Approach to rheumatology (R1) Flashcards
List some key features of a rheumatology history
List 4 things characteristics of joint pain can tell us?
- Is there a musculoskeletal problem or a disease of another system?
- Is the condition articular or periarticular?
- Is the condition inflammatory OR non-inflammatory?
- does it affect appendicular or axial structures or both?
Compare inflammatory vs non-inflammatory characteristics of joint pain
Inflammatory: Erythema, pain, swelling, stiffness after prolonged rest, improvement with movements
Non-inflammatory: pain without swelling, pain worse with activities
What term is used to describe the following number of joints affected:
- 1 joint
- 2-4 joints
- > 4 joints
What condition is associated with each?
1 joint: Monoarticular ➞ septic arthritis, gout
2-4 joints: Oligoarticular ➞ seronegative spondyloarthropathies
>4 joints: Polyarticular ➞ rheumatoid arthritis
List 4 other ‘patterns’ of joints we should consider in a history
Incl common examples of each
- symmetrical or asymmetrical
- axial or peripheral
- small joints or large joints
- migratory (viral arthritis)
- additive (RA)
- Intermittent (Gout)
Compare the timeframe of acute vs chronic MSK disorders
Incl examples of common conditions
Acute (self-limited) < 6 weeks duration
- Viral arthritis
- Gout Reactive arthritis
Chronic >6 weeks duration
- Osteoarthritis
- Rheumatoid arthritis
In rheumatology there may be other organ involvement, give 4 examples + how they present
Compare articular vs periarticular in terms of:
- Structures
- Characteristics
- Signs/symptoms seen in a physical exam
Articular:
- Structures: synovium, SF, articular cartilage, intra-articular ligament, joint capsule and juxta-articular bone
- Characteristics: deep and diffuse pain
- S/S: pain in passive and active ROM, swelling , crepitation, deformity
Periarticular:
- Structures: supportive extra-articular: ligaments, tendons, muscles, nerves, overlying skin
- Characteristics: pain on active movements
- S/S: joint or local tenderness in regions adjacent to articular structures
What are the 3 KEY laboratory tests we should run for rheumatological conditions
Blood, Urine, Synovial Fluid
List 4 things we may look for on a blood test (there are heaps!)
List 4 autoantibodies which can aid diagnosis of RA
- Rheumatoid Factor (RF)
- Anti-cyclic citrullinated peptide antibodies (Anti- CCP)
- Antinuclear antibodies (ANA)
- Anti-neutrophil cytoplasmic antibodies (ANCA)
What is Rheumatoid Factor (RF)?
Can this be accurately used to diagnose RA alone?
Antibody directed to the Fcγ chains of IgG molecules
Low specificty - RF may be found in patients with and without RA
List 4 inflammatory conditions RF is associated with and 4 non-inflammatory conditions
Inflammatory: RA, Sjogren syndrome, SLE, Cryoglobulinemia
Non-inflammatory: bacterial endocarditis, HBV, HCV, TB, autoimmune Hepatitis, PBC, elderly
What is Anti-CCP
What is this beneift of this compared to RF?
Anti-cyclic citrullinated peptide antibodies (Anti- CCP)
This is a RA-specific autoantibody, it has low sensitivity BUT high specificity
What is ANA?
Antinuclear antibodies: the antibodies that target “normal” proteins within the nucleus of a cell
Indirect immunofluorence is the reference method for screening and titration of circulating autoantibodies
What is ANCA and what are its 2 sub-types?
Anti-neutrophil cytoplasmic antibodies: antibodies against antigens in the cytoplasm of neutrophil granulocytes and monocytes
- C-ANCA (cytoplasmatic)- proteinase 3 (PR3) antigen
- P-ANCA (perinuclear)- myeloperoxidase (MPO) antigen
What antigen is seen commonly in patients with ankylosing spondylitis?
Human leukocyte antigen B27 (HLA B27)
Hypothesis: Misfolding causing arthritogenic peptide presentation and T cell activation
Compare and contrast 4 features of synovial fluid in:
- Inflammatory
- Non-inflammatory
- Septic
- Hemorhagic
List 3 abnormalities in a patients urine which may indicate there is an issue?
Why do we do a urine dipstick?
Blood, protein, casts
Important to see if there is any kidney involvement, inflammatory or autoimmune diseases
List 4 imaging modalities we can use to aid diagnosis in rheumatology
MRI, X-ray, Ultra sound, nerve conduction, PET scan
