Arthritis Flashcards
What kind of pain is worst in the morning, improves with activity and may affect many systems?
Inflammatory
What pain is worst with activity and relives with rest?
Non inflammatory
What disease is anti ds DNA specific for?
SLE
What autoantibodies are associated with sjogrens syndrome?
Anti Ro and La
What auto antibodies are associated with ant centromere and Anti scl 70?
Systemic sclerosis
What autoantibody is Anti RNP associated with?
Mixed connective tissue disease
What autoantibody is polymyositis associated with?
Anti Jo 1
What autoantibody is anti phospholipid syndrome associated with?
Anti - cardiolipin antibodies, lupus anti coagulant
What are the two first choice DMARDS?
Methotrexate and sulfasalazine
What are the adverse effects of methotrexate?
Leucopenia, liver damage, pnumonitis, teratogenicity
A lady who is on methotrexate for RA wants to get pregnant. What do you do?
Stop the methotrexate three months before conception
A ma who is on methotrexate for RA wants his wife to get pregnant. What do you do?
Stop methotrexate three months before conception
Name three DMARDS used?
Methotrexate, sulfasalazine, hydroxycholoroquine
Give an example of an anti TNF treatment
Infliximab
Why does anti TNF treatment work in RA?
TNF encourages and increases inflammation in the body. In healthy people this is blocked naturally.
What two criteria must patients fill before being started on anti TNF therapy?
- High disease activity
2. Previous use of DMARDs
What conditions are contra indications for anti TNF medication?
Heart failure
Pulmonary fibrosis
How is infliximab given?
IV
What biologic can be used in connective tissue disease?
Rituximab
What biologic can be used in psoriatic arthritis?
Anti TNF
Ustekinumub
What biologic can be used in ankylosing spondylitis
Anti TNF
How would you treat an acute attack of gout?
Colchicine
NSAIDS
steroids
What medicine could you start for a man who has had 4 gout flare ups in the last year?
Allopurinol. Co prescribe this with an NSAID for the first 4 weeks.
If this doesn’t work, try febuxostat.
How does allopurinol work?
It is an xanthine oxidase inhibitor and so decreases the metabolism of xanthine into uric acid. This stops the levels getting too high and stops uric acid crystals from accumulating in the joint.
How long should you wait after a gout attack to start allopurinol?
2 - 4 weeks
Why should you not start allopurinol during an acute attack of gout?
Rapid reduction in uric acid levels may result in an exacerbation of the gout attack.
What disease makes problems with allopurinol more likely?
Renal impairment
What drug has a potenitially fatal result if taken with allopurinol
Aziothriorine. Never co prescribe these!!!!!!!
Are corticosteroids lipophillic or lipophobic?
Lipophillic
What HLA allele is strongly linked to ankyolising spondylitis?
HLA B 27
What joints of the hands are most often affected by rheumatoid arthritis?
MCP
PIP
What joints of the hand are most often affected by osteoarthritis?
DIP
What deformitity is this: Hyperextension at the PIP and hyperflexion at the DIP joints?
Swan neck deformity
What deformity is this: Hperflexion at the PIP joints and hyperextension at the DIP joints?
Boutonniere’s deformity.
List 4 deformities caused by rheumatoid arthritis
Swan neck
Boutonnieres
Ulnar deviation
Squaring of the thumb
What joints are damaged that causes ulnar deviation?
MCP
