QuestionSBA
QuestionChoice
In early psoriatic arthritis, there may be no visible change on radiograph, except for some soft tissue swelling due to the inflammatory nature of the condition. Late in the disease course, there is classical osteolysis with new bone formation around the joint margins, which causes a "pencil-in-cup deformity". Over time the arthritis can progress into "arthritis mutilans"
33409
b
Psoriatic arthritis
QuestionChoice
SLE can cause arthritis, particularly of the hands and feet, however this is classically "non-deforming" which means you would not see these destructive changes on imaging
33412
e
Systemic lupus erythematosus (SLE)
QuestionChoice
X-rays of patients with RA may show loss of joint space with peri-articular osteopenia, bony erosions around the joint margins and associated soft tissue swelling. Late on in the disease course, they may reveal joint subluxation. In this radiograph, you can see evidence of all of these features - in keeping with the history of a delayed presentation and relatively advanced disease. Characteristic of rheumatoid, there is also resultant ulnar deviation at the metacarpophalangeal joints and Z thumb deformity
33408
a
Rheumatoid arthritis (RA)
QuestionChoice
Ankylosing spondylitis tends to present with inflammatory **back pain** in young patients, usually in their late teens and early 20s. It is also more common in men, compared to RA which is more common in women
33411
d
Ankylosing spondylitis
QuestionChoice
X-rays in OA show **L**oss of joint space, **O**steophytes, **S**ubchondral cysts and **S**ubarticular sclerosis (helpful acronym to remember these features is **LOSS**). It does not cause the classic ulnar deviation or erosive changes as seen in rheumatoid arthritis
33410
c
Osteoarthritis
QuestionComment
Is this the correct XR for this question? Can't seem to see any of the signs, especially not any ulnar deviation, unless I'm just being really dumb haha
10637
QuestionComment
Spend more time on x rays
22633
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Big mo
QuestionComment
Another unhelpful smartass.

This is a tricky question which require close examination of the XR to see the points made. If you don't have a particularly bright screen this may be a problem. 

In this case it might have been better to also weight the decision more based on the patient history. 
23377
User
subscriber
Acanthosis Nigracan't
User
subscriber
Acute Thermoregulator
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
6682
Picture
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RA Xray.jpeg
images/lz0eu47h1639016735401.jpg
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DAgOBQAFm5RaZ4eIeHh3dwAAAAAA
Topic
54
Rheumatology
A 52-year-old woman presents to her GP with worsening pain and deformity in both her hands. The patient has recently moved to the UK and previously had poor access to healthcare. The pain first started 15 years ago and is worse in the morning, with associated stiffness which does not ease until the middle of the day.

A plain x-ray of her right hand is shown below:

[lightgallery]

What is the most likely diagnosis?
a