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Rheum (Pseudo Gout (Calcium pyrophosphate deposition, Usually affects the…
Rheum
Pseudo Gout
Calcium pyrophosphate deposition
Usually affects the larger joints
RF: Age, hyperparathyroidism, haemochromatosis, hypophosphatemia
Aspirate joint first to rule out Septic arthritis
Usually get chondrocalcinosis on X-ray
Most common cause of acute monoarthropathy in women over 65
SLE
Anti-dsDNA very specific (not sensitive); ANA (most sensitive); can also have Anti-Smith, Anti-Ro, Anti-La
Drug induced: Anti-histone Abs, skin and lung signs more common - remits if drug stopped
General Management: Sun cream, hydroxychloroquine (unless CI), maintenance with NSAIDs + hydroxychloroquine - can use azathioprine, methotrexate as steroid sparing agents - can add on Belimumab
Severe flare ups: IV cyclophosphamide + high-dose pred
Sjögrens: Can be primary or secondary from SLE/RA/Sclerosis; Lymphocytic infiltration of exocrine glands; Sx - xerostomia, vaginal dryness, chronic bronchitis, PBC, interstitial lung disease, decreased tears -->
increased risk of
non-hodgkins B lymphoma
Abs - Anti-Ro + Anti-La - these can cross the placenta and cause congenital heart block; Tx: Hydroxychloroquine, NSAIDs
Rheumatoid Arthritis
Increases the risk of CVS 2/3 fold
HLA DR4/DR1 is closely linked with severity
Extra articular manifestations: Nodules, pleural disease, interstitial fibrosis, brinchiolits, IHD, pericarditis, carpal tunnel
Antibodies: RhF - 70% of pts; Anti-CCP (citrullinated peptide) - very specific (98%)
Felty's syndrome: Splenomegaly + neutropenia in RA patients
Scleroderma
Rend to be ANA +ve
Limited: Anti-centromere antibody associated
Diffuse: Antitopoisomerase-1 (SCL-70) and anti-RNA associated
Acute renal crisis - ACEi (unusually)
Cardiac Tamponade: Pericardial window and ACEi
Spondyloarthritides
Tend to be
RhF -ve, HLA B27 (+ve)
/association, asymmetrical large-joint oligoarthritis
Ank Spond: Enthesitis, acute iritis, osteoporosis, aortic valve incompetence; Diagnosis: Clinical supported by imaging - MRI can show active inflammation
Psoratic arthritis: Pencil in a cup - get symmetrical polyarthritis (like RA), dacylitis, plaque psoriasis - tends to be Rf+ve
Reactive Arthritis: Arthritis occurs as an autoimmune response to infection
somewhere else
in the body - often GI or GU - don't tend to isolate organisms in joint aspirate; treat with 1) NSAIDs 2) Corticosteroids 3) DMARDs
Polymyalgia rheumatica
Inflammatory rheumatological syndrome that manifests as pain and morning stiffness involving the neck, shoulder girdle, and/or pelvic girdle in individuals older than age 50 years
ESR and CRP raised
Rx: Steroids
Gout
Reduced urate excretion: Elderly, men, post-menopausal, impaired renal function, hypertension, metabolic synd, diuretics, antihypertensives, aspirin
Excessive urate production: Dietary, genetic, myelo/lympho-proliferative disorders, psoriasis, tumour lysis syndrome, drugs
Septic arthritis
Knee is affected in >50% of cases
Join aspiration for fluid, culture,
Osteoporosis
DEXA: -1 and -2.5 is classified as osteopenia (low bone mass). A score below -2.5 is defined as osteoporosis.
Osteoporosis: Bisphosphonates and calcium + vit D
Relapsing polychondritis
Affects cartilage e.g. pina of the ear, nasal septum larynx; Associations - Aortic valve disease, polyarthritis, vasculitis - 30% have underlying rheumatic disease
Polymyositis and dermatomyositis
Insidious onset, autoimmune mediated, striated muscle inflammation. Affects women more than men, get proximal muscle weakness and wasting.
Dermatomyositis: Shawl sign (macular rash on shoulders), lilac-purple (heliotrope) rash around eyes with oedema, nailfold erythema, gottron's papules
Get increased muscle enzymes (ALT, AST, LDH, CK, Aldolase) in plasma; need muscle biopsy to con
Padgets Disease
Normal serum calcium and phosphate, raised Alk phos (can be >1000)