How does methotrexate work?
inhibits dihydrofolate reductase which is responsible for converting dihydrofolate to tetrahydrofolate
What can happen to blood test results when taking methotrexate?
Pancytopenia
deficiency in tetrahydrofolate –> used in DNA and RBS synthesis
How should methotrexate be taken and monitored?
taken weekly
monitored with FBC, LFTS, U&Es every 2-3 months
What should be prescribed with methotrexate?
folic acid 5mg
taken 24 hours + after dose
What two fractures are most at risk of compartment syndrome?
- supracondylar fracture
- tibial shaft injuries
What are the signs of compartment syndrome?
- pallor
- pain, even on passive movement
- paresthesia
-lack of pulses
What are the features of antiphospholipid syndrome?
- venous and arterial thrombus
- recurrent miscarriage
- livedo reticularis
What are the investigations and results for antiphospholipid syndrome?
Antibodies: anti-cardiolipin
thrombocytopenia
prolonged APTT
Management of antiphospholipid syndrome
- low dose aspirin
if they have a venous event:
- lifelong warfarin ( target INR 2-3)
How does achilles tendinitis present?
pain in posterior heel that gets worse with exercise
can cause morning stiffness and pain
How does an achilles rupture present?
- hear a ‘pop’
- sudden onset pain
- unable to continue activity
What test is performed for achilles rupture?
Simmonds
What is the first line investigation for achilles rupture?
US
What should be given to patients immediately if GCA is suspected?
high dose steroids
What does positive Fouchers sign mean?
Increase tension of bakers cyst on extension of knee
What are red flags for back pain?
- <20 years old and >50 years old
- history of malignancies
- trauma
- night pain
What does T-score on DEXA scan measure?
bone density compared to healthy population
What does z-score on DEXA scan measure?
bone density compared to same gender, age and ethnicity
What is the most common organism for septic arthritis?
Staph. aureus
What is the most common organism for septic arthritis in young people, who are sexually active?
Neisseria gonorrhoeae
Investigations for Septic arthritis
- needle join aspiration
- blood cultures
- imagine of joint
Management of septic arthritis
- IV flucloxacillin ( clinda if allergic) –> lasts 4-6 weeks and can switch to oral after 2
- wash out
What are the x-ray findings in AS?
- subchondral erosions, sclerosis (sacroiliitis)
- squaring of lumbar vertebrae
- bamboo spine ( uncommon and at later stages)
Management of AS
1) Exercises and NSAIDS
2) anti-TNF (etanercept and adalimumab)
