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MUSCULOSKELETAL & RHEUMATOLOGY Flashcards

1
Q

what is Systemic Lupus Erythematosus (SLE)?

A

chronic autoimmune disease that can affect any part of the body, including the skin, joints, kidneys, brain, and other organs

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2
Q

what is the clinical criteria of SLE?

A
  • malar (butterfly)rash, discoid rash, photosensitivity rash
  • oral ulcers, alopecia
  • arthritis (symmetrical)
  • kidney disorder (proteinuria/cellular casts/high BP),
  • neurological disorder (seizures or psychosis),
  • hematologic disorder (hemolytic anemia (Coombs positive), lymphopenia, or thrombocytopenia)
  • other organ involvement
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3
Q

what are tests done for SLE?

A
  • Anti-dsDNA and Anti-Smith (Anti-Sm) Antibodies - specific
  • Antinuclear Antibody (ANA) Test - positive, less specific
  • complement factors, C3, C4 - low is LSE
  • FBC, CRP, ESR - indicate inflammation and anaemia
  • urinanalyis - kindey involvement
  • imaging eg xray for other organ involvement
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4
Q

what is the treatment/management of SLE?

A
  • (NSAIDs): For joint pain and stiffness.
  • Antimalarial Drugs (Hydroxychloroquine): skin and joint symptoms.
  • Corticosteroids and Immunosuppressive Agents: For more severe disease manifestations
  • cytotoxic drugs
  • Biologics: belimumab
  • Lifestyle Modifications: sun protection, exercise, healthy diet.
  • stem cell transplant
  • Identify patients with phospholipid antibodies
  • assess atherosclerosis/major organs
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5
Q

what is Raynaud’s phenomenon?

A

blood stops flowing properly to your fingers and toes

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6
Q

what causes primary vs secondary Raynaud’s phenomenon?

A

primary - unknown, absence of another underlying disease
secondary - autoimmune diseases (e.g. SLE, scleroderma, rheumatoid arthritis), injuries, drugs, vascular damage

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7
Q

what kind of vascular damage can cause Raynaud’s phenomenon?

A

Atherosclerosis
Frost bite
Vibrating tools

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8
Q

what are the 2 subtypes of systemic slerosis/scleroderma?

A
  • Limited cutaneous systemic sclerosis (lcSSc) (AKA CREST)
  • Diffuse cutaneous systemic sclerosis (dcSSc)
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9
Q

what are the main features of systemic sclerosis?

A

Vasculopathy
Excessive collagen deposition
Inflammation
Auto-antibody production

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10
Q

what is the diffrence between limited and diffuse systemic sclerosis?

A

limited:
- Long history of Raynaud’s phenomenon
- skin thickening at hands, arms, and face
- slow progressing
Diffuse:
- Short History of Raynaud’s phenomenon
- thickening extends to trunk and proximal limbs
- increased risk of organ involvement - renal, lung, cardiac

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11
Q

what investigations/tests are required for systemic sclerosis?

A
  • blood tests - anti-Scl-70 & ANA = diffuse, anti-centromere = limited
  • Pulmonary function tests (PFTs) - asses lung involvement
  • Echocardiogram: To assess for pulmonary hypertension and cardiac involvement.
  • ct scan - organ involvement
  • skin biopsy - extent of fibrosis
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12
Q

what is the treatment/management for systemic sclerosis?

A
  • Mycophenolate - immunosupressant
  • PPI - reflux
  • ACE inhibitors - prevent renal crisis
  • Fluoxetine, vasodilators - raynauds
  • Cyclophosphamide(im-sup), PDE5 - pulmonary fibrosis
  • Annual echocardiograms and pulmonary function tests
  • Early detection of pulmonary arterial hypertension
  • Autologous stem cell transplant - severe cases
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13
Q

what is Sjögren’s Syndrome?

A
  • autoimmune disorder
  • attacks moisture-producing glands, primarily the salivary and lacrimal glands
  • dry mouth and eyes
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14
Q

what is the classification of sjogrens syndrome?

A
  • primary - absence of underlying autoimmune disease
  • secondary - in conjunction with another autoimmune disease eg SLE, RA, Scleroderma, Primary billiary cirrhosis
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15
Q

what are symptoms of sjogrens syndrome?

A

dry eyes
dry mouth
dental problems - swollen parotid gland
fatigue and pain
Skin, nose, and vaginal dryness
systemic involvement - increased risk of gluten sensitivity, lymphoma, Renal tubular acidosis

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16
Q

what are investigtaions/tests for sjogrens syndrome?

A
  • blood test - antibodies positive eg ANA, Ro/La, rheumatoid factor, raised immunoglobins
  • ultrasound - abnormal salivary glands
  • biopsy - Sialadenitis on lip (goldst)
  • Schirmer’s test - Measures tear production to evaluate dry eyes.
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17
Q

what is the treatment for sjogrens syndrome

A
  • dry eyes - cyclosporine eye drops, punctal plugs to retain moisture, artificial tears
  • dry mouth - Saliva substitutes, pilocarpine/cevimeline to stimulate saliva production.
  • Hydroxychloroquine - for fatigue, myalgia, rash
  • Corticosteroids/immunosuppressants
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18
Q

what are examples of autoimmune Connective tissue disease?

A
  • Systemic lupus erythematosus
  • Systemic sclerosis
  • Primary Sjögren’s Syndrome
  • Dermatomyositis/Polymyositis
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19
Q

what is Dermatomyositis/Polymyositis?

A
  • both cause muscle weakness (close to trunk)
  • dermatomyositis also presents with rash
  • can affect lungs
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20
Q

what are characteristic of Dermatomyositis rash?

A
  • violet or dusky red rash
  • face, eyelids, chest, knees, elbows, and knuckles
  • often with swelling
  • Gottron’s papules - scaly rash over knuckles
  • Heliotrope rash - rash over eyelids
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21
Q

what investigations/tests are done for Dermatomyositis/Polymyositis?

A
  • Muscle enzymes (Creatine Kinase) - raised
  • Electromyography (EMG) - Measures electrical activity in muscles
  • Muscle biopsy - shows inflammation/fiber necrosis
  • Screen for malignancy (PET-CT) - Malignancy associated antibodies
  • Chest X ray, PFTs, High resolution CT - for lung involvement
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22
Q

what is the treatment for Dermatomyositis/Polymyositis?

A
  • steroids (inflammation) - Prednisone
  • immunosupressive drugs - eg rituximab, methotrexate
  • Hydroxychloroquine - for rash
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23
Q

what are some Myositis‐specific autoantibodies?

A

MDA5,
NXP2,
TIF1-gamma
ARS

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24
Q

what are some inherited connective tissue disorders?

A
  • Marfan’s
  • Ehlers Danlos
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25
what are some features of marfans syndrome?
- Tall and slender body, hypermobility - Lens dislocation & myopia - dilation of aorta - High arched palate. - Pectus excavatum - depressed chest
26
how is marfans syndrome diagnosed?
- clinical features - FBN1 gene mutation
27
what are features of Ehlers-Danlos Syndrome (EDS)?
- hyperelastic skin, brusies easily - joint hypermobility & disolcation - vascular rigidity - mitral valve prolapse
28
what are features of inflammatory arthritis?
- swelling - red/warm, Synovial (compressible, tender) - worse in morning/inactivity - stiffness over 30 mins - constant/intermitant
29
what are causes of joint inflammation?
- autoimmune Arthritis: RA, - degenerative artheritis - Crystal arthrits – gout and pseudogout - septic arthiritis
30
what are risk factors of Rheumatoid Arthritis?
family history smoking more common in females
31
what are complications of RA if untreated?
- joint damage - CVD - HA, sroke - intestitial lung disease - eye problems - scleritis or uveitis
32
what does Rheumatoid Arthritis affect?
- Symmetrical small joints, hands wrists feet - big joints involved later ( bad prognosis if on presentation)
33
what is Seronegative Arthritis?
-ve for CCP and RF - affects Asymmetrical big joints, with spinal involvement - more common in men - Associated symptoms - IBD, psoriasis, eye inflammation
34
what are 5 different forms of Psoriatic Arthritis?
DIP Arthritis that affects the small joints, ends of fingers, toes, or both Asymmetrical arthritis of the joints in the hands and feet Symmetrical polyarthritis, which is similar to RA Arthritis mutilans, a rare type of arthritis that destroys and deforms joints Psoriatic spondylitis, arthritis of the lower back (sacroiliac sac) and the spine
35
what are the risk factors of gout?
beer, fructose renal impairment, diuretics, aspirin family history - more common in men pseudo gout more in women)
36
how does pseudo gout present on xray?
Chondrocalcinosis
37
what are features of osteoarthritis?
- slow onset - later in life - initially asymmetric - affects weight bearing joints - knees, hips, thumb, big toe - stiffness worse end of day (not morning like other arthiritis)
38
what is important to consider when diagnosing a types of arthiritis?
- inflammation - swelling/flares/CRP - pattern - symmetrical/asymmetrical - associated symptoms eg eye, nail psoriasis, bowels - tests - RF/CCP, uric acid, x-ray
39
what is the pathogenesis of gout?
- overproduction of urate from diet and alcohol - under exretion of urate due to genetics/drugs - causes hyperuricaemia - crystals form - inflammatory response when getting rid of crystals
40
what items in a diet contribute to gout?
beer/larger - contain guanosine red meat, shellfish sweetened soft drinks with fructose
41
what tests/investigations are required for gout?
- monosodium urate (MSU) crystals in the joint fluid or tophus - FBC - raised WWC - LFT if alcohol concern - CRP - xray - if sepsis differential diagnosis or chronic - Serum Uric Acid - normal in acute attack
42
what is the treatment of acute gout?
- lifestyle changes - diet, alcohol, weight, fluid - NSAID - short course - pain relief/inflammation - Colchicine - anti-inflammatory (SE diarrhoea) - corticosteroids - Prednisolone
43
what medication lowers uric acid levels and when is it used?
- Allopurinol – Xanthine Oxidase Inhibitor - Febuxostat - long-term gout
44
what is uric acid target when managing chronic gout?
below 360 umol/l
45
what are complications of gout?
- tophi - renal disease - calculi, acute/chronic urate nephropathy
46
what is the pathophysiology of rheumatoid artheritis?
- T cell attack synovium - leads to synovial hyperplasia - invades and damages cartilage and bone - pro-inflammatory cytokines, tumor necrosis factor (TNF) perpetuates inflammation
47
what are symptoms and signs of rheumatoid artheritis?
- symmetrical Pain and Swelling of joints - hands/wrists/feet - early morning stiffness - Decreased grip strength - fatigue, malaise
48
what are the tests/investigations for Rheumatoid Arthritis?
- CRP - Rheumatoid factor - (70% are +ve, false +ve) -Anti-CCP (cyclic citrullinated peptide) - xray/mri assesses joint damage - FBC - anemia is common
49
what is seen on an xray in RA?
Soft tissue swelling Periarticular osteopenia Joint space narrowing Bone erosion
50
what is the treatment of RA?
- DMARD (Disease-Modifying Anti-Rheumatic Drugs) - Methotrexate (1st line) - biological DMARD - Anti-TNF Medications, TNF-inhibiors, Rituximab, JAK inhibitors etc. - NSAIDS/corticosteroids - pain/inflammation - splints/rest/ice - Colchicine – helpful for crystal arthritis
51
what bacteria causes Prosthetic Joint Infection?
most common - Staphylococcus aureus (including MRSA) Coagulase-negative staphylococci Streptococci Enterococci (gram -ve - bacilli eg e.coli)
52
what are routes of infection to the bone?
- direct inoculation - eg from trauma/surgery - contiguous spread - from adjacent tissue or DM, ulcers, vascular disease - Haematogenous seeding - more common in children
53
what blood tests can suggest osteomyelitis/inflammation?
high ESR high WCC/neutrophils high CRP Procalcitonin - elevated in bacterial infection, rather than other inflammation
54
what are risk factors for septic joint?
- bacteraemia - trauma - Local skin breaks/ ulcers - Damaged joints - Immunosuppression (including steroids only) - Elderly - Rheumatoid arthritis (or other immune-driven disease) - Diabetes
55
what is Gonococcal arthritis?
- infective artheritis caused by bacterium Neisseria gonorrhoeae - can present as: Arthritis-dermatitis syndrome or Purulent arthritis (infection of one or more joints/pus filled)
56
how does a septic joint present?
- Painful, red, swollen, hot joint - **fever** - monoartheritis - most commonly **knee**, also hip & shoulder
57
what are risk factors for osteomyelitis?
- trauma - Vascular Insufficiency eg DM, sickel cell disease - prosthetic joints - immunosuppression - eg HIV/drugs
58
what bones are effected in osteomyelitis?
adluts over 50 - vertebra, clavicle/pelvis children - long bones
59
what part of the bone is affected in osteomyelitis?
metaphysis
60
what are clinical signs of osteomyelitis?
Fever, rigors, sweats, malaise erythema non-healing fractures, ulcers
61
what investigations/tests are done for osteomyelitis?
- blood tests - CRP, WCC, ESR - imaging - MRI, Xray, CT, nuclear bone scan - bone biopsy - may show absess, necrosis, fibrosis
62
what is the treatment for osteomyelitis?
- surgical - Debridement, hardware removal - Antimicrobial therapy (tailored to culture and bone penetration etc.) - wound care - analgesiacs
63
what is spondyloarthritis?
- group of inflammatory rheumatic diseases - include common features: axial involvement , peripheral arthritis, enthesitis, dactylitis
64
what gene is spondyloartheritis associated with?
HLA-B27
65
what are symptoms of spondyloarthritis?
- axial symptoms - chronic back pain/stiffness, improves with exercise not rest, worse at night - Peripheral arthritis - asymetrical lower limbs - Enthesitis - achiles tendon and plantar fascia pain - Dactylitis - "sausage digits" - Uveitis - eye inflammation - Psoriasis - IBD
66
what are tests/investigations for spondyloartheritis?
- HLA-B27 testing - imaging - xray, MRI (shows Sacroiliitis by bone marrow edema) - CRP and ESR elevation - The Assessment of SpondyloArthritis International Society (ASAS) criteria- includes imaging, clinical and hlab27
67
what are the subtypes of spondyloarthritis?
- Ankylosing spondylitis (AS) - spine/sacroiliac joints - Psoriatic arthritis (PsA) - Reactive arthritis (ReA) - to bacteria infection - Enteropathic arthritis - with IBD - Undifferentiated spondyloarthritis (uSpA)
68
what is the treatment of spondyloartheritis?
- NSAIDS - TNF inhibitors and IL-17 inhibitors - DMARDs - corticosteroids - physical therapy/exercise
69
what is the triad of reactive artheritis?
- artheritis - conjuctivitis - urethritis
70
how does Psoriatic Arthritis present?
- skin/NAIL psoriasis - joint pain/swelling - dactylitis
71
how is enteropathic artheritis treated?
- treat IBD - combination of biological therapy - due to IBD
72
what does SPINEACHE stand for?
s - stiffness - morning p - pain - improves with exercise i - inflammation - fever/fatigue n - night pain e - exercise a - age of onset (under 45) c - chronicality - more than 3 months h - HLA-B27 gene e - extra artificial feaatures - proriasis, IBD, uveitis, dactylitis
73
what is the difference in pain in inflammatory vs degenerative bone diseases?
inflammatory - pain eases with use, at rest, long lasting degenerative -pain evening/morning, with exercise, shorter
74
what is the pathogenesis of osteoartheritis?
- loss of cartilage and disordered bone repair - due to trauma, aging and cytokines
75
what are the risk factors of osteoartheritis?
- age - uncommon under 45 - female - more common after menopause - Genetic predisposition - obesity- low grade inflammation state - occupation - football/farming/manual labour - trauma - inflammatory artheritis - RA - Abnormal biomechanics eg hypermobility, dysplasia
76
what are signs of osteoartheritis?
- Alteration in gait - joint swelling - Bony enlargement, Effusion, Synovitis - joint abnormalities - Crepitus, Tenderness
77
what are radiological features of osteoartheritis?
Joint space narrowing Osteophyte formation Subchondral sclerosis Subchondral cysts Abnormalities of bone contour
78
what is non-medical management of osteoartheritis?
Patient education Activity and exercise Weight loss Physiotherapy Occupational therapy Footwear Orthoses Walking aids
79
what is pharmacological management of osteoartheritis?
- NSAIDs - Capsaicin - paracetamol, opioids - Transdermal patches - Intra-articular steroid injections - DMARDs have a role in inflammatory OA
80
what are surgical management of osteoartheritis?
- Arthroscopy - for lose bodies, uncontrolled pain - Osteotomy - Arthroplasty - new joints - Fusion - Usually ankle and foot
81
what does nodal osteoartheritis affect?
distal /proximal interphalangeal joints of the fingers
82
how is an orthopaedic xray presented?
Alignment - Dislocation Bone - Fractures Cartilage – widened joint Soft tissues – swelling, effusion
83
how is septic artheritis diagnosed?
- clinical evaluation of symptoms - eg pain, welling - joint aspiration - WCC, bacteria stain/culture - imaging - shows joint damage - blood test of inflammatory markers
84
what is the treatment of septic artheritis?
- antibiotics - joint aspiration to reduce pain/fluid - analgesics - Arthroscopic Drainage or Open Surgical Drainage - Joint Lavage - removes pus, debris - Debridement - removal of infected tissue if severe
85
what are the 4Rs in fracture treatment?
- resusciate - reduce - Retain - Rehab
86
what crystal cause gout/pseudogout?
- needle-shaped monosodium urate crystals - rhomboid-shaped Pyrophosphate crystals
87
how does gout present?
- sudden onset - eg waking up at night - hot swollen joint - extremely painful - joints commonly affected - big toe, ankle, knee, finger, elbow, wrist - monoartheritis more common (can be symmetrical) - can resolve within 2 weeks
88
what can form due to gout?
tophi - white areas of urate crystals in soft tissue eg in hand/ears - can cause damage to joints
89
what is the process of uric acid forming?
purines to HypoXanthine by enzyme Xanthine oxidase
90
what conditions can increase risk of gout due to too much purine/uric acid?
- Myeloproliferative disease - Psoriasis - Tumour lysis syndrome - Lesch-Nyhan syndrome - most due to increased cell turnover
91
what can cause a decrease in excrertion of uric acid, causing gout?
Renal impairment Thiazide diuretics Low dose aspirin Tacrolimus, ciclosporin Ethambutol, pyrazinamide
92
what can trigger an attack of gout?
Direct trauma to the joint Intercurrent illness Alcohol or shellfish binge Surgery Dehydration Starting hypouricaemic therapy
93
what investigations/tests are done for gout/pseudogout?
Routine bloods Inflammatory markers - high in attack then can go down Uric acid - can be high/low Joint aspiration X-ray - damage with recurrent atatcks
94
what is the treatment for chronic gout?
- lifestyle advice - Allopurinol - given if more than one attack - Febuxostat - Xanthine oxidase inhibitors
95
how is pseudogout different from gout?
- different distribution - larger joints effected - eg Knees>wrists>shoulders>ankles>elbows - calcium pyrophosphate crystals vs uric acid
96
what conditions are risk factors for pseudogout?
Haemochromatosis Hyperparathyroidism Hypophosphatasia Hypomagnesaemia Hypothyroidism Acromegaly
97
what is the treatment of chronic pseudogout?
LT low dose Prednisolone (corticosteroid) LT low dose colchicine Trial of hydroxychloroquine Trial of methotrexate
98
what is osteoporosis?
- low bone massand mineral density - microarchitectural deterioration of bone tissue - increased bone fragility and susceptibility to fracture
99
what are characteristics of Postmenopausal osteoporosis?
- less oestrogen - high bone turnover (cancellous bone loss) - microarchitectural disruption
100
how does trabecular architecture change with aging?
- decrease in trabecular thickness - decreasse in connections between horizontal trabecular - decrease in trabecular strength - increased risk of fracture
101
what methods are used to diagnose osteoporosis
- Bone mineral density test - Dual energy X-ray absorptiometry - DXA - T-score
102
what are risk factors/causes for osteoporosis?
- inflammatory diseases - endocrine diseases - para/thyroid, cushings - low body weight - immobility - drugs - glucosteroids, aromatase inhibitors etc. - alcohol/smoking - family history - previous fracture
103
how is osteoporosis treated?
medication anti-resorptive or anabolic: - Bisphosphonates 1st - denosumab - slows bone loss - PTH analogues - Teriparatide - stim bone growth - lifestyle changes - diet - supplements - fall prevention
104
what enzyme do bisphosphenates inhibit in cholesterol synthesis?
Farnesyl Pyrophosphate Synthase
105
what is the FRAX score?
tool to stimate 10 year fracture risk based on risk factors
106
what is the T score is osteoporosis?
(obtained from DEXA scan) >-1 is normal -1 - -2.5 = osteopenia (low bone mass) <-2.5 = osteoporosis severe if with fracture
107
what are features of Osteogenesis imperfecta?
- autosomal dominant - type 1 collagen affected - low bone mass, increased bone fragility
108
what are symptoms of vit D deficiency?
Bowing of legs Aches Hypocalcaemia Fits Muscle weakness Cardiomyopathy Enamel hypoplasia Fractures
109
what are radiological features of rickets?
Cupping Splaying Fraying Osteopaenia Periosteal elevation
110
what is Achondroplasia?
- shorter, abnormally-shaped bones - shorted stature - mutation in FGFR3 gene
111
what is Polymyalgia rheumatica ?
- inflammatory disorder - muscle pain and stiffness, fatigue - more common in women over 50 - diagnosis clinical + ESR/CPR - treated with corticosteroids
112
what is osteomalacia?
- bone softening due to lack of minerals - eg due to lack of vit D or phosphate, or celiac etc.
113
give examples of vasculitis in different classes?
large vessel - Giant Cell Arteritis medium - Polyarteritis Nodosa, kawasaki small - Granulomatosis with Polyangiitis, Henoch-Schönlein Purpura, Microscopic Polyangiitis
114
what are risk factors for giant cell arteritis?
- over 50 - white, scandinavian - more common in women
115
what are symptoms of giant cell arteritis?
- headache - severe, localised often temples - scalp tenderness - visual disturbances - Jaw Claudication - pain when chewing - fever, fatigue, malasie - Polymyalgia Rheumatica Symptoms
116
what investigations/tests are done for giant cell arteritis?
- blood tests - ESR, CPR - Temporal Artery Biopsy - show inflammation - ultrasound - 'halo' sign
117
what are some negative signs for GCA?
- vomiting - double vision - eg could be menengitis - fever (sometimes)
118
what are some Complications of Giant Cell Arteritis?
- Permanent Vision Loss - stroke - aortic aneurysm - scalp necrosis
119
what are the treatments for GCA?
- corticosteroids - low-dose aspirin to reduce stroke risk
120
what does GCA especially effect?
external carotid artery
121
what are symptoms of Granulomatosis with Polyangiitis?
- runny nose, cough, nosebleeds, sinusitis - Glomerulonephritis - hematuria, proteinuria - rash, purpura, ulcers - eye problems - redness, pain - hearing problems - Arthralgia or arthritis - Fever, fatigue, weight loss, and malaise
122
what are investigations/tests for Granulomatosis with Polyangiitis?
- blood tets - CPR, ESR, PR3-ANCA - urine analysis - kidney involvement - chest xray, CT scan - biopsy - for definitive diagnosis - from affected tissue eg lungs, kidneys, nasal muscosa
123
what is the treatment of Granulomatosis with Polyangiitis?
- corticosteroids - immunosupressants eg rituximab, cyclophosphamide - plasma exchange in severe cases
124
what are complications of Granulomatosis with Polyangiitis?
- kidney failure - due to glomerulonephritis - lung damage - fibrosis/bleeing - hearing loss
125
what are symptoms of Polyarteritis Nodosa?
- fever, malasie, weight loss - joint/muscle pain - rash, ulcers - peripheral neuropathy - pain,
126
what are tests/investigations for Polyarteritis Nodosa?
- blood tests - inflammatory markers ESR, CPR - urinanalysis - kidney involvement - skin or muscle biopsy - if involved - nerve conduction - Echocardiography - asses cardiac involvement
127
what are symptoms of fibromyalgia?
- widespread pain - fatigue - cognative difficulties - fibro fog
128
what is the management of fibromaygia?
- medication eg pain relief, anti-depressants - exercise - CBT therapy
129
what are symptoms of mechanical lower back pain?
- localised pain - spreading to legs - spasms - pain with movement, releif with rest
130
how is mechanical lower pain managed?
- rest - NSAIDS - heat/ice therapy
131
when is a MRI/CT scan performed with lower back pain?
if herniated disc, fracture, tumor suspected
132
where does Osteosarcoma occur?
- knee - upper arm - more common in children/young adults
133
what are examples of primary bone tumours?
- Osteosarcoma - Chondrosarcoma - ewing sarcoma
134
what cancers most commonly spread to the bone?
Breast, prostate, lung, and kidney cancers

2A (9 decks)

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