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MSK CORTEXT > 2- Rheumatology > Flashcards

2- Rheumatology Flashcards

1
Q

What is meant by the term arthropathy

A

Disease of a joint

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2
Q

What is meant by the term arthritis

A

Inflammation of the joint

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3
Q

What is meant by the term arthralgia

A

Pain in a joint

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4
Q

What are auto-antibodies

A

Antibodies generated by the immune system against the body’s own proteins, usually within cells

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5
Q

What can lead to the loss of immune regulation

A

Genetic predisposition

Often combined with environmental insults such as infection or chemicals

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6
Q

What are the 4 main classifications of inflammatory arthropathies

A

Seropositive
Seronegative
Infectious
Crystal deposition disorders

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7
Q

What are the mainstays of treatments for inflammatory arthropathies

A 
Mostly pharmacological:
Simple analgesia 
NSAIDs 
Steroids 
DMARDs
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8
Q

Which joints are most commonly affected by RA

A

Small joints of the hands and feet

As disease progresses it can include the knees, shoulders and elbows

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9
Q

List some potential triggers for RA

A

Smoking
Infection
Trauma

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10
Q

List some extra-articular presentations of RA

A

Rheumatoid nodules - lesions on extensor surfaces

Pleural effusions, fibrosis and pulmonary nodules Ocular involvement

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11
Q

Risk of which diseases is increased by RA

A

Cardiovascular morbidity and mortality

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12
Q

What are the expected levels of CRP, ESR and PV like in RA

A

Raised

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13
Q

List some early X-ray features of RA

A

Peri-articular osteopenia

Soft tissue swelling

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14
Q

What is the aim of RA treatment

A

Relieving symptoms
Preventing disease progression

Best to start early and aggressively

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15
Q

What treatments are used for short term relief of RA

A

Analgesia
NSAIDs
Steroids - oral or intramuscular/intra-articular

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16
Q

Which DMARD is used first line

A

Methotrexate

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17
Q

What are the risks of using DMARDs

A

Increased risk of infection

Bone marrow suppression

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18
Q

When is a patient considered for biologic therapy

A

High disease activity indicated by high DAS28 score

Not responding to DMARD therapy

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19
Q

Name some biologic drugs

A

Anti-TNF drugs
Toclizumab
Rituximab

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20
Q

What are the potential side effects of biologics

A

Increased risk of infection due to targeting of immune system
Reactivation of TB

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21
Q

What DAS28 score indicates low disease activity

A

2.7 - 3.2

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22
Q

What DAS28 score indicates moderate disease activity

A

3.3 - 5.1

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23
Q

What DAS28 score indicates high disease activity

A

more than 5.1

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24
Q

What operations are performed for rheumatoid arthritis

A

Synovectomy
Joint replacement
Joint excision
Tendon transfer

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25
Q

What characterises seronegative arthropathies

A

Inflammation and/or arthritic disease of the spine

Sacroiliitis and dactylitis are also common

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26
Q

What is the endpoint of ankylosing spondylitis

A

eventual fusion of the intervertebral joints and SI joints

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27
Q

Which conditions may be associated with ankylosing spondylitis

A

Anterior uveitis
Aortitis
Pulmonary fibrosis Amyloidosis

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28
Q

What percentage of people with psoriasis get the joint symptoms

A

30%

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29
Q

How do you treat psoriatic arthritis

A

Similar to RA
Use DMARDs
Anti-TNF if not responding
Joint replacement If larger joints severely affected

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30
Q

What is enteropathic arthritis

A

Inflammatory arthritis involving peripheral joints that occurs in patients with IBD

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31
Q

How soon after initial infection does the joint get affected in reactive arthritis

A

1-3 weeks

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32
Q

What is the treatement of reactive arthritis

A

Most are self-limiting
Treat underlying infectious cause
Symptomatic relief - IA or IM steroids
DMARDs in chronic cases

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33
Q

What can cause hyperuricaemia

A

Renal underexcretion - exacerbated by diuretics
Excessive intake of alcohol, red meat and seafood
Genetic predisposition

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34
Q

Which joints are most commonly affected by gout

A

First MCP joint - big toe

Ankle and Knee

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35
Q

How does gout present

A

Intensely painful red, hot swollen joint

36
Q

What can chronic gout lead to

A

Destructive erosive arthritis

37
Q

What conditions often coexist with pseudogout

A 
Hyperparathyroidism 
Hypothyroidism 
Renal osteodystrophy 
Haemochromatosis 
Wilson's disease
38
Q

How do you treat pseudogout

A

NSAIDs
Corticosteroids
Occasionally colchicine

39
Q

What structures does SLE mainly involve

A 
Skin 
Joints 
Kidneys 
Blood cells 
Nervous system 
Variable symptoms
40
Q

What age does SLE usually present

A

20s and 30s

Most common in women of childbearing age

41
Q

What are the constitutional symptoms of SLE

A

Fever
Fatigue
Weight loss

42
Q

What are the MSK symptoms of SLE

A

Arthralgia
Myalgia
Inflammatory arthritis
Increased prevalence of AVN

43
Q

What are the muco-cutaneous symptoms of SLE

A 
Malar rash
Photosensitivity
Discoid lupus
Subacute cutaneous lupus
Oral/nasal ulceration 
Raynauds phenomenon
44
Q

What are the respiratory symptoms of SLE

A 
Pleurisy
Pleural effusion
Pneumonitis
Pulmonary embolism
Pulmonary hypertension, Interstitial lung disease
45
Q

What are the renal symptoms of SLE

A

Lupus nephritis

46
Q

What are the neurological symptoms of SLE

A

Seizures
Pyschosis
Headache
Aseptic meningitis

47
Q

What are the haematological symptoms of SLE

A

Leukopenia
Lymphopenia
Anaemia
Thrombocytopenia

48
Q

What are the cardiac symptoms of SLE

A 
Pericarditis 
Pericardial effusion 
Pulmonary hypertension 
Sterile endocarditis 
Accelerated IHD
49
Q

What would the FBC results look like in an SLE patient

A

May show anaemia, leukopenia and thrombocytopenia

50
Q

How would you manage unresponsive SLE

A

May need IV immunoglobulin therapy and rituximab

51
Q

What monitoring must be carried out for people with SLE

A

Symptom - changes
Check anti-dsDNA antibody and complement levels regularly
Urinalysis - keep eye on kidneys
CV risk

52
Q

What is Sjogren’s syndrome

A

Autoimmune condition
Can be primary or due to RA or SLE
Characterized by lymphocytic infiltrates in exocrine organs

53
Q

What are the symptoms of Sjogren’s syndrome

A 
Dryness of eyes and mouth 
Arthralgia 
Fatigue 
Vaginal dryness 
Parotid gland swelling

May get peripheral neuropathy and lung disease

54
Q

What cancer does Sjogren’s increase the risk of

A

Lymphoma

55
Q

How do you manage Sjogren’s syndrome

A

Symptomatic management
Eyedrops and saliva replacement
Hydroxychloroquine for arthralgia/fatigue

56
Q

What are the cutaneous presentations of systemic sclerosis

A

Raynaud’s
Skin becomes thickened and tight
Beaking of the nose
Calcinosis - calcium deposits in fingers

57
Q

What organs may be involved in systemic sclerosis

A

Skin
Lungs - pulmonary hypertension, fibrosis
Renal - can be crisis
Gut - dysphagia, malabsorption

58
Q

How do you manage systemic sclerosis

A 
Tailored to patients symptoms 
Raynaud's - CCB 
Renal involvement - ACEi 
GI - PPI 
ILD - immunosuppression
59
Q

What is mixed connective tissue disease

A

Defined condition that features symptoms commonly seen in other connective tissue diseases

60
Q

What antibodies are associated with mixed connective tissue disease

A

Anti-RNP

61
Q

How do you manage mixed connective tissue disease

A

Varies depending on presentation
CCB for Raynaud’s
Immunosuppression - if muscle or lung disease

62
Q

What is antiphospholipid syndrome

A

Disorder that manifests as recurrent venous/arterial thrombosis and/or miscarriage

63
Q

What is catastrophic APS

A

Rare but serious (often fatal) manifestation

Multiorgan infarctions occur over days to weeks

64
Q

How do you diagnose APS

A

May be thrombocytopenia and prolonged APTT

Antibody tests

65
Q

How do you manage APS

A

Anticoagulation if there is an episode of thrombosis

LMWH in pregnancy

66
Q

Which age group does polymyalgia rheumatica affect

A

Elderly

Rare in the under 50s

67
Q

How does treatment progress in polymyalgia rheumatica

A

Start on low dose prednisolone
Decrease gradually over 18 months
Condition often resolves after this

68
Q

Describe the headache caused by giant cell arteritis

A 
Continuous 
Located in temporal or occipital areas 
Focal tenderness on palpation 
Scalp tenderness 
Temporal artery may be tender and prominent
69
Q

What is the cause of jaw claudication in GCA

A

Due to temporal arteritis leading to ischaemia of the maxillary artery

70
Q

How do you treat giant cell arteritis

A

Corticosteroids - started ASAP

dose reduced over 2 years and most will resolve

71
Q

Which age groups are affected by polymyositis and dermatomyositis

A

Adults over 20

Especially 45-60 years

72
Q

What investigations are done for polymyositis

A

Blood tests - inflammatory markers, antibodies
MRI - shows muscle damage
EMG - abnormal in most
Muscle biopsy

73
Q

What is the prognosis for polymyositis

A

Usually responds to treatment
30% left with some weakness
Older you are = worse the response

74
Q

What does dermatomyositis increase your risk of

A

Malignancy
Occurs in 1/4 of patients
Includes breast, ovarian, lung, colon, oesophagus and bladder

75
Q

How is dermatomyositis managed

A

Same as polymyositis

Steroids and immunosuppression

76
Q

What is fibromyalgia

A

Unexplained condition causing widespread muscle pain and fatigue

77
Q

Fibromyalgia can be associated with which other conditions

A 
RA - 25% 
SLE - 50%
Depression 
IBS 
Migraines
78
Q

What is vasculitis

A

Inflammation of the blood vessels

Results in vessel wall thickening, stenosis, and occlusion with subsequent ischemia

79
Q

What age does Takayasu arteritis occur

A

Rarely after 50

80
Q

Which countries have high incidences of TA

A

East Asian

81
Q

Which arteries does GCA typically affect

A

Temporal arteries

Can impact other large vessels

82
Q

What are common features of GCA

A

Fever, malaise, night sweat and weight loss
Claudicant symptoms in limbs
Headache

83
Q

How do you treat GCA

A

Corticosteroids - prednisolone

84
Q

What are some general features of small vessel vasculitis

A 
Fever and weight loss 
A raised, non blanching purpuric rash 
Arthralgia/arthritis 
Mononeuritis multiplex 
Glomerulonephritis 
Lung opacities on x-ray
85
Q

Who is commonly affected by Henoch-Schonlein purpura

A

Children

Often with history of URTI

MSK CORTEXT (13 decks)

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