5. Rheumatology

Question 1

What are autoimmune rheumatic diseases?

Answer 1

A heterogenous group of diseases, involving immune tolerance breakdown and production of pathogenic antibodies. Has multisystemic features and is likely to affect the hands and wrists.

Question 2

What groups of people are more likely to have systemic lupus erythematosus?

Answer 2

Females, afro-caribbeans followed by south Asians.

Question 3

The glove and sweater approach is used for history taking when you suspect a patient has lupus. Give 2 examples of symptoms for each. (You would then exam for these signs after).

Answer 3

Gloves - raynauds, joint pain and swelling, hand rash.
Sweater - myalgia, hair loss, eye and mouth dryness, nose bleeds, mouth ulcers, pleuritic chest pain, pericardial pain, truncated rash/photosensitivity, limb weakness.

Question 4

What does a raised CRP in lupus indicate?

Answer 4

That the patient also has an infection.

Question 5

Give 2 types of treatments for lupus.

Answer 5

Patient education eg use of sunscreen.
Disease-modifying Enti-rheumatic drugs eg hydroxychloroquine.
Steroids eg prednisolone.
IV cyclophosphamide in severe cases.

Question 6

There are 11 criteria items for diagnosing lupus. How many need to be present to make a definite diagnosis?

Answer 6

4 or more

Question 7

What group of people are more likely to have rheumatoid arthritis?

Answer 7

Females

Question 8

The S factor can be used to assess a patient when you suspect a diagnosis of rheumatoid arthritis. What is this?

Answer 8

Stiffness - in the morning lasting over 30 minutes.
Swelling - persistent swelling of one joint or more, especially the hand joints.
Squeezing - squeezing the joints is painful in inflammatory arthritis.

Question 9

Give 2 types of treatment used for rheumatoid arthritis

Answer 9

Disease-modifying anti-rheumatic drugs eg methotrexate hydroxychloroquine.
Steroids eg prednisolone.
Combination therapy is usual.