Rheumatology

Dr Liz Doxford-Hook Dr Laura Glenn FY1 Colorectal

Aims and Objectives

Learn some rheumatology
Arthritis Crystal arthropathies Auto immune conditions Vasculitis

Not be bored to death Slide show

Arthritis
OA
Number of joints Symptoms & Signs Monoarthropathy Pain at end of the day , stiffness

RA
Polyarthropathy Swelling, ulnar deviation, dorsal wrist subluxation, boutonniere and swan neck, z deformity. Plus extra articular

Tests

XR LOSS L - Loss of joint space O - Osteophytes S - Subchondral sclerosis S - Subchondral cysts

XR SPADES S soft tissue swelling P periarticular osteopenia A D deformity E erosions S subluxation

NSAIDs and analgesia and Steroids Physio Aids and appliances DMARDs (methotrexate, Sulfasalazine,
Hydroxychloroquine, Infliximab)

Management

Exercise, analgesia, weight loss, supportive aids, steroid injections and joint replacement

OA

RA

Septic arthritis
Always think about in a red hot joint can destroy a joint in 24 hrs RF IVDU, DM, trauma, prosthetic joint House officer role Bloods, cultures, analgesia IV flucloxacillin Senior aspriation, washout in theatre

Crystal arthropathies

GOUT Monosodium urate Needle shaped negatively birefringent urate crystals Trauma, surgery, starvation, diuretics & infection Ix microscopy plasma urate Rx NSAIDs, colchicine, allopurinol

PSEUDOGOUT Calcium pyrophosphate rhomboid shaped weakly positive birefringent crytals Illness, surgery and trauma Ix microscopy Rx - NSAIDs steroids

Spondyloarthropathies

Ankylosing Sponydlitis Young men Question mark posture Ix - Clinical diagnosis Mx exercise, NSAIDs, or TNF a-blockers. Surgery Psoriatic arthritis Symmmetrical polyarth Nail changes NSAIDs, methotrexate Reactive arthritis Sterile arthritis 1-4w after urethritis Rest, NSAIDs, steroids

Autoimmune connective tissue disorders

SLE Non-specific symptoms ANA, dsDNA Can be drug induced Mx different for different systems Systemic sclerosis CREST (anti-centromere antibodies) Diffuse systemic sclerosis Dermatomyositis

Vasculitis
Large GCA (temporal arteritis) Medium PAN, kawasaki Small ANCA +ve Wegners granulomatosis - ANCA ve HSP, goodpastures

Question 1
a. What is this nail sign? b. What condition is it associated with? c. How would you manage it?

Question 2
a. What are these signs called? b. What condition are they associated with?

Question 3
Patient with headaches and AKI What sign is evident? What is the background pathology?

Question 4
Small boy has this rash. He has a cannula and oxygen. What is it? What 3 things would you do?

Question 5
What is shown? What is the underlying physiology? Why would this person have deranged LFTs and leg pain?

Question 6
What does this film show? What is the definitive treatment?

Question 7
25 year old with haematuria. What is shown in his urine microscopy? Underlying cause?

Question 8
19 year old student generally unwell with sore throat. Takes antibiotics from friend being treated for ear infection then gets a rash. What is his underlying pathogen? What antibiotic was taken?

Chest xray what are the findings?