• Archive for June, 2013

    Calcium pyrophosphate deposition disease (CPDD)

    by  • 30/06/2013 • Rheumatology

     Inflammatory arthritis due to deposition of pyrophosphate crystals, associated with OA, hyperparathyroidism, and haemochromatosis.  P/c: less severe than gout, difficult to differentiate from other athritides. Knee, wrist, shoulder affected, maybe triggered by inter-current illness, and metabolic disturbance.  Ix: chondrocalcinosis maybe seen on Xray (calcification of articular cartilage), joint crystals present. ...

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    Acute & Chronic Gout

    by  • 29/06/2013 • Rheumatology

    Acute gout  Intermittent attacks of acute joint pain due to uric acid crystal accumulation, 3-8/1000, inc with age, men.  RFs: FH, obesity, excess alcohol, high purine diet, diuretics, acute infection, ketosis, surgery, psoriasis, polycythaemia, leukaemia, cytotoxics, renal failure.  p/c: acute painful swollen joint (big toe), red peeling skin, fever, can be...

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    Enteropathic Spondyloarthropathy

    by  • 29/06/2013 • Rheumatology

     Oligoarticular or polyarticular arthritis linked to IBD  p/c: sacroiliitis, plantar fasciitis, enthsitides (insertional ligament/tendon inflammation), arthritis remission/exacerbartion may not mirror IBD flares.  Mx: NSAIDs (may help arthritis, but flare up IBD), refer to rheum.  

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    Reactive arthritis (Reiter’s disease)

    by  • 28/06/2013 • Rheumatology

     Asymmetrical aseptic in >1 joint, 2-6/52 post infection elsewhere (gastroenteritis, salmonella, campylobacter), more in HLA B27+ve individuals.  Can’t see, pee, or climb a tree (eye involvement = uveitis, water infections = dysuria/frequency, arthritis).  Mx: NSAIDs, steroid joint injections, self-limiting, maybe chronic requiring DMARDs = refer. 

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    Psoriatic Arthritis

    by  • 28/06/2013 • Rheumatology

     Inflammatory arthritis associated to psoriasis (40% of psoriasis pts have PA)  Men = women, 75% have psoriasis before arthropathy, in 10% arthropathy precedes.  Presentations variable:  Distal = DIP swelling, nail dystrophy, flexion deformities, dactylitis  Rheumatoid-like = polyarthropathy but less symmetrical and RhF-ve    Mutilans = severe psoriasis, erosions,...

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    The Spondyloarthropathies

    by  • 27/06/2013 • Rheumatology

     Group of inflammatory rheumatic diseases (involve axial and peripheral joints, and enthuses):  Include: ankylosing spondylitis, psoriatic arthritis, reiter’s disease, IBD-associated arthritis, Behcets syndrome, Whipple’s disease.  Sacroiliitis and spondylitis occur with all of them. Associated with HLA-B27 genotype. 

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    Rheumatoid arthritis (RA)

    by  • 26/06/2013 • Rheumatology

     Affects 1% of population o Immunological disease triggered by environmental factors in pts with genetic predisposition. Exacerbations / remissions are common. o Refer early as early DMARDs tx can significantly improve outcome.  P/c: middle age, female, often gradual/can be acute onset, symmetrical peripheral joint pain/stiffness/swelling/loss of function, effusions and swellings, early morning...

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    Osteoarthritis (OA)

    by  • 25/06/2013 • Rheumatology

    Wear and tear (of bone/cartilage/synovial joint) arthritis – most common locomotor disability. Now thought to be metabolically active process.  RFs: increasing age, female, black/asian, genetics/FH, obesity, abnormal joint loading de to previous injury, weak muscles, certain occupations (farming)…  P/c: pain in joint, stiffness, synovial capsule tightening and thickening, deformity (odd bone angulation),...

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    Osteoporosis

    by  • 24/06/2013 • Rheumatology

     Lifetime risk of OP fracture =40% in women, 13% in men.  Highest morbidity linked to hip fracture in >70yo.  OP is a bone mineral density (BMD) >2.5 SD below the young adult mean (T = – 2.5), tested by DEXA (dual energy x-ray absorptionometry) scan.  Complete DEXA scan if: <75yo...

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    Pagets disease

    by  • 23/06/2013 • Rheumatology

    (5% of UK):  Disorder of bone remodeling with increased osteoclasts resorption, followed by increased bone formation (compensation of osteoblasts)  Can lead to – abnormality in X-ray, pain, deformities and increased risk of fractures, cranial nerve entrapment  Only 30% have symptoms!   P/c:  Skull commonly effected and can lead to deafness...

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