Arthropathies

Question 1

List 3 medications for acute gout

Answer 1

Naproxen
Colchicine bd
Analgesia
Prednisolone

Question 2

Prevention of Gout

Answer 2

Allopurinol (start at 100mg)
Cover with colchicine/NSAIDs

Renal impairment -> Monitor renal & urate

Target urate <360

Question 3

4 clinical features of Temporal/Giant-Cell Arteritis

Answer 3

Temporal Headache Raised
Scalp tenderness
Jaw claudication
Visual loss

Associated:
Polymyalgic symptoms
Elderly: CVA, malaise

Question 4

SINGLE SWOLLEN JOINT

History Taking questions

Answer 4

recent infection/sexual history
recent travel
HIV/Hepatitis/VDRL/Drugs
FH: Psoriasis/colitis/Crohn’s/Iritis
Co-morbidity

Question 5

SINGLE SWOLLEN JOINT

Why aspirate?

Answer 5

ASPIRATE (before antibiotics): MC&S, crystals, (TB)
Orthopaedics: ?septic arthritis - joint washout
CRP

Question 6

Rheumatoid Arthritis

List 2 prognostic indicators

Answer 6

RhF +ve, Anti-CCP+, erosions on Xray (hands & feet)

and raised ESR/CRP are associated with a worse outcome

Question 7

Criteria for suspected RA referral

Answer 7

Any of:
• 3 or more swollen joints
• A positive squeeze test
• Early Morning Stiffness > 30 mins (Raised ESR/CRP, Rheumatoid F +ve
Anti-CCP +ve)

NICE guidelines: RA = specialist review within 3 weeks

Question 8

Biologic therapies in RA: Anti-TNF medications

Answer 8

Infliximab

Humira

Question 9

Biologic therapies in RA: Anti-B cell medication

Answer 9

Rituximab

Question 10

Infections to consider in Patients with Rheumatic disease on immunosuppressants:

Answer 10

• Bacterial infection
• Viral infection
- disseminated varicella with Methotrexate
- Hepatitis B with Rituximab
- HIV
• Atypical infections – pneumocystis carinii
• Tuberculosis with anti-TNFs

Question 11

Principles of Management of infection in Patients with Rheumatic disease on immunosuppressants

Answer 11

Pause/stop DMARDs/Biologics (but not corticosteroids)

Low threshold for investigation/intervention

Question 12

27 female patient, Family from Mozambique.
Presented to A&E: Acute polyarthritis
Vasculitic rash
Hair loss

Top two differentials

Answer 12

SLE
Hair loss
Mouth ulcers
Facial rash/other rash
Photosensitivity
Migraines
Pregnancy loss/thrombosis
Pleuritic chest pain
Arthralgia/arthritis
Raynaud’s

VASCULITIS
Rash
Arthralgia/arthritis
Nasal symptoms
Hearing
Conjunctivitis
Lung
Renal
Anaemia/GI bleeding

Question 13

27 female patient, Family from Mozambique.
Presented to A&E: Acute polyarthritis
Vasculitic rash
Hair loss

Investigations?

Answer 13

SLE: ANA, dsDNA, C3 C4, ACLA
Lupus anticoagulant, ENA
URINE DIPSTICK

VASCULITIS: ANCA, tissue biopsy
Lung & renal evaluation
Angiography
URINE DIPSTICK

Question 14

Two types of large vessel vasculitis

Answer 14

Takayasu arteritis

giant cell arteritis

Question 15

Two types of medium vessel vasculitis

Answer 15

polyarteritis nodosa

Kawasaki disease

Question 16

Types of ANCA associated small vessel vasculitis

Answer 16

• Microscopic Polyangitis
• granulomatosis with polyangiitis (Wegener’s)
• Eosinophlic granulomatosis with polyangiitis (Churg-strauss)

Question 17

Vasculitis: List 2 Types that ANCA+ and two that ANCA-

Answer 17

ANCA+

• granulomatosis with polyangiitis (Wegener’s)
• Microscopic Polyangitis
• Eosinophlic granulomatosis with polyangiitis

ANCA - 
Polyarteritis Nodosum (PAN): Renal infarcts, renal artery
stenosis, and visceral microaneurysms (glomerulonephritis=rare)