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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
What characterises seronegative arthropathies
Inflammation and/or arthritic disease of the spine | Sacroiliitis and dactylitis are also common
26
What is the endpoint of ankylosing spondylitis
eventual fusion of the intervertebral joints and SI joints
27
Which conditions may be associated with ankylosing spondylitis
Anterior uveitis Aortitis Pulmonary fibrosis Amyloidosis
28
What percentage of people with psoriasis get the joint symptoms
30%
29
How do you treat psoriatic arthritis
Similar to RA Use DMARDs Anti-TNF if not responding Joint replacement If larger joints severely affected
30
What is enteropathic arthritis
Inflammatory arthritis involving peripheral joints that occurs in patients with IBD
31
How soon after initial infection does the joint get affected in reactive arthritis
1-3 weeks
32
What is the treatement of reactive arthritis
Most are self-limiting Treat underlying infectious cause Symptomatic relief - IA or IM steroids DMARDs in chronic cases
33
What can cause hyperuricaemia
Renal underexcretion - exacerbated by diuretics Excessive intake of alcohol, red meat and seafood Genetic predisposition
34
Which joints are most commonly affected by gout
First MCP joint - big toe | Ankle and Knee
35
How does gout present
Intensely painful red, hot swollen joint
36
What can chronic gout lead to
Destructive erosive arthritis
37
What conditions often coexist with pseudogout
``` Hyperparathyroidism Hypothyroidism Renal osteodystrophy Haemochromatosis Wilson's disease ```
38
How do you treat pseudogout
NSAIDs Corticosteroids Occasionally colchicine
39
What structures does SLE mainly involve
``` Skin Joints Kidneys Blood cells Nervous system Variable symptoms ```
40
What age does SLE usually present
20s and 30s | Most common in women of childbearing age
41
What are the constitutional symptoms of SLE
Fever Fatigue Weight loss
42
What are the MSK symptoms of SLE
Arthralgia Myalgia Inflammatory arthritis Increased prevalence of AVN
43
What are the muco-cutaneous symptoms of SLE
``` Malar rash Photosensitivity Discoid lupus Subacute cutaneous lupus Oral/nasal ulceration Raynauds phenomenon ```
44
What are the respiratory symptoms of SLE
``` Pleurisy Pleural effusion Pneumonitis Pulmonary embolism Pulmonary hypertension, Interstitial lung disease ```
45
What are the renal symptoms of SLE
Lupus nephritis
46
What are the neurological symptoms of SLE
Seizures Pyschosis Headache Aseptic meningitis
47
What are the haematological symptoms of SLE
Leukopenia Lymphopenia Anaemia Thrombocytopenia
48
What are the cardiac symptoms of SLE
``` Pericarditis Pericardial effusion Pulmonary hypertension Sterile endocarditis Accelerated IHD ```
49
What would the FBC results look like in an SLE patient
May show anaemia, leukopenia and thrombocytopenia
50
How would you manage unresponsive SLE
May need IV immunoglobulin therapy and rituximab
51
What monitoring must be carried out for people with SLE
Symptom - changes Check anti-dsDNA antibody and complement levels regularly Urinalysis - keep eye on kidneys CV risk
52
What is Sjogren's syndrome
Autoimmune condition Can be primary or due to RA or SLE Characterized by lymphocytic infiltrates in exocrine organs
53
What are the symptoms of Sjogren's syndrome
``` Dryness of eyes and mouth Arthralgia Fatigue Vaginal dryness Parotid gland swelling ``` May get peripheral neuropathy and lung disease
54
What cancer does Sjogren's increase the risk of
Lymphoma
55
How do you manage Sjogren's syndrome
Symptomatic management Eyedrops and saliva replacement Hydroxychloroquine for arthralgia/fatigue
56
What are the cutaneous presentations of systemic sclerosis
Raynaud's Skin becomes thickened and tight Beaking of the nose Calcinosis - calcium deposits in fingers
57
What organs may be involved in systemic sclerosis
Skin Lungs - pulmonary hypertension, fibrosis Renal - can be crisis Gut - dysphagia, malabsorption
58
How do you manage systemic sclerosis
``` Tailored to patients symptoms Raynaud's - CCB Renal involvement - ACEi GI - PPI ILD - immunosuppression ```
59
What is mixed connective tissue disease
Defined condition that features symptoms commonly seen in other connective tissue diseases
60
What antibodies are associated with mixed connective tissue disease
Anti-RNP
61
How do you manage mixed connective tissue disease
Varies depending on presentation CCB for Raynaud's Immunosuppression - if muscle or lung disease
62
What is antiphospholipid syndrome
Disorder that manifests as recurrent venous/arterial thrombosis and/or miscarriage
63
What is catastrophic APS
Rare but serious (often fatal) manifestation | Multiorgan infarctions occur over days to weeks
64
How do you diagnose APS
May be thrombocytopenia and prolonged APTT | Antibody tests
65
How do you manage APS
Anticoagulation if there is an episode of thrombosis | LMWH in pregnancy
66
Which age group does polymyalgia rheumatica affect
Elderly | Rare in the under 50s
67
How does treatment progress in polymyalgia rheumatica
Start on low dose prednisolone Decrease gradually over 18 months Condition often resolves after this
68
Describe the headache caused by giant cell arteritis
``` Continuous Located in temporal or occipital areas Focal tenderness on palpation Scalp tenderness Temporal artery may be tender and prominent ```
69
What is the cause of jaw claudication in GCA
Due to temporal arteritis leading to ischaemia of the maxillary artery
70
How do you treat giant cell arteritis
Corticosteroids - started ASAP | dose reduced over 2 years and most will resolve
71
Which age groups are affected by polymyositis and dermatomyositis
Adults over 20 | Especially 45-60 years
72
What investigations are done for polymyositis
Blood tests - inflammatory markers, antibodies MRI - shows muscle damage EMG - abnormal in most Muscle biopsy
73
What is the prognosis for polymyositis
Usually responds to treatment 30% left with some weakness Older you are = worse the response
74
What does dermatomyositis increase your risk of
Malignancy Occurs in 1/4 of patients Includes breast, ovarian, lung, colon, oesophagus and bladder
75
How is dermatomyositis managed
Same as polymyositis | Steroids and immunosuppression
76
What is fibromyalgia
Unexplained condition causing widespread muscle pain and fatigue
77
Fibromyalgia can be associated with which other conditions
``` RA - 25% SLE - 50% Depression IBS Migraines ```
78
What is vasculitis
Inflammation of the blood vessels | Results in vessel wall thickening, stenosis, and occlusion with subsequent ischemia
79
What age does Takayasu arteritis occur
Rarely after 50
80
Which countries have high incidences of TA
East Asian
81
Which arteries does GCA typically affect
Temporal arteries | Can impact other large vessels
82
What are common features of GCA
Fever, malaise, night sweat and weight loss Claudicant symptoms in limbs Headache
83
How do you treat GCA
Corticosteroids - prednisolone
84
What are some general features of small vessel vasculitis
``` Fever and weight loss A raised, non blanching purpuric rash Arthralgia/arthritis Mononeuritis multiplex Glomerulonephritis Lung opacities on x-ray ```
85
Who is commonly affected by Henoch-Schonlein purpura
Children | Often with history of URTI

MSK CORTEXT (13 decks)

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