QuestionSBA
QuestionChoice
Osteoarthritis is a non-inflammatory "wear and tear" arthritis. It presents with degenerative joint pain. This means there will not be any morning stiffness (or <30 minutes), and the pain gets worse on exercise. In addition, osteoarthritis typically affects those over 45 years old and has a longer, more gradual onset (typically over years). Although osteoarthritis can affect the hands, it is unlikely to affect so many joints in the hand symmetrically
33659
b
Osteoarthritis
QuestionChoice
Enteric arthropathy is a spondyloarthropathy that is often associated with inflammatory bowel disease. The joints affected include the spine and large peripheral joints. The absence of inflammatory bowel disease and the distribution of joint disease makes enteric arthropathy a less likely diagnosis
33661
d
Enteric arthropathy
QuestionChoice
Psoriatic arthritis is also an inflammatory arthritis. Symmetrical polyarthritis is a subtype of psoriatic arthritis that can present in the same distribution shown in the question. However, it tends to be associated with skin psoriasis, so many patients will also present with psoriatic plaques or psoriatic nail changes (although some patients will still not present with skin psoriasis). In addition, psoriatic arthritis also tends to affect the distal interphalangeal joints (DIPJ), unlike rheumatoid arthritis. The absence of DIPJ involvement and skin psoriasis makes a diagnosis of rheumatoid arthritis more likely
33660
c
Psoriatic arthritis
QuestionChoice
Rheumatoid arthritis is an inflammatory arthritis that can present at any age but typically presents in middle-aged females and smokers. It typically comes on over a few months, with pain and stiffness improved with exercise and worsened by rest, along with prolonged morning stiffness. The typical distribution in early rheumatoid arthritis is the metacarpophalangeal joints and proximal interphalangeal joints in the hands and the small joints of the feet and wrists. The distal interphalangeal joints are characteristically not affected in rheumatoid arthritis. This patient should have some blood tests, hand x-rays and a referral to rheumatology for consideration of a disease-modifying anti-rheumatic drug (DMARD)
33658
a
Rheumatoid arthritis
QuestionChoice
Systemic lupus erythematosus (SLE) is a connective tissue disease that presents with inflammatory arthritis. However, there are often other extra-articular features in SLE, including fatigue, fever, weight loss, alopecia, malar rash, pericarditis, pleural effusion, blood abnormalities, neurological involvement, and there is an association with antiphospholipid syndrome. None of these features are present in this case, making a diagnosis of SLE less likely
33662
e
Systemic lupus erythematosus
Concept
Chapter
# Side effects of corticosteroids

**Corticosteroids** (think CORTICOSTEROIDS):

- Cushing's syndrome
- Osteoporosis
- Retardation of growth
- Thin skin, easy bruising
- Immunosuppression
- Cataracts and glaucoma
- Oedema
- Suppression of HPA axis
- Teratogenic
- Emotional disturbance (including psychosis
- Rise in BP
- Obesity (truncal)
- Increased hair growth (hirsutism)
- Diabetes mellitus
- Striae

# Side effects of NSAIDs

- Indigestion
- Peptic ulcer disease,
- Increased risk of venous thrombo-embolus
- Peripheral oedema
- Slightly increased risk of stroke and heart attack

# Side effects of Methotrexate

- Gastro-intestinal disturbance
- Folate deficiency - anaemia
- Immunosuppression
- Pulmonary fibrosis
- Liver toxicity
- Interstitial pneumonitis
- Rash
- Teratogenicity - Methotrexate is contraindicated during conception and pregnancy. The recommendation is a washout of a few months (at least 3 months) before conception. In the event of a disease flare, low-dose steroids are thought to be relatively safe. Note that high doses are associated with a small increased risk of the child having a cleft palate.

# Side effects of Sulfasalazine

- Myelosuppression
- Nausea
- Rash
- Oral ulcers
- Decreased sperm count

# Side effects of Hydroxychloroquine

- Retinopathy
- Rash

# Side effects of Biologic therapy (e.g. etanercept, infliximab, adalimumab)

- Immunosuppression
- Reactivation of TB
- Allergic reaction, reaction at infusion site

# Side effects of Gold

- Myelosuppression
- Renal toxicity (Nephrotic syndrome)
- Mouth ulcers
- Photosensitivity
- Chrysiasis (skin discolouration)
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Side Effects of Drugs used to Treat Rheumatoid Arthritis
Topic
54
Rheumatology
6732
A 31-year-old female medical secretary presents to her GP with a two-month history of painful and stiff hands. The pain gets better throughout the day, but she has to get up 3 hours before work to have time for the stiffness to subside. On examination, there is swelling over all metacarpophalangeal joints and proximal interphalangeal joints on both hands.

What is the most likely diagnosis?
a