RHEUMATOLOGY REVISION
Arthritis
Non- Inflammatory
inflammatory
Seronega Seroposit Crysta Infecti
tive ive l
HLA-B27 Rheumatoid
Ank spond SLE
Psoriatic Scleroderma
OSTEOARTHRITIS (OA)
- Degenerative, cartilage loss
- Sx: non-inflammatory unilateral joint pain/stiffness*, functional difficulties, bony deformities
(thumb squaring, BP, HD), limited ROM, malalignment, tenderness, crepitus,
haemarthrosis
- *Pain follows use, improves with rest, not systemic
- Affects larger joints (hip, knee) and hands (carpometacarpal, PIP, DIP)
- Dx: x-ray (Loss of joint space, Osteophytes, Subchondral sclerosis, Subchondral cysts)
- Tx: #1 lifestyle + paracetamol ± NSAID gel (hand or knee), #2 NSAID, opioid, capsaicin
cream, steroid injection
ANKYLOSING SPONDYLITIS
- ‘The A’s’ - Apical fibrosis, Anterior uveitis, Achilles tendonitis, AVN block, Amyloidosis,
Aortic regurgitation
- Sx: inflammatory back pain/stiffness, insidious onset, enthesitis, fatigue
- Dx: x-ray (Sacroiliitis, bamboo Spine, Syndespositis) + Schober’s test (<5cm lateral
flexion) + bloods (high CRP and ESR)
- Tx: NSAIDs + exercise ± physio (biologics in severe unresponsive cases, DMARDs if
peripheral joint involvement, steroid injection if intra-articular inflammation or enthesitis)
PSORIATIC ARTHRITIS
- Classification: symmetrical polyarthritis (like RA), asymmetric oligoarthritis (hands and
feet), DIP arthritis, psoriatic spondylitis (like ank-spond), arthritis mutilans
- Dx: x-ray (pencil in cup) + bloods (high CRP and ESR)
- Tx: NSAIDs ± physio ± steroid injection (DMARDs if progressive disease)
REACTIVE ARTHRITIS
, - Chlamydia trachomatis
- ‘Can’t see, can’t pee, can’t climb a tree’
- Sx: preceding STI or GI infection (within 4w lasting 4-6mo), conjunctivitis, urethritis,
inflammatory peripheral arthritis, dactylitis, circinate balanitis, keratoderma blennorrhagica
- Dx: bloods (high CRP and ESR), urogenital and stool cultures, x-ray, joint aspiration
- Tx: NSAIDs (DMARDs in chronic cases lasting >6mo)
RHEUMATOID ARTHRITIS (RA)
- Autoimmune, synovial inflammation
- Sx: inflammatory symmetrical joint pain/stiffness*, bony deformities (swan-neck, Z
deformity, Boutonniere’s), limited ROM, rheumatoid nodules
- *Pain follows rest (night pain), improves with use, systemic
- Affects smaller joints (wrist) and hands (MCP, PIP)
- Dx: bloods (RF, anti-CCP, high CRP and ESR), x-ray (juxta-articular osteopenia, soft
tissue swelling, marginal erosion, subluxation), DAS28
- Tx:
- Acute - prednisolone (steroid bridging tx) + NSAID
- Chronic - #1 DMARD monotherapy (MTX + folic acid or SSZ or leflunomide or
hydroxychloroquine), #2 DMARD dual therapy, #3 add biologic
- Felty’s syndrome - RA + splenomegaly + leukopenia
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
- Sx: malar rash associated with photosensitivity, alopecia, livedo reticularis and Raynaud’s
- Dx: bloods (RF, ANA, anti-dsDNA (monitoring), anti-histone (drug-induced commonly
by procainamide, hydralazine, isoniazid), normal CRP, high ESR, high aPTT, low C3/C4)
- Tx: hydroxychloroquine* + lifestyle** ± NSAID ± prednisolone
- *Monitor eyes, **Diet, smoking, sun, exercise
SCLERODERMA
- Limited cutaneous - RF, ACA/anti-centromere
- Scleroderma (face, distal limbs), Raynaud’s, ‘CREST’ subtype
- Diffuse cutaneous - RF, anti-scl-70/anti-topoisomerase
- Scleroderma (trunk, proximal limbs), hypertension, lung fibrosis, renal involvement
SJOGREN’S SYNDROME
- Sx: tiredness, Sicca syndrome (dry eyes and mouth), Raynaud’s
- Dx: Schirmer’s test (<5mm wetting in 5m), bloods (RF, anti-Ro, anti-La)
- Associated with primary biliary cholangitis
VASCULITIDES
- Small vessel
- ANCA-associated
