A 33-year-old female presents 6 weeks after the birth of her first child with a two-week history of polyarthralgia, fever and a skin rash. First-line investigations show:
What is the most likely diagnosis?
Correct Answer B: Unlike many autoimmune diseases systemic lupus erythematous (SLE) often becomes worse during pregnancy and the puerperium.
SLE: pregnancy: Overview:
A 57-year-old woman with a history of polymyalgia rheumatica has been taking prednisolone 10 mg for the past 5 months. A DEXA scan is reported as follows:
What is the most suitable management?
Correct Answer E: This patient has been taking 10mg of prednisolone for the past 5 months and hence should be assessed for bone protection. The T score of less than -1.5 SD is an indication for a bisphosphonate. This should be co-prescribed with calcium + vitamin D.
Osteoporosis: glucocorticoid-induced:
Patients who take the equivalent of prednisolone 7.5 mg or more each day for 3 months or longer should be assessed and where necessary given prophylactic treatment.
Assessment for treatment - patients taking the equivalent of prednisolone 7.5 mg or more each day for 3 months, and one of the following:
Treatment:
Which one of the following would not suggest an underlying connective tissue disorder in a patient with Raynaud's?
Correct Answer D: Raynaud's disease (i.e. primary) presents in young women with bilateral symptoms.
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 66-year-old female presents with pain at the base of her left thumb. She has no past medical history of note. On examination there is diffuse tenderness and swelling of her left first carpometacarpal joint.
Correct Answer A: The trapeziometacarpal joint (base of thumb) is the most common site of hand osteoarthritis.
Osteoarthritis: management: NICE published guidelines on the management of osteoarthritis (OA) in 2008:
What is the role of glucosamine?
A 66-year-old female is on long-term prednisolone therapy for polymyalgia rheumatica.
What is the most appropriate protection against osteoporosis?
Correct Answer C: Oral bisphosphonate therapy is recommended for patients older than 65 years who have taken, or who are likely to remain on oral corticosteroids for more than 3 months.
Bisphosphonates:
Bisphosphonates are analogues of pyrophosphate, a molecule which decreases demineralization in bone. They inhibit osteoclasts by reducing recruitment and promoting apoptosis.
Clinical uses:
Adverse effects:
The BNF suggests the following counselling for patients taking oral bisphosphonates:
Click to expand