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what are charcot's joints?
severely deformed joints due to neuropathic injury
what are the causes of charcot's joints?
- tabes dorsalis (neurosyphilis)
- DM neuropathy
what are the x-ray characteristics of pagets disease of the bone?
sclerotic and lytic lesions (bone formation and breakdown)
what are the blood test findings of pagets disease of the bone?
raised Alk phase
what are the cardiac features of pagets disease?
high output heart failure
what is the treatment of pagets disease?
in which disease do both ESR and CRP rise during active disease?
what are the differences in the biochemical markers between osteomalacia and osteoporosis?
- osteomalacia: low serum calcium, low phosphate, raised ALP, raised PTH
- osteoporosis: serum calcium, phosphate and al phase are normal
what are the xray changes in osteomalacia?
- looser's zones: incomplete stress fractures eg in pubic rami, femoral neck and humeral neck, scapulae
what is osteoporosis?
- reduced bone density
- see on DEXA scan
in OP, what detects where the fractures happen?
- if trabecular bone is mostly affected: vertebral crush fractures (dowagers hump)
- if cortical bone: long bone fracture e.g. femoral neck
what is the treatment of osteoporosis?
- calcium rich diet
- calcium and vit D supplements
- Raloxifene (SERM) may also reduce breast ca risk
- calcitonin: reduces pain post vertebral fracure
- recombinant PTH: teriparatide. stimulates new bone formation and prevents fractures (use if intol to bisphos)
- strontium ranelate: increase bone formation, reduce resorption, reduce fracture rate
what is osteomalacia?
- normal amount of bone
- but reduced mineral content (excess uncalcified osteoid and cartilage)
what are the causes of osteomalacia? (4 categories)
- vitamin D deficiency: malab, poor diet, no sun
- renal: no 1alpha hydrox
- vitamin D resistance
- liver disease: less 25 hydroxyls and cirrhosis causes malab of vitamin D
what are the symptoms of osteomalacia?
- bone pain
- proximal myopathy and waddling gait as low phosphate and vitamin D deficiency
what is the treatment of osteomalacia?
- if due to malab: give calciferol (active vitaminD3) tablets
- if vitamin D resistanct give calciferol
- if renal disease: alphacalcidiol (1alpha hydroxy vitamin D) n.b. check calcium rise!
what are the SE of gold as a DMARD?
- BM suppression
- agranulocytosis and infection
- purpuric rash
- (give weekly injection)
what are the SE of penicillamine?
- lupus like syndrome
- high ANA too!
what are the SE of hydroxychloroquine? what type of drug is it?
- anti malarial
- BM suppression
what is behcets disease associated with, which HLA?
what are the symptoms/complicaitons of pagets?
- bone pain
- enlarged skull, femur, clavicle
- pathological fractures
what are the complications of pagets?
- nerve deafness (bone growth)
- high output CCF
- bone sarcoma
what is the treatment of pagets?
- Calcitonin if bis don't work
which autoAb are associated with sjogrens?
how would you differentiate PMR from DM or PM on blood tests?
in PMR the CK would be normal as it is not a myositis