RHEUMATOLOGY
, Good in Pregnancy:
Bad in Pregnancy: • Hydroxychloroquine
• Leflunomide • Azathioprine
• MMF ↳Co-presenbeFOLAI a • Sulphasalazine
• Methotrexate • Ciclosporin
• Cyclophosphamide • Tacrolimus
• All Anti-TNF
RHEUMATOLOGY (MSK)
itiligo
↳ Confirmed under Wood's lamp-complete loss of melanocytes
↳ IST LINE =
topical corticosteroids
, OSTEOARTHRITIS
Degenerative joint disease, cartilage breakdown, subchondral bone remodelling, inflammation
• Primary OA causes = age, genetic factors, female
• Secondary OA causes = trauma, obesity, joint malalignment, repetitive stress, inflammatory arthritis
Presentation
• Symptoms = joint pain, decreased range of motion, weakness
• Signs = bony enlargement, crepitus, tenderness to palpation along the joint line
• Pain which worsens with activity, improves with rest
• No systemic symptoms, inflammatory markers should be normal
Investigations
• 1ST LINE = X-ray
- Loss of joint space, osteophytes, subchondral scleorisis + cysts
• CT - visualise cartilage loss to evaluate severity of OA
• MRI - inflammation in the synovial, visualise cartilage and tendons
• Bloods - normal, rule out inflammatory arthritis
Risk factors
• Can diagnose without any investigations if >45 + typical pain with activity + no morning stiffness
• Obesity
• Genetics
Management
• Age
• Lifestyle modifications - weight loss, exercise, physiotherapy/occupational therapy, braces
• Occupation
• 1ST LINE = topical NSAIDs
• Abnormal joint loading
• 2ND LINE = oral NSAIDs -> co-prescribe with PPI
• Instability
- Topical = Capsaicin cream, topical NSAIDs
• Dysplasia
- Intra-articular injections = corticosteroids, hyaluronic acid -> short term relief
• Menisecotomy
• Surgical = joint replacement surgery, osteotomy = joint realignment surgery
↳ Joint authroplasty • ACL tears
severe on
symptomtreatment
o
=
, Good in Pregnancy:
Bad in Pregnancy: • Hydroxychloroquine
• Leflunomide • Azathioprine
• MMF ↳Co-presenbeFOLAI a • Sulphasalazine
• Methotrexate • Ciclosporin
• Cyclophosphamide • Tacrolimus
• All Anti-TNF
RHEUMATOLOGY (MSK)
itiligo
↳ Confirmed under Wood's lamp-complete loss of melanocytes
↳ IST LINE =
topical corticosteroids
, OSTEOARTHRITIS
Degenerative joint disease, cartilage breakdown, subchondral bone remodelling, inflammation
• Primary OA causes = age, genetic factors, female
• Secondary OA causes = trauma, obesity, joint malalignment, repetitive stress, inflammatory arthritis
Presentation
• Symptoms = joint pain, decreased range of motion, weakness
• Signs = bony enlargement, crepitus, tenderness to palpation along the joint line
• Pain which worsens with activity, improves with rest
• No systemic symptoms, inflammatory markers should be normal
Investigations
• 1ST LINE = X-ray
- Loss of joint space, osteophytes, subchondral scleorisis + cysts
• CT - visualise cartilage loss to evaluate severity of OA
• MRI - inflammation in the synovial, visualise cartilage and tendons
• Bloods - normal, rule out inflammatory arthritis
Risk factors
• Can diagnose without any investigations if >45 + typical pain with activity + no morning stiffness
• Obesity
• Genetics
Management
• Age
• Lifestyle modifications - weight loss, exercise, physiotherapy/occupational therapy, braces
• Occupation
• 1ST LINE = topical NSAIDs
• Abnormal joint loading
• 2ND LINE = oral NSAIDs -> co-prescribe with PPI
• Instability
- Topical = Capsaicin cream, topical NSAIDs
• Dysplasia
- Intra-articular injections = corticosteroids, hyaluronic acid -> short term relief
• Menisecotomy
• Surgical = joint replacement surgery, osteotomy = joint realignment surgery
↳ Joint authroplasty • ACL tears
severe on
symptomtreatment
o
=
