Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Rheumatology > 2: Autoimmune Inflammatory Arthritis > Flashcards

2: Autoimmune Inflammatory Arthritis Flashcards

1
Q

what is rheumatoid arthritis

A

Inflammatory autoimmune disease characterised by joint pain, swelling and synovial destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

in which gender is rheumatoid arthritis more common

A

Females (4:1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the peak incidence for rheumatoid arthritis

A

50-75y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what causes rheumatoid arthritis

A

Combination of genetic and environmental factors. Genetic factors include HLADR1 and HLADR4. Environmental includes smoking + infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

explain how rheumatoid arthritis presents

A
  • Symmetrical polyarthritis
  • Tends to affect smaller joints
  • Morning stiffness >30m
  • Swollen and painful joints (often without erythema)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

which joints does RA typically affect

A

MCP and PIP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is a never event in RA

A

That it affects DIPs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are 5 signs of the rheumatoid hand

A
  • Guttering
  • Swan neck
  • Boutoneire’s
  • Z-shaped
  • Positive squeeze test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is guttering

A

Wasting of the interoessi muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is swan neck deformity

A
  • Hyperextension at PIPS

- Flexion at DIPS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is boutonniere deformity

A
  • Flexion at DIPs

- Hyperextension at PIPs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is z-shaped deformity

A

Flexion at MCP, Hyperextension at DIPs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is flexion at the PIPs and hyper-extension at the DIPs called

A

Boutonierre’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is hyperextension at the PIPS and flexion and the DIPS called

A

Swan neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is hypertension at the DIPS with flexion at the MCP joint called

A

Z-shaped deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a positive squeeze test

A

when there is pain on squeezing over MCP or Meta-tarsal joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a deformity of the spine that can be present in rheumatoid arthritis

A

Atlanto-axial subluxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a deformity of the feet that can be present in RA

A

Hammer toe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 4 constitutional symptoms of RA

A
  • Malaise
  • Low grade fever
  • Myalgia
  • Night sweats
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a deformity of the skin present in RA

A

Rheumatoid nodules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are 2 lung problems that may be present in RA

A

Fibrosis

Pleural effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are 3 eye problems that can be present in RA

A

Episcleritis
Keratoconjunctivitis
Scleritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what haematological disease is present in RA

A

Normocytic normochromic anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how will RA of the cervical spine present

A

Atlanto-axial subluxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is felty syndrome

A

A severe form of seropositive RA. Presents with a triad of symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the triad in felty syndrome

A
  • Arthritis
  • Neutropenia
  • Splenomegaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Explain the pathophysiology of RA

A
  • autoimmune disorder triggered by interaction of genetic + enviroemntal
  • citrullination (arginine to citrulline) occurs in type II collagen
  • Susceptibility genes (HLA DR1 and HLA DR4) mean immune cells do not recognise the citrullinated protein and activate CD4 cells
  • CD4 causes prolifération of B cells to produce antibodies which enter joints
  • CD4 cells also recruit macrophages (using IL17 and IFNg) which then release TNFa, IL1 and IL6 which cause synovial cells to proliferate forming a pannus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What 4 investigations are ordered in RA

A
  1. CRP and ESR
  2. anti-CCP
  3. RF
  4. X-ray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How will CRP and ESR present

A

Raised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What antibody is very specific for RA

A

anti-CCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is rheumatoid factor

A

IgM antibody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the problem with rheumatoid factor

A

low specificity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What criteria is used to diagnose rheumatoid arthritis

A

American College of Rheumatology Criteria

34
Q

What score on the american college of rheumatology criteria defines RA

A

> 6/10

35
Q

What are the 4 categories in the american college of rheumatology criteria

A
  1. Joint involvement
  2. Antibodies (RF, ACPA)
  3. Serology (CRP, ESR)
  4. Duration of symptoms (> or < 6W)
36
Q

if individuals have suspected RA, what x-rays should be ordered

A

X-ray of the hands and feet

37
Q

What is a mnemonic to remember the 3 early signs of RA on x-ray

A

JLS

38
Q

What ate the late findings of RA on x-ray

A

Juxta-articular osteopenia
Loss of joint space
Soft-tissue swelling

39
Q

What score is used to look at the activity of RA for a patient

A

DAS28

40
Q

What are the 4 domains of the DAS28 score

A
  1. No. swollen joints
  2. No. tender joints
  3. ESR + CRP
  4. Subjective (line 1-10cm)
41
Q

What score indicates active disease in DAS28

A

> 5.1

42
Q

What score indicates low disease activity in DAS28

A

<3.2

43
Q

What score indicates remission in DAS28

A

<2.6

44
Q

What is first-line management for RA

A

disease modifying anti-rheumatic drugs (DMARD)

45
Q

What are the 4 dMARDs that could be offered

A
  1. Methotrexate
  2. Sulfalazine
  3. Hydroxycholorquine
  4. Lefluonomide
46
Q

what is the most common dMARD offered

A

Methotrexate

47
Q

What monitoring is required for methotrexate

A

FBC + LFT

48
Q

Why is FBC and LFTs monitored for methotrexate

A

Due to risk of myelosupression and liver cirrhosis

49
Q

Which is the only dMARD considered safe for pregnancy

A

Sulfasalazine, hydroxychloroquine

50
Q

What is second-line treatment for RA

A

Biological agents

51
Q

What are the criteria for sarliumab

A

DAS28 >5.1

52
Q

What is the mechanism of action of Sarliumab

A

monoclonal antibody raised against IL6

53
Q

What are 4 alternatives to sarliumab

A

etanercepts, infiximab, adalimumab

54
Q

What is third-line medication for RA

A

rituximab

55
Q

What is the MOA of ritxuimab

A

anti CD20 and therefore depletes B cells

56
Q

What is the criteria for rituximab

A
  • DAS28 >5.1

- Tried methotrexate and at least on other anti-TNF

57
Q

What are 5 factors associated with poor prognosis of RA

A 
Female 
Onset >60 
Smoker 
Prolonged progression
Raised CRP, ESR, RF, ACPA
58
Q

What are 5 complications of RA

A
  1. Joint deformity
  2. Lung fibrosis
  3. Myocarditis
  4. Pericarditis
  5. Amyloidosis
  6. Septic arthritis
  7. Sjogren’s syndrome
59
Q

What is psoriatic arthritis

A

Seronegative spondyloarthropathy that occurs with psoriasis

60
Q

What gene is present in 50% of cases of psoriatic arthritis

A

HLAB27

61
Q

what % of individuals with cutaneous arthritis will develop joint arthritis

A

10-20%

62
Q

What are the 5 patterns of psoriatic arthritis

A
  1. Asymmetrical oligoarthritis
  2. Arthritis mutilants
  3. Psoriasis spondyloarthropathy
  4. DIP predominant
  5. Symmetrical, RF negative arthritis
63
Q

What is the main presentation of psoriatic arthritis

A

Asymmetrical oligoarthritis (MCP, DIP, PIP) (70%)

64
Q

How does psoriatic arthritis differ from RA

A

It is asymmetrical oligoarthritis, whereas RA is typically symmetrical

65
Q

What is arthritis mutilans

A

Severe form of psoriatic arthritis that presents with telescoping of the fingers

66
Q

What joint does psoriatic spondyloarthropathy affect

A

Spine (40%)

67
Q

OE/ what may be seen in psoriatic arthritis

A

Erythematous, silver scaly patches over extensor surfaces (hands + knees)

68
Q

Do joint symptoms or cutaneous symptoms come first in majority of individuals

A

Cutaneous - often precede joint symptoms by several years in 75%

69
Q

What surface is the rash in psoriasis over

A

Extensor

70
Q

How may fingers present in psoriatic arthritis

A

Dactylitis

71
Q

How may nails present in psoriatic arthritis

A
  • Onychodystrophy (Pitting)

- Onycholysis

72
Q

How may eyes present in psoriatic arthritis

A

Chronic uveitis

73
Q

How may joints present in psoriatic arthritis

A

Tenosynovitis

74
Q

What criteria is used for psoriatic arthritis

A

CASPAR

75
Q

What 6 items is the CASPAR criteria based on

A
  1. Evidence psoriasis (FHx, cutaneous)
  2. Nail dystrophy
  3. Negative RF
  4. Dactylitis
  5. Radiologyical
76
Q

What 3 findings may be seen on x-ray of the hands in psoriatic arthritis

A
  1. Fluffy periostitis
  2. Pencil in cup deformity
  3. Acroosteolysis
77
Q

What is pencil in cup deformity

A

Re-absorption of head of middle phalanx and widening of base of distal phalanx

78
Q

What is acrostolysis

A

Reabsorption of distal phalanx

79
Q

How may the spine present

A

Syndesmophytes

Paravertebral ossification

80
Q

How is mild psoriatic arthritis managed

A

NSAIDs, PPI

81
Q

How is moderate psoriatic arthritis managed

A

dMARDs

82
Q

What investigation should be performed prior to starting someone on anti-TNF for RA and why

A

chest x-ray, to check for TB. As anti-biologics may cause re-activation

Rheumatology (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions