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25 Cards in this Set
- Front
- Back
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Azathiprine SEs |
- Hepatotoxicity - Myelosuppression such as neutropenia and thrombocytopenia (not iron deficiency anaemia) - Azoospermia (like sulfasalazine) in males - Alopecia - Nausea and vomiting - Hepatitis - Increased susceptibility to infection - Cancer associated with long term use - lymphoma and skin cancer. |
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ddx seropositive joint pain |
- RA -SLE - Scleroderma - Polymyositis - Sjogren's - Usually chronic (>6wks) |
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ddx seronegative asymmetrical |
- Psoriatic arthritis - reactive arthritis |
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ddx seronegative symmetrical |
- Ankolosis Spon |
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ddx acute polyarthritis/oligoarthritis (<6wks) |
- Post-viral (parvovirus B19) - Acute rheumatic fever - Infectious - Gout - Sarcoidosis - Lyme disease - HIV |
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Characteristics seronegative disease |
- M>F - Usually asymmetrical - Usually larger joints, lower extremities (except in PsA) - DIPs in PsA - Dactylitis - Usually has sacroilitius - Usually has enthesitis Extra art: *Iritis *oral ulcers *gastrointest *derm issues |
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Characteristics seropositive disease |
- F>M - Symmeterical - Small joints (PIP, MCP) + med joints (wrist, knee, elbow common). DIP less commonly involved - No axial/pelivic disease except C spine - No enthesitis Extra art: *Nodules *Vasculitis *Sicca *raynaud's |
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Characteristic pathologies for inflammatory joint disease |
- Synovitis - Joint space narrowing - Erosion - Cartilage destruction |
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Characteristic pathologies for degenerative joints |
- Loss of joint space -Osteophytes - Cartilage destruction |
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Radiograph hallmarks of OA |
• Joint space narrowing • Subchondral sclerosis • Subchondral cysts • Osteophytes |
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OA ix |
- Bloods: normal CBE, ESR, CRP - Neg RF and ANA - Radiology • Joint space narrowing • Subchondral sclerosis • Subchondral cysts • Osteophytes - Non inflamm synovial fluid |
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OA tx |
- No tx alters natural hx - Lower weight, prevent sports injuries, heat/cold - Physio - OT - Paracetamol 1st line for pain - Intrart steroids for a flare (lasts 4 weeks) |
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ANA positive diseases |
- SLE (98%) - Mixed connective tissue disease (100%) - Sjorgren's syndrome (40-70%) - CREST (60-80%) - High false pos rate |
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RF positive diseases |
RA (80%) (anti CCP also 80%) SS (50%) SLE (20%) |
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RA tx |
- CVD risk factor monitoring - Excersize + smoking cessation - Fish oil - Paracetamol for pain - DMARDS - pred - biologics |
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DMARDs for RA |
- Start with: *methotrexate + folic acid Add (or if MTX not tolerated) *hydroxychloraquine AND/OR sulfasalazine *Leflunomide/cyclosporin = 2nd line Response should be w/i 12 weeks - Can use prednisalone while waiting for DMARDs to take effect |
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Biologic agents for RA |
- if remission not achieved w DMARDs - TNF-a inhibs (etanercept, infliximab) - B/T lymphocyte modulators (abatacept, rituximab) - Combine with MTX - Watch for immunosuppression |
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Methotrexate |
- Goes into breast milk - Not for pregnant women |
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Sulfasalazine SEs |
- Oligospermia - Haemolytic anaemia - Folate deficiency - Hepatotoxicity |
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Leflunomide SEs |
- Opportunistic infections - Hepatotoxicity - Agranulocytosis, pancytopenia - Steven's johnson - Not in preg |
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Hydroxychloroquine SEs |
- Aplastic anaemia, leukopenia, thrombocytopenia - Cardiomyopathy - Retinal damage - Not for preg or breast feeding |
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Methotrexate monitoring |
- Major toxic effects, such as hepatic, pulmonary, renal and bone marrow abnormalities, require careful monitoring. *AST/albumin levels=>biopsy if persistently unusual *CBE: hb, leukocytes, plt, creatinine *chest xray (pulmonary fibrosis) • follow-up every 3-6 mo, then 6-12 mo after inflammation has been suppressed |
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SLE arthritis tx |
- NSAIDs for pain - Hydroxychloroquin improves long term control + prevents flares - Bisphosphonates, calc, vit D to stop osteoporos |
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Polymyositits /DMM ix |
- Bloods: CK, ANA, anti-Jo-1(DMM), anti-Mi -2, anti-SRP - EMG - Muscle biopsy |
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Polymyositis/DMM mgmt |
- Physio and OT, sunprotection - High dose corticosteroid and slow taper - Add: Immunosuppression w azathioprine, MTX, cyclosporine - Add: IVIg if severe or refractory + hydroxychloroquine for DMM rash +colchisine for calcinosis +Diltiazem (CCB) for HTN - Surveillance for malignancy *detail hx and PE (breast, pelvic, rectal) *CXR, abdo/pelvic US, foecal occult blood, pap, mammogram + pan CT |
