fever spikes uveitis ``` family hx of autoimmune conditions
juvenile RA
52
Investigations and diagnosis for juvenile RA?
elevated ESR/CRP ANA+ RF +
53
Management for juvenile RA?
NSAIDs | DMARDs
54
``` arthritis raynaud's phenomenon malar rash photosensitivity fatigue weight loss and fevers oral ulcers alopecia/hair loss ```
Systemic Lupus Erythematous (SLE)
55
Investiagations and diagnosis for SLE?
``` ANA+ anti-dsDNA/anti-smith antibodies low complement C3/4 levels raised CRP/ESR immunoglobulins ``` urine/ACR = protineuria = lupus nephritis - if found then renal biopsy should be done
56
What blood test is specific to SLE?
anti-dsDNA and anti-smith
57
Management of SLE?
hydroxychloroquinolone NSAIDs and steroids - pred in severe/resistant SLE = trial other immunosuppressants or biological therapies

YEAR 2 FCM Revision (8 decks)

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