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module 2 diseases (connective tissue (SLE (induced by drugs (minocycline,…

- - - - minocycline
      - oral contraceptive pill
      - hydralazine
      - mild
      - spares the kidneys
      - settles when drug removed
    - - B cell hyperactivity
      - dysfunction of complement
      - t cell dysfucntion
      - faulty apoptosis
      - antibodies
        
        anti ro
        
        anti double stranded DNA
        
        anti c ('anti coagulation')
        
        ANA
        
        anti la
      - vasculopathy and clotting cascade issues
    - - 15-40
      - general
        
        fatigue
        
        constitiutional symptoms
      - musculoskeletal
        
        deformity from tenosynovitis and fibrosis
        
        myositis
        
        poly articular arthralgia
      - dermatological
        
        butterfly rash
        
        photosensitiity
        
        discoid lupus
        
        alopecia
        
        mucousal ulceration
- - - - children
      - defective mineralization of cartilage in the epiphyseal growth plates
    - - bone pain
      - skeletal deformity
      - muscle weakness
      - fracture
- - - - needle shaped
      - strong negative birefrigence
    - - maybe elevated serum urate
      - raised ESR and CRP
      - polymorphonuclear leukocytosis
    - - NSAIDS
        
        Ibuprofen 400mg TDS
      - colchicine
        
        500micrograms TDS
        
        stop if diarhoea
      - steroid joint injections
        
        if cant tolerate NSAIDS/colchicine
      - allopurinol is preventative
        
        reduces uric acid synthesis by inhibiting the enzyme xanthine oxidase
    - - tophus formation
        
        soft tissue depositions of urate
      - joint distruction
        
        cartilage distruction
        
        bony erosion
      - urate deposition in kidney may cause nephropathy
  - - - mainly in cartilage
    - - acute is like normal gout
      - chronic is like osteoarthritis
    - - rhomboid or rod shaped crystals
      - weak positive birefringence
    - - Chondrocalcinosis.
      - OA changes
        
        cartialge loss
        
        sclerosis
        
        cysts
        
        osteophytes
    - - analgesics
      - joint aspiration
      - intra-articular corticosterod injection
- - - - joint pain stiffness and swelling
        
        ulnar deviation
        
        boutonniere
        
        swan neck
        
        neck pain
      - worse in morning, improves with use
      - small and medium joints
      - loss of function
    - - rheumatoid nodules
      - tenosynovitis and bursitis # #
      - carpal tunnel #
    - - symmetrical poly-arthritis involving the hands
      - females more than males
      - HLADR4 genes
      - treat with NSAIDs and DMARDS and steroids and biologics
    - - generally unwell
      - distant organs
        
        aneamia
        
        felty syndrome
        
        lung disease
        
        plural effusions
        
        lung nodules
        
        ILD
    - - soft tissue swelling
      - periarticular osteoprosis
      - juxtarticular erosions
      - narrowing of joint space
  - - - synovial joint disease
        
        articular surface degeneration
        
        formation of new bone
        
        secondary inflammation
      - common, older people
      - repeated microtrauma
      - primary or secondary
      - ON XRAY
        
        joint space narrowing
        
        sclerosis
        
        cysts
        
        osteophytes
    - - surgical
        
        joint replacement
        
        joint fusion
        
        joint excision
        
        re-alignment urgery
      - medical
        
        lifetyle
        
        NSAIDS + analgesics
        
        physio
    - - slow onset
      - asymetrical
      - worse after activity, relieved by rest
      - knee, hip, first caropmetacarpal joint, DIP, PIP