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- Created by: anishaVp
- Created on: 19-06-21 18:23
Rheumatoid arthritis: presentation
-ftures? 2 + test
-devel over how long?
-late features:
-ftures? 2 + test
-devel over how long?
-late features:
-late
1 of 32
Joint aspirate in rheumatoid arthritis shows:
-high WBC count:
predominantly PMNs
-typically yellow and cloudy
-absence of crystals
predominantly PMNs
-typically yellow and cloudy
-absence of crystals
2 of 32
Rheumatoid arthritis: complications
extra-articular complications:
-respiratory:
pulmonary fibrosis
pleural effusion
pleurisy
bronchiolitis obliterans
methotrexate pneumonitis
-ocular:
keratoconjunctivitis sicca (most common)
keratitis
episcleritis, scleritis
corneal ulceration
steroi
-respiratory:
pulmonary fibrosis
pleural effusion
pleurisy
bronchiolitis obliterans
methotrexate pneumonitis
-ocular:
keratoconjunctivitis sicca (most common)
keratitis
episcleritis, scleritis
corneal ulceration
steroi
3 of 32
Rheumatoid arthritis: x-ray changes
Early x-ray findings:
juxta-articular osteoporosis
loss of joint space
soft-tissue swelling
JLS came early. no RHEUM for little mix PLS
Late x-ray findings:
periarticular erosions
subluxation
juxta-articular osteoporosis
loss of joint space
soft-tissue swelling
JLS came early. no RHEUM for little mix PLS
Late x-ray findings:
periarticular erosions
subluxation
4 of 32
Systemic lupus erythematosus: investigations
Antibodies
Monitoring
Antibodies
Monitoring
Antibodies:
-99% are ANA positive:
(high sensitivity- so good rule out test!)
low specificity
-anti-dsDNA:
highly specific (> 99%)
but less sensitive (70%)
-anti-Smith:
highly specific (> 99%)
even less sensitivity (30%)
20% are rheumatoid fac
-99% are ANA positive:
(high sensitivity- so good rule out test!)
low specificity
-anti-dsDNA:
highly specific (> 99%)
but less sensitive (70%)
-anti-Smith:
highly specific (> 99%)
even less sensitivity (30%)
20% are rheumatoid fac
5 of 32
Paget's disease of the bone
-=?
-bones most commonly affected?
-Predisposing factors
-stereotypical presentation
-Clinical features - only 5% of patients are symptomatic
-=?
-bones most commonly affected?
-Predisposing factors
-stereotypical presentation
-Clinical features - only 5% of patients are symptomatic
-male sex
-^ing ag
-^ing ag
6 of 32
pagets dis: indications for trtment
trt:
trt:
-bone pain
-skull or long bone deformity
-fracture, periarticular Paget's
-bisphosphonate (either oral risedronate or IV zoledronate)
calcitonin is less commonly used now
-skull or long bone deformity
-fracture, periarticular Paget's
-bisphosphonate (either oral risedronate or IV zoledronate)
calcitonin is less commonly used now
7 of 32
Psoriatic arthropathy
-=?
-classified as
-presentation:
-other signs:
-=?
-classified as
-presentation:
-other signs:
-an inflammatory arthritis, associated with psoriasis
-classed as one of the seronegative spondyloarthropathies.
1.symmetric polyarthritis
very similar to rheumatoid arthritis
30-40% of cases, most common type
2.asymmetrical oligoarthritis:
20-
-classed as one of the seronegative spondyloarthropathies.
1.symmetric polyarthritis
very similar to rheumatoid arthritis
30-40% of cases, most common type
2.asymmetrical oligoarthritis:
20-
8 of 32
Psoriatic arthropathy- Investigation
Psoriatic arthropathy- Management
Psoriatic arthropathy- Management
-X-ray
unusual combo: coexistence of erosive changes and new bone formation
'pencil-in-cup' appearance
periostitis
refer to rheumatologist
treat as RA but better prognosis
unusual combo: coexistence of erosive changes and new bone formation
'pencil-in-cup' appearance
periostitis
refer to rheumatologist
treat as RA but better prognosis
9 of 32
A 45-year-old woman is seen in the rheumatology clinic with a 2-month history of joint pain. She has pain in her wrists and fingers bilaterally, which is worse in the morning and improves throughout the day. She is an artist by trade and finds it increasi
Inflammatory arthritis involving DIP swelling and dactylitis points to a diagnosis of psoriatic arthritis
10 of 32
Temporal arteritis
-=?
-Histology shows:
-ftures: age, onset, symps
-investigs:
-=?
-Histology shows:
-ftures: age, onset, symps
-investigs:
-large vessel vasculitis
-which overlaps with polymyalgia rheumatica (TA-P-R)
-changes characteristically 'skips' certain sections of affected artery, whilst damaging others.
-typically patient > 60 years old
-usually rapid onset (e.g. < 1 month
-which overlaps with polymyalgia rheumatica (TA-P-R)
-changes characteristically 'skips' certain sections of affected artery, whilst damaging others.
-typically patient > 60 years old
-usually rapid onset (e.g. < 1 month
11 of 32
Temporal arteritis- management:
-urgent high-dose glucocorticoids:
as soon as diag suspected
before the temporal artery biopsy
if no visual loss, pred
if evolving visual loss, IV METHYL-PRED
there should be a dramatic response
-urgent ophthalmology review
patients with visual sympt
as soon as diag suspected
before the temporal artery biopsy
if no visual loss, pred
if evolving visual loss, IV METHYL-PRED
there should be a dramatic response
-urgent ophthalmology review
patients with visual sympt
12 of 32
Antiphospholipid syndrome
-kinda disorder?
-characterised by? (3)
-other features:
-can be 1ary or 2ndary:
-serum tests?
-kinda disorder?
-characterised by? (3)
-other features:
-can be 1ary or 2ndary:
-serum tests?
acquired disorder
characterised by:
predisposition to both venous & arterial thromboses,
recurrent fetal loss
thrombocytopenia.
other ftures:
livedo reticularis
prolonged APTT
pre-eclampsia, pulmonary hypertension
It may occur as a 1ary disorder
characterised by:
predisposition to both venous & arterial thromboses,
recurrent fetal loss
thrombocytopenia.
other ftures:
livedo reticularis
prolonged APTT
pre-eclampsia, pulmonary hypertension
It may occur as a 1ary disorder
13 of 32
Antiphospholipid syndrome- manage
primary thromboprophylaxis
low-dose aspirin
secondary thromboprophylaxis
initial venous thromboembolic events: lifelong warfarin. target INR of 2-3
recurrent venous thromboembolic events: lifelong warfarin; if occurred whilst taking warfarin then consid
low-dose aspirin
secondary thromboprophylaxis
initial venous thromboembolic events: lifelong warfarin. target INR of 2-3
recurrent venous thromboembolic events: lifelong warfarin; if occurred whilst taking warfarin then consid
14 of 32
Sjogren's syndrome
-=?
-can be 1ary or 2ndary to?
-why learn it?
-ftres:
-investigs:
-=?
-can be 1ary or 2ndary to?
-why learn it?
-ftres:
-investigs:
autoimmune disorder
-affecting exocrine glands -> dry mucosal surfaces.
secondary to:
RA
other connective tissue disorders
usually develops around 10 years after the initial onset.
-Sjogren's syndrome is much more common in females (ratio 9:1).
-affecting exocrine glands -> dry mucosal surfaces.
secondary to:
RA
other connective tissue disorders
usually develops around 10 years after the initial onset.
-Sjogren's syndrome is much more common in females (ratio 9:1).
15 of 32
Sjogren's syndrome- Management
artificial saliva and tears
pilocarpine may stimulate saliva production
pilocarpine may stimulate saliva production
16 of 32
Pseudogout
-caused by:
-strongly *** with:
-most commonly affected joints:
fts:
-caused by:
-strongly *** with:
-most commonly affected joints:
fts:
deposition of calcium pyrophosphate dihydrate crystals in the synovium.
A monoarthropathy which affects large joints- esp kneww
strongly associated with ^d age.
Patients who develop pseudogout at a younger age (e.g. < 60 years) gen have some underlyi
A monoarthropathy which affects large joints- esp kneww
strongly associated with ^d age.
Patients who develop pseudogout at a younger age (e.g. < 60 years) gen have some underlyi
17 of 32
pseudogout-management:
-aspiration of joint fluid, to:
exclude septic arthritis
NSAIDs or intra-articular, intra-muscular or oral steroids as for gout
exclude septic arthritis
NSAIDs or intra-articular, intra-muscular or oral steroids as for gout
18 of 32
Septic Arthritis in adults:
-causative org:
-pathophys:
-features:
-examination findings:
-investigs:
-causative org:
-pathophys:
-features:
-examination findings:
-investigs:
most common organism overall is Staphylococcus aureus
young adults who are sexually active, Neisseria gonorrhoeae is the most common organism (disseminated gonococcal infection)
-most common cause is hematogenous spread
may be from distant bacterial in
young adults who are sexually active, Neisseria gonorrhoeae is the most common organism (disseminated gonococcal infection)
-most common cause is hematogenous spread
may be from distant bacterial in
19 of 32
Managing Septic Arthritis in Adults:
IV antibiotics which cover Gram-positive cocci are indicated:
BNF Ssays flucloxacillin
clindamycin if penicillin allergic
for 6-12 wks
needle aspiration should be used to decompress the joint
arthroscopic lavage may be required
BNF Ssays flucloxacillin
clindamycin if penicillin allergic
for 6-12 wks
needle aspiration should be used to decompress the joint
arthroscopic lavage may be required
20 of 32
Marfan's syndrome
-=? (with inheritance)
-cause?
-features:
-LE:
-=? (with inheritance)
-cause?
-features:
-LE:
-autosomal dominant connective tissue disorder
-caused by defect in FBN1 gene (on chromosome15) that codes for the protein FiBrillin-1
-tall stature
-arm span to height ratio > 1.05
-arachnodactyly
-high-arched palate
-pectus excavatum, pes pla
-caused by defect in FBN1 gene (on chromosome15) that codes for the protein FiBrillin-1
-tall stature
-arm span to height ratio > 1.05
-arachnodactyly
-high-arched palate
-pectus excavatum, pes pla
21 of 32
managing Marfan's syndrome
-regular echocardiography monitoring
-beta-blocker/ACE-inhibitor therapy
- Aortic dissection and other cardiovascular problems remain the leading cause of death however.
-beta-blocker/ACE-inhibitor therapy
- Aortic dissection and other cardiovascular problems remain the leading cause of death however.
22 of 32
Hydroxychloroquine
used to manage?
AEs - +what do about them
but + point
used to manage?
AEs - +what do about them
but + point
Hydroxychloroquine is used in the management of:
heumatoid arthritis
systemic/discoid lupus erythematosus.
v similar to chloroquine which is used to treat malaria
(OXy) bull's eye retinopathy - may result in severe and permanent visual loss
baseline
heumatoid arthritis
systemic/discoid lupus erythematosus.
v similar to chloroquine which is used to treat malaria
(OXy) bull's eye retinopathy - may result in severe and permanent visual loss
baseline
23 of 32
Systemic sclerosis:
-=?
-=?
-cond of unknown aetiology, characterised by
hardened, sclerotic skin
& hardened, sclerotic other connective tissues
hardened, sclerotic skin
& hardened, sclerotic other connective tissues
24 of 32
Systemic sclerosis:
-3 patterns of disease:
-1st sign
-whats predominantly affected?
-*** with which antibodies?
-3 patterns of disease:
-1st sign
-whats predominantly affected?
-*** with which antibodies?
Limited cutaneous systemic sclerosis:
Raynaud's may be first sign
scleroderma affects face and distal limbs predominately
*** with anti-centromere antibodies
a subtype of limited systemic sclerosis is CREST syndrome:
Calcinosis,
Raynaud's phenomenon
o
Raynaud's may be first sign
scleroderma affects face and distal limbs predominately
*** with anti-centromere antibodies
a subtype of limited systemic sclerosis is CREST syndrome:
Calcinosis,
Raynaud's phenomenon
o
25 of 32
Systemic sclerosis: Antibodies
ANA positive in 90%
RF positive in 30%
anti-scl-70 antibodies associated with diffuse cutaneous systemic sclerosis
anti-centromere antibodies associated with limited cutaneous systemic sclerosi
RF positive in 30%
anti-scl-70 antibodies associated with diffuse cutaneous systemic sclerosis
anti-centromere antibodies associated with limited cutaneous systemic sclerosi
26 of 32
Reactive arthritis:
-=?
-formerly known as?
-triad:
-ftres: time course,
-=?
-formerly known as?
-triad:
-ftres: time course,
Features:
typically devels within 4 weeks of initial infection - symps last around 4-6 months
conjunctivitis (&ant uveitis)
arthritis, typically an;
- asymmetrical oligoarthritis of lower limbs
urethritis
-+ dactylitis
-+ skin:
circinate balanitis
typically devels within 4 weeks of initial infection - symps last around 4-6 months
conjunctivitis (&ant uveitis)
arthritis, typically an;
- asymmetrical oligoarthritis of lower limbs
urethritis
-+ dactylitis
-+ skin:
circinate balanitis
27 of 32
Osteogenesis imperfecta
-more commonly known as?
-=?
-most common form?
-inheritance?
-ftures:
-more commonly known as?
-=?
-most common form?
-inheritance?
-ftures:
-more commonly known as :
brittle bone disease)
-group of disorders of collagen metabolism
-> bone fragility and fractures
most common, and milder, form of osteogenesis imperfecta is:
- type 1
-autosomal dominant
-presents in childhood
-
brittle bone disease)
-group of disorders of collagen metabolism
-> bone fragility and fractures
most common, and milder, form of osteogenesis imperfecta is:
- type 1
-autosomal dominant
-presents in childhood
-
28 of 32
Investigations- Osteogenesis imperfecta
way to memorise the cond:
way to memorise the cond:
adjusted calcium, phosphate, parathyroid hormone and ALP results are usually normal in osteogenesis imperfecta
Autosomal Dominant
Blue Sclera
Carries
Deafness (Otosclerosis)
Every Fracture Explained
Autosomal Dominant
Blue Sclera
Carries
Deafness (Otosclerosis)
Every Fracture Explained
29 of 32
Lateral epicondylitis
-cause:
-most common in?
-typically affects?
-features:
-duration
-cause:
-most common in?
-typically affects?
-features:
-duration
unaccustomed activity such as house painting or playing tennis ('tennis elbow')
most common in:
people aged 45-55 years
- typically affects the dominant arm
-pain and tenderness localised to the lateral epicondyle
pain worse on wrist extension ag
most common in:
people aged 45-55 years
- typically affects the dominant arm
-pain and tenderness localised to the lateral epicondyle
pain worse on wrist extension ag
30 of 32
Lateral epicondylitis- Management options:
-advice on avoiding muscle overload
-simple analgesia
-steroid injection
-physiotherapy
-simple analgesia
-steroid injection
-physiotherapy
31 of 32
Antisynthetase syndrome
-caused by:
-ftures:
-caused by:
-ftures:
-caused by autoantibodies against aminoacyl-tRNA synthetase e.g. anti-Jo1.
It is characterised by
-myositis
-interstitial lung disease
-thickened and cracked skin of the hands (mechanic's hands)
-Raynaud's phenomenon
Pneumonic = RIM JOB
R- Rayn
It is characterised by
-myositis
-interstitial lung disease
-thickened and cracked skin of the hands (mechanic's hands)
-Raynaud's phenomenon
Pneumonic = RIM JOB
R- Rayn
32 of 32
Other cards in this set
Card 2
Front
Joint aspirate in rheumatoid arthritis shows:
Back
-high WBC count:
predominantly PMNs
-typically yellow and cloudy
-absence of crystals
predominantly PMNs
-typically yellow and cloudy
-absence of crystals
Card 3
Front
Rheumatoid arthritis: complications
Back
Card 4
Front
Rheumatoid arthritis: x-ray changes
Back
Card 5
Front
Systemic lupus erythematosus: investigations
Antibodies
Monitoring
Antibodies
Monitoring
Back
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