A 57-year-old man with a history of ischaemic heart disease presents with an hot, erythematous and painful left 1st metatarsophalangeal joint. The attack settles following a course of non-steroidal antiinflammatories. He currently takes aspirin 75 mg od for secondary prevention of ischaemic heart disease.
What should happen regarding his medication?
Correct Answer B: Aspirin in a dose of 75-150mg is not thought to have a significant effect on plasma urate levels - please see the British Society for Rheumatology guidelines for more details.
Gout: drug causes: Gout is a form of microcrystal synovitis caused by the deposition of monosodium urate monohydrate in the synovium. It is caused by chronic hyperuricaemia (uric acid > 0.45 mmol/l).
Drug causes:
Osteopetrosis is due to a defect in:
Correct Answer A:
Osteopetrosis:
Overview:
Each one of the following is seen in reactive arthritis, except:
Correct Answer D:
Reactive arthritis: features:
Reactive arthritis is one of the HLA-B27 associated seronegative spondyloarthropathies. It encompasses Reiter's syndrome, a term which described a classic triad of urethritis, conjunctivitis and arthritis following a dysenteric illness during the Second World War. Later studies identified patients who developed symptoms following a sexually transmitted infection (post-STI, now sometimes referred to as sexually acquired reactive arthritis, SARA).
Reactive arthritis is defined as an arthritis that develops following an infection where the organism cannot be recovered from the joint.
Features:
Around 25% of patients have recurrent episodes whilst 10% of patients develop chronic disease.
Which of the following is not a recognized cause of Raynaud's phenomenon?
Correct Answer D: Ergotamine rather than pizotifen is associated with Raynaud's phenomenon.
Raynaud's:
Raynaud's phenomena may be primary (Raynaud's disease) or secondary (Raynaud's phenomenon).
Raynaud's disease typically presents in young women (e.g. 30 years old) with symmetrical attacks.
Factors suggesting underlying connective tissue disease:
Secondary causes:
Management:
A 54-year-old man with a history of type 2 diabetes mellitus presents with a history of right shoulder pain. On examination there is limited movement of the right shoulder in all directions.
What is the most likely diagnosis?
Correct Answer A: Diabetic amyotrophy affects the lower limbs.
Adhesive capsulitis:
Adhesive capsulitis (frozen shoulder) is a common cause of shoulder pain. It is most common in middle-aged patients. The aetiology of frozen shoulder is not fully understood.
Associations:
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