Passmed Rheumatology Mushkies Flashcards
1
Q
What shoulder never be prescribed with methotrexate?
A
Co-trimoxazole/trimethoprim
2
Q
What is the MOA of methotrexate?
A
Antimetabolite that inhibits DHFR, which is essential for the synthesis of purines and pyrimidines
3
Q
What are 3 indications of methotrexate?
A
- RhA
- Psoriasis
- Chemo for e.g. ALL
4
Q
What are 5 adverse effects of methotrexate?
A
- Mucositis
- Myelosuppression
- Pneumonitis
- Pulmonary fibrosis
- Liver fibrosis
5
Q
What are some guidelines regarding methotrexate and pregnancy?
A
- Women should avoid pregnancy for at least 6m after treatment has stopped
- Men using methotrexate need to use effective contraception for at least 6m after treatment
6
Q
How often is methotrexate given?
A
Weekly
7
Q
How is methotrexate monitored?
A
FBC, U&E and LFTs before treatment, weekly until therapy stabilised, then every 2-3m
8
Q
What should be co-prescribed with methotrexate?
A
Folic acid 5mg once weekly, taken >24hrs after methorexate dose
9
Q
What is the starting dose of methotrexate?
A
7.5mg weekly
10
Q
What is the usual dose of one tablet of methotrexate?
A
2.5mg
11
Q
What is the treatment of choice for methotrexate toxicity?
A
Folinic acid
12
Q
What drug increases the risk of methotrexate toxicity secondary to redeced excretion?
A
High dose aspirin
13
Q
When does the risk of osteoporosis increase significantly for pts on steroids?
A
Equivalent of 7.5mg prednisolone per day for 3 or more months
14
Q
If pt is at risk of corticosteroid induced osteoporosis, what should they be prescribed?
A
- Calcium
- Vitamin D
- Bisphosphonate
15
Q
What drugs are associated with an increased risk of atypical stress fractures?
A
Bisphosphonates
16
Q
What is the MOA of bisphosphonates?
A
Inhibit osteoclasts by reducing recruitment and promoting apoptosis
17
Q
What are 4 uses for bisphosphonates?
A
- Prevention and Tx of osteoporosis
- Hypercalcaemia
- Paget’s
- Pain from bone metastases
18
Q
What are 5 complications of bisphosphonates?
A
- Oeseophageal reactions (oesophagitis, oesophageal ulcers)
- Osteonecrosis of the jaw
- Atypical stress fractures
- Acute phase response (fever, myalgia and arthralgia may occur following administration)
- Hypocalcaemia
19
Q
How does the BNF suggest pts should take bisphosphonates?
A
Tablets should be swallowed whole with plenty of water while sitting or standing; to be given on an empty stomach at least 30 minutes before breakfast (or another oral medication); patient should stand or sit upright for at least 30 minutes after taking tablet
20
Q
When should bisphosphonates be stopped after 5 years of treatment?
A
- Pt <75 y/o
- Femoral neck T score >-2.5
- Low risk according to FRAX/NOGG
21
Q
What kind of receptors do IFNa/b bind to?
A
Type I receptors
22
Q
What kind of receptors do IFNy receptors bind to?
A
Type II receptors
23
Q
What are 2 side effects of IFNa?
A
Flu-like symptoms and depression
24
Q
What are 4 uses of IFNa?
A
- Hep B&C
- Kaposi’s sarcoma
- Metastatic RCC
- Hairy cell leukaemia
25
What is a use for IFNb?
Reduces the frequency of exacerbations in pts with relapsing-remitting MS
26
What are 2 uses for IFNy?
CGD and osteopetrosis
27
What is the treatment for Paget's disease of the bone?
Oral risedronate or IV zoledronate
28
What are risk factors for Paget's disease?
1. Age
2. Male
3. Northern latitude
4. FHx
29
What are classical, untreated features of Paget's disease?
Bowing of tibia and bossing of skull
30
What are 5 complications of Paget's disease?
1. Deafness (CN entrapment)
2. Bone sarcoma
3. Fractures
4. Skull thickening
5. High output CF
31
Which bones does Paget's disease typically effect?
1. Skull
2. Spine/pelvis
3. Long bones of lower extremities
32
What is a complication of using TNFa inhibitors?
Reactivation of TB
33
What is the first line management for RhA?
DMARD monotherapy +/- a short course of bridging prednisolone
34
How can you monitor RhA response to tx?
CRP and DAS28
35
What is the most common DMARD used for tx of RhA?
Methotrexate?
36
What are 4 DMARDs?
Methotrexate, Sulfasalazine, leflunomide, hydroxychloroquine
37
What is the current indication for a TNF inhbitor for tx of RhA?
Inadequate response to at least 2 DMARDs including methotrexate
38
How is rituximab given?
2 x 1g infusions are given 2 weeks apart
39
What is the first line analgesic management of OA?
Paracetamol + topical NSAIDs
40
What is the first line conservative management of OA?
Weight loss, local muscle strengthening exercises and general aerobic fitness
41
What are the second line analgesic treatments for OA?
1. NSAIDs/COX2i
2. Opioids
3. Capsaicin cream
4. Intra-articular corticosteroids
42
What is a non-pharmacological management for OA?
1. Supports and braces
2. TENS
3. Shock-absorbing insoles or shoes
43
How can you classify the X-ray findings of RhA?
Early and late X ray findings
44
What are the early X ray findings of RhA?
1. Loss of joint space
2. Juxta-articular osteoporosis
3. Soft tissue swelling
45
What are the late X ray findings of RhA/
1. Peri-articular erosions
| 2. Subluxation
46
Which inflammatory marker is usually normal in SLE?
CRP
47
What is the most common cause of death with diffuse cutaneous systemic sclerosis?
Respiratory involvement --> ILD/Pulmonary arterial HTN
48
What is scleroderma?
Tightening of skin without internal organ involvement
49
What antibodies are associated with drug-induced lupus?
Anti-histone
50
What are some characteristic features of drug-induced lupus?
Usually resolves on drug stopping, dsDNA negative
51
What is a drug that can cause drug-induced lupus?
Isoniazid
52
What is the treatment of choice for acute reactive arthritis?
NSAIDs, as long as there are no contraindications
53
What are treatments for persistent reactive arthritis?
1. Intra-articular steroids
2. Sulfasalazine
3. Methotrexate
54
What is keratoderma blenorrhagicum?
Waxy yellow/brown papules on palms and soles due to reactive arthritis
55
What is circinate balanitis?
Painless vesicles on the coronal margin of the prepuce
56
What is the typical pattern seen in reactive arthritis?
Asymmetrical oligoarthritis of the lower limbs
57
What may/should the ESR be in PMR?
>40mm/hr
58
What is the management for PMR?
Prednisolone e.g. 15mg OD should lead to a dramatic response
59
What is Felty's syndrome?
Triad of Reactive arthritis, splenomegaly and neutropenia
60
How can you classify the extra-articular features of RhA?
1. Ocular
2. Respiratory
3. IHD
4. Infections
5. Depression
6 Osteoporosis
61
What are some resp complications of RhA?
1. Pulmonary fibrosis
2. Pleural efflusion
3. Pleurisy
4. Pulmonary nodules
5. Bronchiolitis obliterans
4. Methotrexate pneumonitis
62
What are some ocular complications of RhA?
1. Keratoconjunctivitis sicca (most common)
2. Episcleritis
3. Scleritis
4. Corneal ulceration
5. Keratitis
6. Steroid-induced cataracts
7. HCQ retinopathy
63
What additional skin change is Behcets syndrome associated with?
Erythema nodosum
64
What is asteatotic eczema also known as?
Crazy paving eczema
65
What is asteatotic eczema associated with?
Hypothyroidism and lymphoma
66
What does guttate psoriasis look like?
Teardrops
67
When is guttate psoriasis typically seen?
After streptococcal throat infections
68
What is the triad of Behcets syndrome?
Oral ulcers, genital ulcers, anterior uveitis (it is a clinical diagnosis, there is no definitive test)
69
What test is suggestive of Behcets?
Positive pathergy test (puncture site following needle prick becomes inflamed with small pustule forming)
70
What is the treatment of choice for osteomalacia?
Vitamin D3 supplementation
71
What are some causes of osteomalacia?
1. Vit D deficiency = malabsorptive, lack of sunlight, diet
2. Renal failure
3. Liver disease e.g. cirrhosis
4. Drugs induced e.g. anticonvulsants
5. Genetic
72
What are 5 side effects of sulfasalazine?
1. Oligospermia
2. Stevens Johnson Syndrome
3. Lung fibrosis
4. Myelosuppression
5. May colour tears --> stained contact lenses
73
What are 4 poor prognostic features for RhA?
1. RhF positive
2. HLA DR4
3. Insidious onset
4. Anti-CCP Abs
74
How do you define dermatomyositis?
Inflammatory disorder causing symmetrical proximal muscle weakness and characteristic skin lesions
75
What is dermatomyositis often associated with?
Cancer (esp. ovarian, breast, lung) - with dermatomyositis being a paraneoplastic complications of the malignancy
76
What are 5 skin signs of dermatomyositis?
1. Gottron's papules
2. Heliotrope rash (periorbital)
3. Macular rash over back and shoulder
4. Nail fold capillary dilatation
5. Photosensitive
77
What are gottron's papules?
Roughened red papules over extensor surfaces of fingers
78
What is pencil cup deformity of the DIPs associated with?
Psoriatic arthritis
79
What are the types of psoriatic arthropathy?
1. Symmetrical polyarthritis (similar to RhA) (30-40%)
2. Asymmetrical oligoarthritis (20-30%)
3. DIP joint disease (10%)
4. Spondyloarthritis
5. Arthritis mutilans
80
What is the buzzword for arthritis mutilans?
Telescoping fingers
81
What is needed for definitive diagnosis of ankylosing spondylitis?
A radiological feature and clinical feature
82
What percentage of the general population is HLA B27 positive?
12%
83
What percentage of pts with ankylosing spondylitis are HLA B27 positive?
90%
84
What might you see on X ray of ankylosing spondylitis?
1. Sacroiliitis (subchondral erosions, sclerosis)
2. Squaring of lumbar vertebra
3. Bamboo spine
4. Syndesmophytes
85
What may you see on CXR of ankylosing spondylitis?
Apical fibrosis
86
What is a syndesmophyte?
A bony outgrowth originating inside a ligament
87
What may you see on spirometry of ankylosing spondylitis?
A restrictive defect due to a combination of:
1. Pulmonary fibrosis
2. Kyphosis
3. Ankylosis
88
How can you distinguish pseudogout from gout on plain radiograph?
Chondrocalcinosis
89
What is chondrocalcinosis?
Visible calcification of cartilage
90
What are some risk factors for pseudogout?
1. Haemochromatosis
2. HPT
3. Acromegaly
4. Wilson's disease
5. Low Mg/P
91
What is the management of pseudogout?
1. NSAIDS
2. Inra-articular/muscular steroids
3. Oral steroids
92
What joints does pseudogout most commonly affect?
Knee, wrist and shoulders
93
What are two forms of serositis you can see in SLE?
Pleuritis and pericarditis
94
How is denosumab given?
SC injection every 6m
95
When do you offer urate lowering therapy to pts with gout?
To all pts after their first attack of gout (allopurinol 1st line)
96
What is a good antihypertensive to give to pts with gout and why?
Losartan as it has a specific uricosuric action
97
What subtype of dermatomyositis is characterised by a combination of myositis and interstitial lung disease?
Anti-synthetase syndrome (anti-Jo1, anti-tRNA synthetase)
98
What are some common and less common drugs that cause drug-induced lupus?
1. Common = procainamide, hydralazine
| 2. Less common = isoniazid, minocycline, phenytoin
99
What is the mechanism by which Marfan's causes aortic dissection?
Dilatation of the aortic sinuses
100
What gene mutation causes Marfan's?
Fibrillin-1 on Chr 15
101
What are 3 eye signs of Marfans?
1. Upward lens dislocation
2. Blue sclerae
3. Myopia
102
What is the leading cause of death in Marfans?
Aortic dissection and other CVS problems
103
If a pt is suffering from significant upper Gi s/e from alendronate, what can you change their treatment to?
Risedronate or etidronate
104
Can ankylosing spondylitis present with night pain?
Ye boi
105
What is the dagger sign and what is it a sign of?
1. A single radiodense line related to ossification of supraspinous and interspinous ligaments
2. Ankylosing spondylitis
106
What are 4 causes of a raised pANCA?
1. MPA
2. eGPA
3. GPA (in 25%, fun fun fun)
4. Immune crescenteric glomerulonephritis
5. PSC
107
What are 3 systemic causes of a raised ANCA?
1. IBD (UC > CD)
2. CTD (RA, SLE, Sjogrens)
3. Autoimmune hepatitis
108
What are periarticular erosions typically seen in?
Rheumatoid arthritis
109
What is a 'plantar spur' on X-ray associated with?
Psoriatic arthritis
110
What does chondrocalcinosis on X ray suggest?
Pseudogout
111
What criteria is used to assess the probability of septic arthritis in children?
Kocher's criteria
112
What are the parameters in Kocher's criteria?
1. Non-weight bearing
2. Fever > 38.5
3. Raised WCC
4. ESR > 40
113
What are some conditions associated with a positive RhF?
1. RhA, SLE, Sjogrens, Felty's
2. Infective endocarditis
3. SLE
4. Systemic sclerosis
5. Infections = TB, HBV. EBV< leprosy
114
In what percentage of the population do you find a positive RhF?
5%
115
What test is highly specific for RhA?
Anti-CCP (may be detectable up to 10 years before the development of RhA)
116
What is a classic side effect of colchicine?
Diarrhoea
117
What is the most specific test for SLE?
Anti-smith Abs
118
What markers can be used for disease monitoring of SLE?
ESR, C3, C4, anti-dsDNA titres
119
What mushkie is not associated with developing osteoporosis?
Obesity (in fact, low body mass is associated with it)
120
What score can be used to help assess hypermobility?
Beighton score (positive if >5/9 in adults, >6/9 in children)
121
What is the most common cause of septic arthritis?
S. aureus
122
What is the most common cause of septic arthritis in young sexually active people?
N. gonorrhoeae
123
How long is abx treatment for septic arthritis?
6-12 weeks (BNF)
124
What kind of crystals are found in pseudogout?
Weakly positively birefringent rhomboid-shaped crystals
125
What imaging must be done on pts with RhA before having surgery and why?
1. AP and lateral C-spine radiographs
2. To look for atlanto-axial subluxation, as it can lead to cord compression --> ensure pts neck is not hyperextended on intubation
126
What antibiotics should not be given to pts on sulfasalazine?
Sulphonamides, due to cross-sensitivity leading to an allergic reaction
127
What is sulfasalazine?
A pro-drug for 5-ASA
128
What medication can be safely used during pregnancy in RhA?
HCQ - does cross the placenta, but does not appear to have fetal toxicity with the doses used for Tx of RhA
129
What is the main adverse effect of HCQ?
Bull's eye retinopathy = may result in severe and permanent visual loss
130
How does one monitor the main s'e of HCQ?
Monitor visual acuity annually with a fundus photograph,, OCT scan (optical coherence tomography) and FAF imaging (fundus autofluorescence)
131
What is the rate of occurence of bull's eye retinopathy in pts on HCQ?
1. >5yrs --> 7%
| 2. >20yrs --> 20-50%
132
Allergy to new watch - what is the offending precipitant and what is the G&C classification?
1. Nickel
| 2. IV
133
What is the classical demographic affected by Ankylosing spondylitis?
1. Males (3M:1F) aged 20-30 y/o
134
What is Schober's test for?
Reduced forward flexion in Ankylosing spondylitis
135
How does one perform Schober's test?
A line is drawn 10cm above and 5cm below the dimpes of Venus, the two lines should increase by >5cm when the pt bends as far as possible
136
What are the 8 A's of ankylosing spondylitis?
1. Anterior uveitis
2. Apical fibrosis
3. Aortic regurgitation
4. AV node block
5. Achilles tendonitis
6. Amyloidosis
7. Arthritis (peripheral)
8. And cauda equina syndrome
137
When should methotrexate be stopped before trying to conceive?
6 months before trying to conceive (in both men and women)
138
Low calcium and phosphate with raised ALP?
Osteomalacia
139
What is the Z score in DEXA scans adjusted for?
Age, gender and ethnic factors
140
What is the initial management of pts with RhA?
DMARD monotherapy (methotrextate) +/- a short course of bridging prednisolone
141
How do you monitor response to RhA treatment?
CRP and DAS28
142
What condition does anti-phospholipid syndrome most commonly occur secondary to?
SLE
143
How does antiphospholipid syndrome affect?
Causes a paradoxical rise in APTT, due to an ex-vivo reaction of the lupus anticoagulant Abs with phospholipids involved in the cascase
144
What treatment should pts with antiphospholipid syndrome be on?
Warfarin
145
What is the triad of presentation of anti-phospholipid syndrome?
1. Recurrent venous and arterial thromboses
2. Recurrent miscarriage
3. Thrombocytopenia
146
What are the anti-phospholipid antibodies?
1. Anti-cardiolipin antibodies
| 2. Lupus anticoagulant
147
What are 5 non-skin features of dermatomyositis?
1. Proximal muscle weakness
2. Raynauds
3. Respiratory muscle weakness
4. Interstitial lung disease
5. Dysphagia, odynophagia
148
How can you classify Sjogrens syndrome?
1. Primary (PSS)
| 2. Secondary to RhA or other connective tissue disorders
149
When does secondary sjogrens syndrome (SSS) start to appear?
10 years after initial onset of disease
150
What malignancy are you at increased risk of with Sjogrens syndrome?
Lymphoid malignancy (40-60 fold)
151
What is the M:F ratio of Sjogrens?
1M:9F
152
What are the notable Abs positive in Sjogrens syndrome?
1. RhF = almost 100%
2. Anti-Ro (SSA) = 70%
3. Anti-La (SSB) = 30%
153
What is the management of sjogrens syndrome?
1. Artificial saliva and tears
| 2. Pilocarpine may stimulate saliva production
154
What are cautions to consider before a pt is started on sulfasalazine?
1. G6PD deficiency
| 2. Allergy to aspirin/sulphonamides
155
What causes Lesch-Nyhan syndrome?
An X-linked deficiency in HGPRT
156
What are features of Lesch-Nyhan syndrome?
1. Learning disability
2. Self mutilating behaviour
3. Hyperuricaemia (and gout)
4. Renal failure
157
How can you classify the causes of gout?
1. Decreased excretion of uric acid
2. Increased production of uric acid
3. Congenital = Lesch-Nyhan syndrome
158
What are 3 causes of decreased excretion of uric acid?
1. Drugs e.g. diuretics
2. CLD
3. Lead toxicity
159
What are 3 causes of increased production of uric acid?
1. Myeloproliferative/myeloproliferative disorder
2. Cytotoxic drugs
3. Severe psoriasis
160
What are some foods rich in purine?
Liver, kidneys, seafood, oily fish and yeast products
161
What are 4 causes of dactylitis?
1. Spondyloarthritis e.g. psoriatic and reactive arthritis
2. Sickle cell disease
3. Infection = TB, syphilis
4. Sarcoidosis
162
What causes trochanteric bursitis and how does it present?
Repeated movements of the fibroelastic band and pain and tenderness over the lateral side of the thigh
163
What is meralgia paraesthetica and how does it present?
1. Compression of lateral cutaneous nerve of the thigh
| 2. Burning sensation over ALT
164
What is transient idiopathic osteoporosis?
Uncommon condition sometimes seen in the third trimester of pregnancy, with groin pain associated with a limited range of movement in the hip and inability to weight bear. ESR may be elevated.
165
What is the first line management for ankylosing spondylitis?
1. Regular exercise e.g. swimming and physiotherapy
2. NSAIDs (1st line treatment)
3. Anti-TNF should be given to pts with persistently high disease activity despite conventional Tx e.g. sulfasalazine
166
What is the now preferred term for trochanteric bursitis?
Greater trochanteric pain syndrome
167
In what pt group is trochanteric bursitis most common?
Women aged 50-yo years old
168
How do you differentiate between inflammatory arthritis and osteoarthritis?
Inflammatory arthritis has pain that is worse in the mornings, whilst osteoarthritis has pain that is worse on exercise
169
What is the usual time frame for onset of PMR?
Usually rapid onset (<1m)
170
What is a solid mnemonic for the causes of gout?
```
DART
Diuretics
Alcohol
Renal disease
Trauma
```
171
What joint is most commonly affected by an acute attack of gout?
1st MTP joint
172
What other drug can be given to a pt with gout if allopurinol is not tolerated or is c/i?
Febuxostat (a XO inhibitor)
173
What is the characteristic pattern of pyrexia in Still's disease?
Rises in the late afternoon/early evening in a daily pattern, and accompanies a worsening of joint symptoms and rash
174
What is the criteria used for the diagnosis of Still's disease?
Yamaguchi criteria
175
What is the management of Still's disease?
1. NSAIDs
2. Steroids if not controlled after 1 wk on steroids
3. Methotrexate, anti-TNF, IL1
176
What are 2 rheum condition are associated with livedo reticularis?
1. Antiphospholipid syndrome
| 2. Polyarteritis Nodosa
177
What are 2 causes of a saddle shaped nose?
1. GPA
| 2. Relapsing polychondritis
178
Oligoarthritis with ulcerative colitis, what test and why?
1. HLA B27
| 2. Enteropathic arthritis is a seronegative spondyloarthropathy
179
What is the prevalence of TPMT deficiency?
1/200
180
What levels must be checked before starting a patient on azathioprine?
TPMT levels
181
What are 4 features of osteogenesis imperfecta?
1. Multiple fractures
2. Blue sclerae
3. Dental caries
4. Deafness (due to otosclerosis)
182
What may indicate referred lumbar spine pain as a cause of hip pain?
A positive femoral nerve stretch test
183
Do you get thrombocytopenia or thrombocytosis in antiphospholipid syndrome?
Thrombocytopenia
184
What is the APTT like in antiphospholipid syndrome?
Prolonged (a pradoxical rise)
185
What are the rotator cuff muscles?
```
SITS
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
```
186
What is the function of supraspinatus?
Abducts arm before deltoid (first 20 degrees)
187
What is the function of infraspinatus?
External rotation of shoulder
188
What is the function of teres minor?
External rotation of shoulder
189
What is the function of subscapularis?
Adducts and rotates arm medially
190
Which rotator cuff muscle is most commonly injured?
Supraspinatus
191
Which 2 rotator cuff muscles essentially do the same thing?
Infraspinatus and teres minor
192
Why should NSAIDs be avoided in elderly pts taking warfarin?
Due to the risk of life-threatening GI haemorrhage
193
What is the epidemiology of fibromyalgia?
1. 1M:5F
| 2. 30-50 y/o
194
What are the features of fibromyalgia?
1. Chronic multi-site pain
2. Lethargy
3. Cognitive impairment 'fibro-fog'
4. Sleep disturbance, headaches, dizziness
195
What is the management for fibromyalgia?
1. Aerobic exercise (strongest evidence base)
2. CBT
3. Amitryptiline/pregabalin/duloxetine
196
What is a fun fact about proximal myopathy in polymyalgia rheumatica?
There is no true weakness of limb girdles in PMR on examination, any weakness of muscles is due to myalgia (pain inhibition)
197
What is Buerger's disease?
Segmental thrombotic occlusions of the small and medium sized lower limb vessels, commonest in young male smokers
198
What might you see on angio in Buergers disease?
Tortuous corkscrew shaped collateral vessels
199
What can help in the management of Buerger's disease?
Smoking cessation
200
What is a quirk of allopurinol when using it to manage gout?
Should not be started until an acute attack has settled, although if they are already prescribed it they should continue to take it
201
What is a cardiac complication of RhA?
IHD
202
What is the current guideline regarding bisphosphonate holidays?
1. After a five year period for oral bisphosphonates (three years for IV zoledronate), treatment should be re-assessed for ongoing treatment, with an updated FRAX score and DEXA scan.
2. This guidance separates patients into high and low risk groups (high = e.g. age > 75, steroids, T
203
What antibodies must be negative to diagnose adult-onset Still's disease?
RhF and ANA as Still's is a Diagnosis of exclusion
204
What clinical test is suggestive of ankylosing spondylitis?
1. Schober's test <5cm
2. Reduced lateral flexion of the lumbar spine
3. Loss of lumbar lordosis and accentuated thoracic kyphosis
205
What is the formal name for tennis elbow?
Lateral epicondylitis
206
What is a clinical sign of lateral epicondylitis?
Pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended
207
What are the 4 management strategies for lateral epicondylitis?
1. Avoiding muscle overload
2. Simple analgesia
3. Steroid injection
4. Physiotherapy
208
When should anti-TNFa be used in pts with axial ankylosing spondylitis?
Has failed on 2 different NSAIDS and meets criteria for active disease on 2 occasions 12 weeks apart
209
Have DMARDs been shown to be beneficial for ankylosing spondylitis?
NO
210
How can you classify the causes of Raynaud's?
1. Primary = Raynaud's disease
| 2. Secondary = Raynaud's phenomenon
211
What are some secondary causes of Raynaud's phenomenon?
1. Connective tissue disorders = scleroderma, RhA, SLE
2. Leukaemia
3. Use of vibrating tools
4. Drugs = OCP
5. Cervical rib
212
What is the connective tissue disorder most commonly associated with Raynaud's?
Scleroderma
213
What is the management for Raynaud's disease?
1. CCBs e.g. nifedipine
| 2. IV prostacyclin infusions (effects may last several weeks/months)
214
What is PAN?
A medium-vessel vasculitis with necrotising inflammation leading to aneurysm formation
215
What infection is associated with PAN?
Hep B
216
What causes visual loss in GCA?
Anterior ischaemic optic neuropathy
217
What is the HLA association for Behcet's?
HLA B51
218
How can you classify the causes of reactive arthritis?
1. Post-STI
| 2. Post-dysenteric
219
What is the main post-STI organism responsible for reactive arthritis?
C. trachomatis
220
What are the post-dysenteric organisms responsible for reactive arthritis?
1. Salmonella
2. Shigella
3. Yersinia
4. Campylobacter
