Week 2 Flashcards
Women 30 years presents with 6 weeks history of bilateral wrist pain, its worse in the morning lasting over an hour before easing off. The wrists appear swollen. She also smokes. No medications but takes overcounter aspirin which helps pain. Diagnosis?
Rheumatoid arthritis due to morning stiffness, bilateral involvement and synovial joints effected. NSAIDs known treatment
What type of joints does rheumatoid arthritis effect?
Synovial joints aside from DIP due to the small quantity of synovial fluid e.g PIP, MCP, shoulders, elbows, C1/C2
What are some of the complications of long term untreated rheumatoid arthritis?
Joint destruction
Extensor tenosynovitis
Swan necking of tarsals and sublaxation of the tendons in feet (walking on pebbles)
What is osteoarthritis
Degradation of the cartilage on the articular surfaces of the bones making the joint. Causes inflammation and swelling of the osteophyte and pain. Common in joints that weight bear and have excessive use. Will have loss of joint space
What is epidemiology of people osteoarthritis?
45years + and 70years++
Females, obese, previous injuries like high impact athletes
What is cartilage composed of? 3 components, where mutation of any of these can cause OA
Chondrocytes
Type 2 collagen fibres
Proteoglycon
45 yrs women presents with worsening pain in her right knee over the last 3 years, she was a previous sprinter. Aggrevated with movement and relieved by rest. On exam it is swollen, crepitus present and there is genu varus present. Investigations? Likely diagnosis?
Xray of the knee would show loss of joint space but more a clinical diagnosis.
Osteoarthritis due to long time onset, former athelete, unilateral joint involvement andn mechanical pain
What condition is heberdens and bouchards nodes associated with? What are they?
Bony enlargments of the DIP and PIP joints in the hands respectively
Osteoarthritis
What are the treatments for OA if surgery its not optional
Just for pain management so analgesia, paracetamol, NSAIDS, amitriptyline, steroids
Physiotherapy
What factors increase your predispostion to gout? Genetic and environmental
Increased urate production like in psoriasis, myeloproliferative disorders, haemolytic disorders, alcohol, high red meat (purine)
Decreased urate excretion; renal impairment, heart failure, hypothyroidism, DIURETICS, cytotoxic drugs
How would you treat acute gout?
It will settle within 10 days usually, or can use NSAIDs, Colchine, steroids
What would you use as prophylaxis of someone prone to gout?
Allopurinol with NSAID
Male athlete is on a high protein diet presenting with red, inflamed, painful big toe. It has occurred over the last day and is incredible sore. He has no fever. You take an aspiration of the synovial fluid and it shows negative bifringent crystals. Diagnosis ?
Gout
What condition has deposition of calcium pyrophosphate crystals in joints?
Pseudo gout
What results would you expect in someone newly diagnosed with Rheumatoid arthritis? FBC, Xrays, ultrasound,
FBC; low haemoglobin but normal MCV due to bone not producing enough RBCs, inflammatory markers elevated, autoantibodies (RF)
Xrays; if caught early then normal, later stages show bone erosion
Ultrasound; show increased blood flow to area indicitive of damage (pannus)
Gout doesnt occur in premenopausal women. T/F? Why?
True due to oestrogen having a protective effect, hence why this condition more common in men
Women 70 presents with bilateral tenosynovitis of the hands, early morning stiffness, swelling of the PIP and MCP joints. Occuring over the 6-8 weeks with worsening pain. She is a heavy smoker. Diagnosis?
Rheumatoid arthritis
What are some of the features on xray you would expect from someone with osteoarthritis
Joint space narrowing
Cysts
Osteophytes (bony projections)
Subchondral sclerosis (increased whiteness of bone)
Young man presents with swollen red painful ankle, he has a fever, shivering and sweaty this occured over the last 2 days. What main questions would you like to know?
Any open wounds previously as this is likely septic arthritis and is an emergency. So need antibiotics
Medications for gout (diuretics) but gout unlikley due to systemic involvments
Why might during a flare of gout, urate be low inthe blood?
As it has all crystalised in the joints
Man 50yrs presents with red eyes, constantly painful hands with swollen PIP joints and a high white cell count. This occured over the last few days. He is a heavy drinker. Diagnosis? Treatment?
Gout
NSAIDS
Women presents with episodic joint inflammation of her PIP and MCPs, when inflammed they are swollen and red then relieve over a few days. Likely diagnosis?
Palandromic rheumatism
When prescribing methotrexate to a young women what must you consider?
If they want to start a family , as bad contraindications during pregnancy to the baby
What are common syndrome to occur with lupus?
Antiphospholipid syndrome Rheumatoid arthritis Sjogrens syndrome Scleroderma Myositis UCTD Myositis
