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75 Cards in this Set
- Front
- Back
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Defining pattern of disease 4 |
Axial/Appendicular Acute(<6weeks) or Chronic Mono, oligo or poly Which joings |
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Causative Organisms of Septic Arthritis |
Staph Aureus - gram positive cocci (anaerobe) Strep Pneumonia - gram positive cocci Neisseria Gonorrhoea - gram negative diplococci Haemophilius - gram positive coccobacilary |
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Risk factors for septic arthritis 4 |
Rh arthritis Diabetes Surgery/penetrating trauma Foci of infection |
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Investigations 4 |
Joint aspiration CRP Blood cultures - antibioitic guidance Focus of infection - CXR, skin, urine |
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Treatment |
>6 weeks course of antibiotics Empirical start - fluclox, clindamyin, vancomycin |
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Risk factors for crystal Arthropathies |
Trauma Osteoarthritis Wilson's disease Haemochromatosis Hypoparathyroidism Loop diuretics - hypomagnesia Renal impairment |
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Gout Presentation 4 |
Acute Tender Swollen Red joint |
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Joints affected by gout 3 |
First metotarsal Ankles, wrists and knees |
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Different presentations of gout |
Polyarticular in elderly women Rheumatoid like - Tophi, chronic Urate renal stones |
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Presentation of Pseudogout |
Similar to gout Large joints are usually affected |
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Fluid microscopy Gout |
Urate crystal Negatively birifingent needle shaped |
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Fluid microscopy Pseudogout |
Calcium pyrophosphate crystals Positively birifringent Rhomboids |
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X ray Gout |
Punched out lesions with sclerotic overhanging edges Sclerosis Tophi Preservation of joint space |
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Pseudogout |
chondrocalcinosis |
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Acute Treatment of Crystal arthropathy |
NSAID (naproxen) -tapering dose Colchicine Oral steroids (if renally impaired) |
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chronic managment of Gout |
Lifestyle Change medications - diuretics, renal function, hyperlipidaemia Allopurinol - do not start during an attack but don't stop it once started. Not in renal failure. Febuxostat - renal failure or allopurinol not sufficient |
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Inflammatory Oligoarthritis 4 |
PEAR Psoriatic Enteropathic Ankylosing Spondylitis Reactive |
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Features of Inflammatory oligoarthrites 4 + 1 |
SHED Spondyloarthropaties HLA B27 Enthesitis Dacyltis (Also seronegative) |
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Psoriatic Arthritis Presentation |
Plague psoriasis and nails Dactylitis Spondylitis Enthesitis Uveitis Affects Spine, DIPs, Elbows, Knees, Ankles |
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Psoriatic Arthritis Joints Affected |
Spine DIPs Elbows, Knees and Ankles |
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Psoriatic Arthritis Management |
NSAIDS Steroid Injections DMARDS Biologics |
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Enteropathic Arthritis Presentation |
Flares at same time as IBD Affects limbs and spine Uveitis |
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Enteropathic Arthritis Management |
Steroids DMARDS Biologics |
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Ankylosing Spondylitis Presentation |
Affects any part of spine, shoulders and hips Dull pain - radiates to buttocks Young men 20-30 |
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Ankylosing Spondylitis Associated Conditions 4 |
Cardiovascular Involvement Lung Fibrosis - upper lobe Prostate Inflammation Uveitis AVN block |
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Ank Spond Progression |
Inflammation of ligaments Syndesmophtes - bony protuberences across discs Bamboo spine |
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Ank Spond management 4 |
NSAIDS - indomethacin Sulfalasine Biologics Anti IL17 and 6 |
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Reactive Arthritis Causative Organisms 4 |
Shigella - dyssetry Salmonella Campylobacter Chlamydia |
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Reactive Arthritis Symptoms |
Can't see, can't pee, can't climb a tree Uveitis/conjunctivitis Urethritis Assymetric oligoarthritis - additive/migratory |
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SLE risk factors 5 |
Female sex hormones Sunlight Smoking Vitamin D deficiency Genetic |
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SLE triad |
Fever Joint pain Malar Rash |
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SLE Skin 5 |
Malar rash Discoid Acute cutaneous - looks like satellite psoriasis Alopecia Raynauds |
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SLE Joints |
Inflammatory arthritis - looks like rheumatoid Assymetrical Avascular necrosis |
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SLE Muscles |
Myalgia Weakness |
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SLE cardiac |
Peri/endo/myocarditis Clots - antiphospholipid antibodies |
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SLE renal |
Glomerulonephritis - leads to renal failure |
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SLE Neurological |
Seizures Cognitive impariment |
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SLE associated 3 |
rheumatoid arthritis Antiphospholipid syndrome Heart block in infants due to anti ro/anti la |
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SLE investigations 5 |
Antiphospholipid antibodies - prolonged activated PTT Anti ro anti la anti dsdna Smith antigen Low C4 |
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SLE differentials |
Hypothyroidism Rh arthritis Antiphospholipid syndrome |
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SLE treatment |
NSAIDS Hydroxychloroquinine - can cause macular disease Methotrexate Azathioprine - maintenance |
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Sjogren's syndrome Risk factors |
Female SLE, Rh arthritis Systemic Sclerosis |
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Sjogren's Syndrome symptoms 4 |
Keratoconjunctivitis Sicca Xerostomia Vasculitis Nephritis |
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Other effects |
Arthralgia/myalgia Peripheral neuropathy Venous thromboembolism Primary Biliary Cirrhosis |
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Sjogren's Syndrome Investigations |
Schirmer's test - <5mm in 5 minutes ANA - anti ro anti La |
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Sjogren's Associated Conditions |
autoimmune thyroitis MS Rheumatic disease Non Hodgkin Lymphoma |
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Hand signs in Osteoarthritis and Rheumatoid Arthritis |
Swan neck deformity Ulnar deviation Boutonniere deformity |
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z thumb |
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Boutonniere's deformity |
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Swan neck deformity |
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Rheumatoid Arthritis Joints affected |
Symmetrical involvement of MCP, PIP, MTP and synovial joints C spine |
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Rheumatoid Arthritis Signs |
Synovial inflammation causing spongy effusion Local osteoporosis Ulnar subluxation Hammer toe |
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Rheumatoid arthritis SKin |
Nodules Pyoderma gangrenosum Erythema nodosum Palmar erythema |
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Rheumatoid Arthritis Lung |
Fibrosis - related to RA and DMARDs |
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Rheumatoid arthritis other |
Renal amyloidosis Atherosclerosis |
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Rheumatoid arthritis bloods |
Anaemia of chonic disease Caused by increased hepcidin causing cellular uptake of iron Micro/normocytic with high ferritin Manage with EPO, iron and rbc transfusion |
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Rheumatoid arthritis Investigations |
Rh factor Anti CCP |
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Rh arthritis Management |
Methotrexate (sulfalasine during pregnancy) Steroids NSAIDS Quit smoking |
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Rh arthritis differentials and tests |
Psoriatic arthritis - seronegative Gout - aspiration and assymmetry Osteoathritis - seronegative assymetry SLE - anti dsdna Lyme disaese |
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Rh arthritis Radiological signs |
LESS Loss of joint space Erosion Soft Tissue swelling Soft bones |
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Osteoarthritis Initial symptoms 4 |
Pain and stiffness Better following light exercise then worse Swelling Decreased range of movement |
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Osteroarthritis Radiological signs |
LOSS Loss of joint space Osteophytes Subcondral sclerosis Subcondral cysts |
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Treatment for mild 5 |
Paracetamol + topical analgesia NSAIDS Opioids intraarticular steroid injection Intraarticular hydraronic acid |
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Treatment for severe |
All of the above + surgery |
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Systemic Sclerosis Presentation types 2 aka Scleroderma |
Skin - limted cutaneous Systemic - localised + visceral involvment Known as diffuse cutaneous |
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SS Limited Cutaneous Symptoms |
Tight, erythemous and scaly skin CREST |
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CREST Investigation 2 |
Calcinosis Raynaud's Esophageal dysfunction Sclerodactyly Telangectasia anti centromere antibody (also ANA positive) |
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SS - diffuse Main organ Investigation |
Kidney - malignant hypertension and pulmonary hypertension anti-Scl70 (ANA) |
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SS mangement |
NSAIDS Steroids nifedipine (raynauds) ACE inhibitor - AKI and hypertension Cyclophosphamide - acute alveolitis |
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Wegener's Granulomatosis (Granulomatosis with Polyangiitis) Main feature |
Visceral vasculitis |
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Presentation WG 6 |
Glomerulonephritis - kidney failure Necrotising vasculitis Necrotising granulmatour inflammation of lungs (pulmonary nodules, heamoptosis, dyspnoea) ENT Eye problems - all of the itis Inflammatory Arthritis |
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WG investigations |
Lung and kidney biopsys - granulomas cANCA |
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WG treatment |
cyclophosphamide Steroids DMARCs methotrexate, azathioprine |
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Polymyalgia Rheumatica Presentation |
Pain and stiffness Fatigue anorexia anemia Fever Temporal arteritis |
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Polymyalgia Rheumatica Invesgations 2 Treatment |
Temporal biopsy CRP, ESR Prednisolone |
