Arthritic Conditions

Question 1

Women 40 years presents with symmetrical pain in her MCP joints, she complains of morning stiffness lasting more than 30 minutes, she feels SOB, and is dull on her left chest side on percussion. This has been going on for >6weeks. She is also a heavy smoker. On bloods you find anti-CCP antibodies. Diagnosis?

Answer 1

Rheumatoid arthritis with pleural effusion

Question 2

Treatment for rheumatoid arthritis?

Answer 2

DMARD therapy e.g methotrexate, steroids, NSAIDs

If DAS 28 score >5.1 and tried 2 DMARDS then can give TNF alpha blockers

Question 3

Women of 22 years presents with fever, tiredness, arthralgia, oral ulcers and gets white fingers when outside, she has also noticed clumps of hair on her pillow when she wakes. You do bloods and find anti-double stranded antibody and anti-sm. diagnosis?

Answer 3

Systemic lupus erythematosis

Due to antibodies anti-dsDNA and anti-sm hallmarks for SLE, and raynauds phenomenon

Question 4

Once SLE diagnosis made, what should do next?

Answer 4

URINALYSIS to check for glomerulonephritis, CT to check for lung involvement (pneumonitis/ effusions)

Question 5

Treatment for SLE?

Answer 5

For cutaneous symptoms and arthralgia then HYDROXYLCHLOROQUINE
If inflammatory arthritis/pericardial disease/ILD then immunosuppression AZIATHIOPRINE
If nephritis or CNS involvmeent IV STEROIDS AND CYCLOPHOSPHAMIDE (immunosuppresant

Question 6

In SLE what blood results would you expect for a flare?

Answer 6

CRP stay the same
Drop in C3/4
Anti-dsDNA to rise

Question 7

Anti-CCP antibody and RF present in blood. Diagnosis?

Answer 7

Rheumatoid arthritis

Question 8

?Anti-dsDNA, anti-sm, anti-ro, anti-RNP, ANCA present in blood. Diagnosis

Answer 8

Systemic lupus erythematosis

Question 9

Anti-cardiolipid antibody, lupus anticoagulant, anti beta 2 glycoprotein present in blood. Diagnoss?

Answer 9

Anti-phospholipid syndrome

Think as causes blood clots then cardio

Question 10

Anti-ro antibody and anti-la antibody present in blood. Diagnisos?

Answer 10

Sjogrens syndrome

SchgROgens

Question 11

Anti-centromere antibody present in blood. Diagnosis?

Answer 11

Systemic sclerosis limited (opposite as what think as it effects the peripheris not centrally

ANTI centre so why it effects the peripheries

Question 12

Anti-scl-70 antibody present in the blood. Diagnisos?

Answer 12

Systemic sclerosis diffuse

Question 13

cANCA and PR3 present in the blood. Diagnosis?

Answer 13

Granulomatosis with polyagitis

Think c- as causes Collapse of the nose

Question 14

Women 40yrs presents with joint pain in both her PIP joints, its been going on for 6 weeks. She gets stiffness in the morning bettering throughout the day, her joints are swollen. She mentions that now both her MCP joints are also sore. On examination you notice both her lower lungs fields are dull, she mentions she has been taking ibuprofen and it has helped the pain. Diagnosis?

Answer 14

Rheumatoid arthritis

Question 15

What is the treatment for 1st stage arthritis, then 2nd stage

Answer 15

Methotrexate with NSAIDs for the first 6 weeks

2. Add another DMARD like sulfasalazine

Question 16

Women with known rheumatoid arthritis wants to get pregnant, she is currently on methotrexate and NSAID therapy. What advice would you give her?

Answer 16

She has to STOP the methotrexate as it is tetragenic aka causes deformities. So switch to sulphasalazine and use protection for at least 3 months before trying for a family.

Question 17

Women has been diagnosed with rheumatoid arthritis, what do you do/prescribe?

Answer 17

Methotrexate & NSAIDs

Urinanalysis to see kidney involvement

Question 18

What DAS score is required in rheumatoid arthritis to qualify a patient for biologic therapy like adalimumab?

Answer 18

> 5.1

Question 19

Asian women of 22 years with known anti-phospholipid syndrome presents with fever, weight loss, painful DIP/ PIP joints and nasal ulcers. They are currently on the pill. What investigations would you do? Likely diagnosis?

Answer 19

Bloods for anti-double stranded antibody (dsDNA) and C3/4 low

Systemic lupus erythematosis

Question 20

What is the step up treatment for systemic lupus erythematosis?

Answer 20

Hydroxychloroquine (everyone gets this then add other things) + NSAIDs, Steroids

If arthritis or pericardial disease, ILD give immunosuppression like aziathioprine or methotrexate

Question 21

If a person is negative for glomerulonephritis what should their urine protein/ creatine be?

Answer 21

> 15

And their serum albumin will be low

Question 22

If positive for lupus nephritis then what should be given?

Answer 22

IV steroids and cyclophsophamide (immunosuppressant)

Question 23

Women 29 years presents with multiple misscarriages, persistent headaches and mottled legs. You do an antibody test and she si anti-beta 2 glycoprotein positive. Diagnosis?

Answer 23

Anti-phospholipid syndrome

Mottled legs known as livedo reticularis

Question 24

Young women presents with multiple PE’s occuring frequently in the space of 2 years, she also has suffered MI in the past. You do bloods and discover thrombocytopenia and prolonged APTT. She is lupus anti-coagulant positive. Diagnosis?

Answer 24

Anti-phospholipid syndrome

Due to recurrent thrombitic episodes and prolonged coagulation time. Other antibodies you could find would be anti-cardiolipin, anti-beta 2 glycoprotein.

Question 25

Women presents with extremely dry eyes, mouth, vagina and pain in her wrists lasting > 3 months. On examination there is swelling of the parotid gland and schirmers test positive. Diagnosis?

Answer 25

Sjogrens syndrome with rheumatoid arthritis

Due to SICCA symptoms of dry eyes, mouth and CT disorders so painful wrists. Also females more likely

Question 26

Women presents with caries, dry mouth and generalised fatigue. You do bloods and find anti-ro and anti-la antibodies. Diagnosis?

Answer 26

Sjogrens syndrome

Caries are tooth decay

Question 27

What are the treatments for sjogrens syndrome?

Answer 27

Symptoms based, so eye drops, saliva replacement, hydroychloroquine for arthralgia/ fatigue, immunosuppression if organ involvment like ILD

Question 28

Women presents with whitening of fingers when cold, tightness of her the skin round her fingers, heart burn after eating and red marks around her face. What is the likley diagnosis? What investigations would you request?

Answer 28

CREST symptoms so likely limited systemic sclerosis (raynauds, oesophgesal dysfunction, sclerodactyl, telangectasia)

Antibody for anti-centromere

Question 29

What are the treatents for systemic sclerosis?

Answer 29

Symptomatic so calcium channel blockers for raynauds, PPI for reflux, if ILD then azathioprine,

Question 30

Man 22 presents with back pain, stiff in themorning but better as day goes on, it gets worse with rest. On examination there is a question mark spine, and reduced chest expansion and he is schobers test positive. This has been going on for more than 3 months. On bloods he is HLA B27 +. What investigations would you do? Likley diagnosis?

Answer 30

MRI scan for inflammation of the spine showing osteopenia, sacroiliac joint fusion, syndesmophytes (bony spurs)

Ankylosing spondylitis

Question 31

What is the treatment for ankylosing sponylitis?

Answer 31

NSAIDs (naproxene or ibuprofen) and physiotherapy

Question 32

Women presents with pain in her DIP joints, and sausage fingers, occuring for more than 4 months. It started in her DIP but now also in her wrists and PIP. On examination she has onycholysis, pitting nails but none of her joints are red. She has a family history of psoriasis. Diagnosis and treatment?

Answer 32

Psoriatic arthritis

DMARDS (methotrexate)

Question 33

Young female recently back from T in the park presents with painful knee about 3 weeks after the event. She also has urethritis. What questions would you like to ask? Likely diagnosis? Treament?

Answer 33

Did you have any unprotected sex? Any stomach/ GI upset in the last 3 weeks?

Reactive arthritis likely secondary to chlyamydia or campylobacter.
If secondary to STI treat STI, otherwise this is self limiting.

Question 34

Young man with crohns disease presents with painful right knee and left elbow. He feels awful with a fever and has some weight loss. He has been having watery stool. Investigations? Likely diagnosis?

Answer 34

Endoscopy if not already had one
Joint aspirates to exclude other diagnosis

Enteropathic arthritis

Question 35

Treatment for enteropathic arthritis?

Answer 35

Treat underyling condition like crohns/ UC
NSAIDs if no contraindications but not in crohns due to gastric ulceration
Steroidal injection to jionts,
If doesnt settle then methotrexate

Question 36

Man presents with intensely painful red hot swollen big toe, occuring overnight. He is a body builder so has a high red meat diet. You do an aspiration of the joint and find negatively bifringement monosodium urate crystals. What is the diagnosis and treatment?

Answer 36

Gout

Self limiting 7-10 days but can give NSAIDs or colchicine

Question 37

You suspect pseudogout, what would you expect to find under microscope from joint aspiration?

Answer 37

Positively bifringenent crystals of calcium pyrophsophate

Question 38

You can give allopurinol for prophylaxis for pseudogout. T/F?

Answer 38

FALSE

Urate lowering drug and pseudogout is calcium pyrophosphate crystals

Question 39

Man of 70 years presents with groin pain with movement, it is relieved by rest and he has had this worsening for last 5 years. On examination there is joint tenderness, you do an Xray and find osteophyte presence, loss of joint space and some sclerosis of the femoral head. Diagnosis?

Answer 39

Osteoarthritis