• Rheumatology

    Mixed Connective Tissue Diseases (+Misc?):

    by  • 15/07/2014 • Rheumatology

     Lupus: o Systemic lupus erythematosus (SLE) o Drug induced lupus o Discoid Lupus Erythematosus   Antiphospholipid syndrome   Raynaud’s syndrome   Polymyositis   Systemic sclerosis and CREST syndrome   Sjogren’s syndrome   Polymyalgia rheumatic (PMR) and giant cell arteritis (GCA)   Vasculitis o Erythema nodosum o Henoch-Schonlein purpura (HSP) o Polyarteritis nodosa (PAN)...

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    Fibromyalgia

    by  • 13/07/2013 • Rheumatology

    Painful, non-articular condition of unknown cause, involving muscles. Common and results in significant disability and handicap, 90% female, 40-50yo.  p/c: pain/tenderness locations o Insertion of nuchal muscles into the occiput o Upper border of trapezius midportion o Muscle attachments to upper medial border of scapula o Anterior aspects of C5, C7 intertransverse spaces...

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    Chronic fatigue syndrome (CFS) / myalgic encephalomyelitis (ME)

    by  • 12/07/2013 • Rheumatology

       Debilitating and distressing, prevalence 0.2-2.6%, women.  Cause: unknown, follows virus (10% EBV), immunization, chemical toxins (e.g. organophosphates, CT)…  p/c: unexplained fatigue for >6/12, not due to ongoing exertion, nor alleviated by rest, reduced activity and >4 of following = impaired memory/concentration, tender cervical/axillary LNs, post-exertional malaise lasting >24h (delayed: starting...

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    Vasculitis

    by  • 11/07/2013 • Rheumatology

    Vasculitis  Inflammation within or around blood vessels (-/+ necrosis). Severity depends on size and site of vessel involved.  Causes: idiopathic (50%), CTD (SLE/RA), infection (rheumatic fever, I.E. Lyme’s disease), drugs (NSAIDSs, antibiotics), neoplasia (lymphoma, leukaemia).  General p/c: skin (=palpable painful purpura on lower legs/buttocks), systemic (=fever, night sweats, malaise, weight loss,...

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    Mixed Connective Tissue Diseases

    by  • 10/07/2013 • Rheumatology

    Overlapping group of disease – common pattern = they all affect many organs and are associated with fever, malaise, are chronic (relapsing/remitting), and respond to steroids. Difficult to diagnose – if unsure, refer to rheum. Systemic lupus erythematosus (SLE)  p/c: Rare (1:3000), autoimmune, female, afro-carribean/asian, 15-40yo, multisystem involvement: joints (arthritis, myalgia…), skin (photosensitivity,...

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    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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