MSK AND RHEUM - SAQ high yield topics Flashcards by Khyati Mundrey Srivastav

what are the typical features of rheumatoid arthritis ?

Swollen painful joints in the hands and feet.
Pain that worsens with rest and improves with activity.
Stiffness that is worse in the morning lasting > 30 minutes
symmetrical joint swelling

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which joints are most commonly affected by RA

MCP
PIP
wrist
MTP

DIP joint is very rarely affected and more likely to represent OA.

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What hand signs exist in RA?

Z shaped deformity ( thumb)
Swan neck deformity
Boutonniere deformity
Ulnar deviation

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what systemic symptoms are present in RA

Low grade fever
weight loss
general malaise

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what extra-articular manifestations can occur in RA

Pulmonary fibrosis
Felty’s syndrome
Sjogren syndrome
AOCD
Eye manifestations such scleritis, episcleritis, keratitis
rheumatoid nodules
carpal tunnel syndrome
bronchiolitis obliterans
amyloidosis

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how is rheumatoid arthritis diagnosed

RF, Anti-CCP antibodies
CRP/ESR
X-ray

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what xray features are present in RA?

LESS

loss of joint space
erosions
Soft tissue swelling
subluxation
Juxta-articular osteoporosis

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how is rheumatoid arthritis ?

DMARD monotherapy +/- a short course of bridging prednisolone.

Methotrexate / Sulfasalazine

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how are flares of rheumatoid arthritis managed ?

corticosteroids - oral or IM

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what is the most common ocularmanifestation of RA ?

Keratoconjunctivitis

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what score is used to monitor disease activity in RA

DAS28

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which are the safest DMARDs to use in pregnancy ?

Hydroxychloroquine / Sulfasalazine

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what are the key xray changes seen in osteoarthritis ?

LOSS
Loss of joint space
Osteophytes
Sub-articular sclerosis
Sub-chondral cysts

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which joints are commonly affected in Osteoarthritis

Knee - most common
Hip - 2nd most common
DIP joint
lumbar and cervical spine

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what are the symptoms of osteoarthritis

Bulky, bony enlargement of the joint
restricted range of motion
crepitus on movement
joint effusion

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what are the signs of osteoarthritis

Heberden’s nodes - DIP
Bouchard’s nodes - PIP
Squaring at the base of the thumb

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what is the criteria for diagnosis of osteoarthritis

patient > 45
typical pain associated with activity
no morning stiffness

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what is the non-pharmacological and pharmacological management of OA

patient education + lifestyle changes
exercise + Weight loss

topical NSAIDs, oral NSAIDs
Intra-articular joint injections

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which medications should be avoided / only used for short-term use in OA?

Paracetamol / weak opioids

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what conditions are the ANCA antibodies associated with

Granulomatosis with polyangiitis
Eosinophilic granulomatosis with polyangiitis
Microscopic polyangiitis

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which conditions are associated with p-anca ?

microscoPic polyangiitis = P-anca
Eosinophilic Granulomatosis with Polyangiitis = P-anca EEPY

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what conditions are associated with c-anca?

granulomatosis with polyangiitis

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what are the small cell vasculitis?

HSP
Microscopic polyangiitis
Granulomatosis with polyangiitis
Eosinophilic granulomatosis with Polyangiitis

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what are the medium cell vasculitis ?

Polyarteritis nodosa
Kawasaki disease

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What are the large cell vasculitis ?

GCA Takayasu's arteritis

what are the features of 1. Microscopic polyangiitis 2. Granulomatosis with Polyangiitis 3. Eosinophilic Granulomatosis with Polyangiitis

1. Glomerulonephritis, diffuse alveolar haemorrhage. 2. Nasal symptoms, respiratory symptoms, glomerulonephritis. 3. late onset asthma, sinusitis and rhinitis

How does polyarteritis nodosa present?

Renal impairment Hypertension Cardiovascular events Tender skin nodules

How does Kawasaki disease present ?

High fever (more than 5 days) Widespread rash Bilateral conjunctivitis Strawberry tongue Coronary artery aneurysms

how does Takayasu's arteritis present

Aortic arch affected “Pulseless” disease

what are the 4 classic features of HSP ?

Purpura (100%), Joint pain (75%), Abdominal pain (50%) Renal involvement (IgA nephritis) (50%)

what is a classical sign of granulomatosis with polyangiitis

Saddle shaped nose

what is a characteristic finding on FBC in Eosinophilic granulomatosis

Raised eosinophils

what infection can cause polyarteritis nodosa

Hep B

what conditions is dermatomyositis associated with?

Connective tissue disorders Underlying malignancy : Ovarian, breast and lung cancer

what are the skin features of dermatomyositis ?

Gottron's papules : roughened red papules over extensor surfaces of fingers Heliotrope rash in the periorbital region Mechanic's hands : dry and very scaly hands with linear cracks

what antibodies are present in dermatomyositis?

ANA Anti-Jo

what are the non skin features of dermatomyositis ?

muscle weakness Raynaud's respiratory muscle weakness Interstitial lung disease dysphagia and dysphonia

what are the patterns of disease of systemic sclerosis ?

Limited cutaneous systemic sclerosis Diffuse cutaneous systemic sclerosis Scleroderma

what are the signs and symptoms of limited cutaneous systemic sclerosis ? What antibodies is it associated with?

Raynaud's disease Affecting face and distal limbs CREST Calcinosis Raynaud's phenomenon oEsophageal dysmotility Sclerodactyly telangiectasia Anti-centromere antibodies

what are the symptoms of diffuse cutaneous systemic sclerosis ? what antibodies is it associated with?

affects trunk and proximal limbs predominantly respiratory involvement ( ILD, PAH) renal disease and HTN Associated with anti scl-70 antibodies

what are the symptoms of scleroderma

tightening and fibrosis of skin manifests as plaques or linear

what are the causes of gout

chronic hyperuricemia caused due to : drugs - diuretics CKD cytotoxic drugs myeloproliferative drugs lead toxicity

what are the features of gout ? Where does it commonly affect ?

pain, swelling and erythema main joints affected : MTP Ankle wrist Knee

what investigations are performed in gout?

Uric acid measurement in acute setting synovial fluid sampling : needle shaped negatively birefringent monosodium urate crystals under polarised light

how is gout managed ?

NSAIDs / colchicine start allopurinol 2 weeks after initial attack

what are the risk factors for pseudogout

haemochromatosis hyperparathyroidism low magnesium and phosphate acromegaly and Wilson's disease

what is pseudogout caused by?

Deposition of calcium pyrophosphate dihydrate crystals in the synovium

what joints are most commonly affected in pseudogout? What does joint aspiration show

knee, wrist and shoulders Joint aspiration shows weakly positive birefringent rhomboid shaped crystals.

what does xray show in pseudogout

chondrocalcinosis

how is pseudogout managed

aspiration of joint fluid NSAIDs, intramuscular / oral steroids

causes of mononeuritis multiplex

HIV /AIDS , rheumatoid arthritis, diabetes, sarcoidosis, polyarteritis nodosa, leprosy, carcinomatosis.

what conditions present with vasculitis as a feature

Infective endocarditis, rheumatoid arthritis, B ehçet’s, SLE, inflammatory bowel disease, scleroderma, hepatitis В and C, polymyositis, dermatomyositis.

what are the general features of SLE

Fatigue Fever mouth ulcers lymphadenopathy

what are the dermatological features of SLE?

Malar ( butterfly) rash ( sparing nasolabial folds) Discoid rash photosensitivity Raynaud's phenomenon livedo reticularis

what are the other features of SLE?

MSK - arthralgia, non erosive SLE CV- Pericarditis, myocarditis Resp- pleurisy, fibrosing alveolitis Renal - proteinuria, glomerulonephritis Neuro-psychiatric - anxiety, psychosis, seizures

what are the investigations performed for SLE ?

ANA positive - highly sensitive anti-dsDNA and anti-Smith : highly specific low levels of C3, C4

what is the management of ALP syndrome?

primary thromboprophylaxis : Low dose aspirin Secondary thromboprophylaxis : lifelong warfarin

what are the causes of reactive arthritis

Post STI : Chlamydia trachomatis Post dysentery : Shigella, Salmonella, campylobacter, yersinia

what are the features of reactive arthritis ?

urethritis conjunctivitis arthritis

what are the dermatological features of reactive arthritis

circinate balanitis keratoderma blennorrhagica

what is the presentation of psoriatic arthritis ?

symmetrical polyarthritis asymmetrical oligoarthritis typically affecting hands and feet DIP joint disease sarcoiliitis

what is the most severe features of psoriatic arthropathy

arthritis mutilans ( severe deformity fingers / hand and 'telescoping fingers)

what are the nail changes seen in psoriatic arthropathy

Pitting and onycholysis

what xray changes are seen in psoriatic arthropathy ?

''pencil in cup'' appearance

what is the management of psoriatic arthritis?

NSAIDs methotrexate