L6 - Multi system AI disease

Question 1

SPONDYLOARTHROPATHIES

i) where does it occur?
ii) is it seropositive or negative?
iii) what is hallmark involvement?
iv) what is the most common SA? name three others

Answer 1

i) arthritis of the spine
ii) seronegative - RF and anti CCP neg
iii) uveitis is hallmark involvement
iv) most common is anylosing spondylitis

Question 2

CLINICAL CHARACS OF SPONDYLOARTHROPATHIES

i) what pattern does it have? which limbs does it mostly affect? is it symmetrical?
ii) is there signifcant familial aggregation?
iii) which HLA can it be associated with?
iv) name three things that make it likely to be SA?

Answer 2

i) peripheral pattern, mostly lower limb, assymetrical
ii) yes familial agg
iii) HLA B27
iv) <40yrs, improves with exercise, no improve with rest, night pain worse when getting up

Question 3

ANKYLOSING SPONDYLITIS

i) which age group does it mostly affect? what is male:female ratio?
ii) which two bone areas does it mostly affect?
iii) over which area may there be pain?
iv) what charac is seen in the spine? what may be seen on the bone?

Answer 3

i) affects 20-30yrs, M:F 3:1
ii) most affects spine and hips
iii) pain over sacroiliac joint
iv) bamboo spine and also get bony outgrowths

Question 4

CLINICAL FEATURES OF ANK SPOND

i) what is usually the first symptom?
ii) what does buttock pain indicate?
iii) will spinal mobility be affected?
iv) name three other assoc features (eyes, heel, heart)

Answer 4

i) low back pain is usually first symptom
ii) buttock pain > sacroiliac inv
iii) spinal mobility is affected
iv) assoc features - enthesitis (achiles tendon), uveitis, aortic regurg

Question 5

DX OF ANK SPOND

i) which two things are most important? are bloods diagnostic? which bloods may be raised (2)
ii) which imaging is useful? (2) which is best at picking up early changes
iii) name two goals of therapy
iv) what two things may be given first line (non pharma)? what drug can be given if peripheral joints are affected
v) name two other txs

Answer 5

i) hsitory and examination
- bloods arent dx but CRP and ESR may be raised

ii) XRAY and MRI (picks up early disease)
iii) goal is symptomatic relief and restore or preserve fynction

iv) physio/exercise and pain relief (NSAIDs)
- give DMARDS if periph joints affected

v) anti TNF afents and surgery

Question 6

REACTIVE ARTHRITIS

i) what is the reac arth triad?
ii) name two common organisms that cause it
iii) how may joints appear?
iv) what is the main thing looked for in investigations?
v) do you do a bacterial culture?
vi) what is treated

Answer 6

i) conjunctivitis, uretritis, arthritis
ii) chlamidyia, gonorrea, shigella
iii) joints appear swollena nd painfuk
iv) look for inflam markers eg ESR, CRP, RF, anti CCP
v) yes do bacterial culture
vi) treat underlying cause

Question 7

PSORIATIC ARTHRITIS

i) does patient have to have psoriasis?
ii) what change has the strongest assoc with arthritis? name two things seen?
iii) which joints does it affect? what does it not affect?
iv) which joints in the hands are mostly affected?
v) which bone change may be seen on XRAY

Answer 7

i) no
ii) nail changes - leuconichya, pitting
iii) affects periph joints and not spine
iv) DIPs affected
v) see pencil in cup change

Question 8

SLE

i) when is peak onset?
ii) which area of the face does malar rash spare?
iii) which circ disease is associated?
iv) what will be positive on serology?
v) how will C3 and C4 be affected?

Answer 8

i) 15-40yrs
ii) malar rash spares the nasal folds
iii) assoc with ryenauds disease
iv) pos ANA on serology
v) low C3 and C4

Question 9

SJOGRENS SYNDROME

i) what is it? what two things are mostly seen?
ii) what is sicca? what gland is involved in this? what is xerostomia?
iii) name two complications
iv) which two antibodies may be positive?
v) what two things are in conservative tx? what three class of medication can be given?

Answer 9

i) immune disorder > lymphocytic infilrat of exocrine glands
- dry eyes dry mouth

ii) sicca -= dry eyes and shows lacrimal involvement
xerostomia = salivary gland involve

iii) non hodgkins lymphoma and chronic dry eyes/mouth> eye damage and dental caries
iv) Anti Ro and anti La positive
v) conservative > stop smoking and artificial tears/saliva

medications > cholinergics (pilocarpine), NSAIDs, immunosupps (hydroxychlorowuinine, MTX)

Question 10

what condition are these features seen in?

Answer 10

ankylosing spondylitis

Question 11

what condition are these features seen in?

Answer 11

reactive arthritis

Question 12

what condtion are these features seen in?

what is A called? what is B called?

Answer 12

seen in psoriatic arthritis

A - telescoping

B - pencil in cup

Question 13

what is this called? what type of arthritis is it seen in?

Answer 13

dactylitis > psoriatic arthritis

Question 14

which disease is characterised by these features

Answer 14

SLE

Question 15

which disease are these charac of?

Answer 15

systemic sclerosis