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Terms in this set (23)
Diagnosis of RA?
Symmetrical small joint polyarthritis sparing DIPJ
RF or anti-CCP positive
Exclusion of other ddx such as psoriatic, CTD associated arthritis
Duration of symptoms > 6 weeks
What are the hand deformities associated with RA?
Dorsal subluxation of the ulnar styloid
Subluxation of MCPJ with ulnar deviation
Swan neck deformity
What are the articular complications of RA?
Carpal tunnel syndrome
Rotator cuff tear
What are the extra-articular manifestations of RA?
- Pericardial effusion
- Rheumatoid nodules in lung
- Pleural effusion
- Cervical myelopathy
- Carpal tunnel syndrome
- Anaemia of chronic disease
- Felty syndrome (splenomegaly + neutropenia)
- Secondary Sjogren's
What are the X-ray features of RA?
Soft tissue swelling
Symmetrical narrowing of joint space
What are the X-ray features of OA?
Asymmetrical narrowing of joint space
Management of RA
- PT for physiotherapy
- OT for ADL aids, splints for deformed joints
- Podiatry for shoe advice if required
- Steroids for rapid pain relief
Early initiation of DMARDs
- Methotrexate 1st line
- Biologics (Infliximab, Rituximab)
What are the possible joint involvement in psoriatic arthritis?
Sacroilitis / spondylitis
- Asymmetrical and cervical > lumbar
RA pattern - bilateral symmetrical arthritis
DIPJ limited - with nail changes
What are the nail changes associated with psoriasis?
Subungal plaques (Oil spot sign)
Increased thickness (subungal hyperkeratosis)
What are the autoantibodies associated with SLE?
Diagnosis of antiphospholipid syndrome
At least 1 clinical and 1 biochemical
- 1 thrombotic event
- Pregnancy related
a) At least 3 fetal loss < 10 weeks
b) At least 1 fetal loss > 10 weeks
c) At least 1 premature labour < 34 weeks
Biochemical (positive when test positive on 2 occassions 12 weeks apart)
- Lupus anticoagulant
- Anti-Beta 2 glycopeptide I
Management of APS
Lifelong warfarin for symptomatic patients
Consider aspirin prophylaxis in high risk patients who are asymptomatic
What is Raynaud's phenomena?
Abnormal vasoconstriction leading to digital ischaemia brought on by cold or emotional stress.
Can be primary or secondary
How is Raynaud's phenomenon diagnosed?
When all 3 of the following are present:
- Are you fingers unusually sensitive to the cold?
- Do your fingers change colour when exposed to cold?
- Do they turn white, blue or both?
Management of Raynaud's phenomenon?
- Avoid cold, wear gloves
- Avoid caffeine
- Avoid smoking
- Long acting CCB
- Topical nitrates
- PDE inhibitors (sildenafil)
- Prostaglandin analogues
- Digital sympathectomy
Causes of secondary Raynaud's phenomenon?
What is Sjogren's syndrome?
Chronic autoimmune condition characterised by diminished lacrimal and salivary gland functions
What are the autoantibodies associated with Sjogren's?
Management of Sjogren's?
Sugar free sweets
Regular dental review and dental hygiene
Management of scleroderma renal crisis
ACEi (not ARB)
Management of ILD in scleroderma
Pneumococcal and influenza vaccination
MMF / cyclophosphamide
What are the antibodies associated with systemic sclerosis?
Anti-SCL 70 (diffuse)
Anti-RNA pol III (diffuse)
Treatment of dermatomyositis / polymyositis
MTX / Azathioprine