intro to rheumatology

Question 1

what are the three subtypes of inflammatory joint problems?

Answer 1

autoimmune
crystal arthritis
infection

Question 2

What are the 4 pillars of inflammation?

Answer 2

Red (rubor)
Painful (dolor)
Hot (calor)
Swollen (tumour)
[loss of function]

Question 3

what are the characteristics of bone pain?

Answer 3

pain at rest and at night

Question 4

what is the characteristic of pain in degenerative conditions?

Answer 4

pain with use

Question 5

What is the characteristic of pain in inflammatory conditions?

Answer 5

pain eases with use

Question 6

enthesitis and dactylitis are features of RA, T or F?

Answer 6

FALSE - they are features of psoriatic arthritis

Question 7

What is the timeline for gout?

Answer 7

there is an initial acute phase where the gout is episodic and in between episodes, the gout goes away, with time if the gout is not treated, then the gout will become chronic and there will be persistence of symptoms

Question 8

What is the timeline for RA?

Answer 8

RA onset is more slow and it is persistent. can come on by traumatic events if already genetically susceptible

Question 9

what is the timeline for palindromic RA?

Answer 9

episodic, but doesn’t completely go away between episodes

Question 10

what is the timeline for ReA?

Answer 10

gets better over time over a period of months

Question 11

Name two types of deformities that can be seen with RA

Answer 11

ulnar drift

swan neck deformity

Question 12

Is erosion seen with RA?

Answer 12

Yes erosion is a characteristic feature of RA

Question 13

Why is there ulnar drift in RA?

Answer 13

damage to the MCP joint means the extensor tendon pulls the digits towards the ulnar side

Question 14

In inflammatory joint problems how long does it take the pain to go away in the morning

Answer 14

> 60 mins

Question 15

In degenerative joint problems how long does it take the pain to go away in the morning

Answer 15

<30 mins

Question 16

What are the only 2 arthropathies to affect the DIP?

Answer 16

osteoarthritis

psoriatic arthritis

Question 17

What type of arthritis affects the base of the thumb?

Answer 17

osteoarthritis

Question 18

What happens in nodal OA?

Answer 18

there are bony swellings due to osteophytes

Question 19

What are osteophytes

Answer 19

growths of Ca2+ around the joints

Question 20

Do pts with connective tissue diseases have erosive arthritis?

Answer 20

NO! erosion is a feature of RA

Question 21

what are the investigations that can be carried out in rheumatology?

Answer 21

inflammatory markers: ESR, CRP

autoantibodies

Question 22

what do you need to bear in mind when doing an ESR?

Answer 22

ESR takes a long time to rise and fall ie day/weeks
there are some causes of false positives in ESR
ESR cannot differentiate between inflammation and infection

Question 23

what causes the erythrocytes to stick together in ESR?

Answer 23

fibrinogen - an acute phase protein

Question 24

What are some of the reasons that doing an ESR may give a false positive for inflammatory arthropathy?

Answer 24

older age 
female 
obesity
race 
hypercholesterolaemia 
high Igs incl. myeloma

Question 25

What inflammatory marker changes are seen in SLE?

Answer 25

rise in ESR with normal CRP

Question 26

which organ produces CRP?

Answer 26

liver

Question 27

How is CRP produced?

Answer 27

activated macrophages or adipocytes release inflammatory cytokines eg IL1. IL-6, TNF which cause the liver to produce CRP

Question 28

What is CRP’s normal function in the body?

Answer 28

binds to damaged cells
activates complement
causes phagocytosis by macrophages

Question 29

What is an autoantibody?

Answer 29

Igs that bind to self antigens

Question 30

what autoantibodies may be detected in RA?

Answer 30

RF - rheumatoid factor

anti-CCP

Question 31

what autoantibodies may be detected in SLE?

Answer 31

ANA

anti-dsDNA Abs