• Rheumatology

    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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    Rickets

    by  • 22/06/2013 • Rheumatology

     Impaired mineralization of skeleton in childhood.   3 congenital causes:  Hypophoshatemic rickets (X-linked)  Congenital 1a-hydroxylase deficiency  Congenital vitamin D resistance.   P/c: Causes bone pain, deformities, muscle weakness and growth retardation as well as the increased fracture risk. Tx:    The treatment and prevention of rickets is known as...

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    Osteomalacia

    by  • 21/06/2013 • Rheumatology

     Is the impaired mineralization (deposition of hydroxyapatite) of bone in the mature skeleton. Due to inadequate phosphate and or calcium in the extracellular fluid, or a circulating inhibitor of mineralization   Cause:  Vitamin D deficiency.  Abnormal vitamin D metabolism – liver/renal disease or drugs such as anticonvulsants, hypophosphatemia.  Inhibitors of...

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    Fractures

    by  • 20/06/2013 • Rheumatology

    General principles of fractures  Fracture is a loss of continuity of the substance of the bone due to physical force. Covers severely comminuted, hairline crack (can cause a periosteal reaction 2 weeks later) and micro fracture.  Dislocation is a complete loss of contact between articulating surfaces of a joint  Subluxation of...

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    Behcets Disease

    by  • 18/06/2013 • Rheumatology

     Multi-organ disease, unknown cause – infective?  Men, arthritis, ocular symptoms (pain in eyes, reduced vision, floaters, iritis, ulceration of mouth and genitals, colitis, meningoencephalitis.  Mx: refer to GUM and ophthal, high dose prednisolone or colchicine, topical steroids for ulcers. 

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    Ankylosing Spondylitis

    by  • 15/06/2013 • Rheumatology

     1:2000, male, 95% HLA-B27 +ve  p/c: morning back pain/stiffness, progressive spinal fusion (ankylosis) = reduced spinal movement, kyphosis, SI joint fusion, neck hyperextension, and neck rotation, reduced chest expansion, hip/knee arthritis, enthesopathies, iritis, Crohn’s/UC (=IBD), heart disease, OP, psoriaform rashes.  Ix: FBC (anaemia), ESR high, RhF –ve. Xray: widened SIJ and...

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