MRCP Rheumatology Flashcards
Which autoantibodies are associated with limited systemic sclerosis (CREST)?
anti-centromere
Which antibodies are associated with dermatomyositis?
ANA (60%)
Anti-Mi-2 (25%) - more specific than ANA
Describe T scores and what they signify
> -1.0: normal
-1 to -2.5: osteopenia (lifestyle modifications)
When is a Z score used?
In younger patients to assess their bone mineral density
Describe mechanism of action of bisphosphonates
Decreased osteoclastic bone resorption and increased osteoclastic apoptosis
Method of action of allopurinol
Xanthine oxidase inhibitor
Earliest x-ray finding in ank spond?
Blurring of the upper and/or lower vertebral rims at the thoracolumnar junction
What osteoporosis prevention is offered to people on LT steroid therapy?
Alendronic acid, calcium carbonate and vitamin D
Ank spond symptoms remain uncontrolled by 2 NSAIDS - next step
anti-TNF eg adalimumab, etanercept
Autoantibodies associated with diffuse systemic sclerosis
Anti-Scl-70
Which anti-TB drug is most likely to cause raised serum urea and therefore gout?
Pyrazinamide
ethambutol also raises serum urea but to a lesser extent
Autoantibodies associated with polymyositis
ANA (33%)
Anti-Jo-1 (more commonly seen in patient who also have pulmonary fibrosis)
Best investigation for confirming diagnosis of polymyositis or dermatomyositis?
Muscle biopsy
What are the most common pulmonary manifestations of SLE?
Pleurisy and pleural effusions (often bilateral)
Which typically comes first in psoriasis - rash or arthritis?
Rash
HLA type associated with Felty’s syndrome
HLA-DRW4
Biochemical evidence of ACTIVE SLE
Low complement
Raised anti-dsDNA
Rising ESR
Falling Hb/WCC/platelets
Cause of vision loss in GCA
Anterior ischaemic optic neuropathy
Episcleritis vs scleritis
Episcleritis - gritty, red eyes. Visual acuity preserved. Self-limiting.
Scleritis - very painful (esp when moving), red eyes. Watering, photophobia, decreased vision. Requires systemic treatment.
Red hot swollen joint with meniscal calcification on x-ray
Pseudogout (calcium pyrophosphate)
HLA type most commonly associated with rheumatoid arthritis
HLA-DR4
Most common reason for hyperuricaemia in gout?
Decreased renal excretion (around 90% of cases)
Only 10% is increased dietary intake
All patients with lupus nephritis regardless of stage should receive which drug?
Hydroxychloroquine
Stage III/IV require immunosuppression with steroids + cyclophosphamide/mycophenolate mofetil
Most common site affected by Paget’s disease
Spine, esp lumbar
