Polyarthritis Tutorial Flashcards

1
Q

what is polyarthritis?

A

arthritis affecting more than 1 joint

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2
Q

differentials for RA?

A
psoriatic arthritis
CT disease (esp. lupus)
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3
Q

investigations for RA?

A

anti-CCP, ESR, CRP
ultrasound
x ray
DAS score

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4
Q

how could you differentiate RA from psoriatic arthritis using autoantibodies?

A

RA has anti CCP, psoriatic is seronegative so won’t have any autoantibodies

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5
Q

how should you use ANA in clinical practice?

A

use its absence to rule out lupus

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6
Q

early presentation of inflammatory arthritis on x ray?

A
soft tissue swelling
periarticular osteopenia (bone thinning)
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7
Q

what does osteopenia look like on x ray and why?

A

dark areas as thinner bone comes out darker and thicker is whiter

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8
Q

what would you expect to see on hand examination of someone with inflammatory arthritis?

A

swollen PIP and MCP joints

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9
Q

why is ultrasound a good investigation for RA?

A

picks up inflammation

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10
Q

late presentation of RA on x ray?

A

erosion

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11
Q

what would a low Hb and normal MCV indicate on FBC

A

anaemia of chronic disease

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12
Q

why is methotrexate the preferred DMARD

A

only have to take it once a week

works within 6 weeks- quicker than others

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13
Q

what treatment should be given in a severe flare up of arthritis

A
  1. add sulfasalazine

2. add biologic id DAS >5.1

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14
Q

when is the only time a biologic should be considered in arthritis

A

if DAS >5.1

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15
Q

how would you measure disease activity and response to treatment in a patient on a DMARD

A

DAS score

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16
Q

do you need to stop drinking alcohol on methotrexate

A

no, but limit it to avoid hepatitis

17
Q

what conditions are biologics not suitable for

A
heart failure
lung disease
chronic infection
previous/latent TB
demyelinating disease eg MS
18
Q

2 main contraindications of biologics?

A

immunosuppression

reactivation of TB

19
Q

which condition is worsening pain when walking downhill common?

A

osteoarthritis

20
Q

is a serum ANA of 1 : 80 high or low

A

low, just past upper limit of normal

21
Q

should you use steroids in mild lupus?

A

no, only moderate

22
Q

why can complement be low in lupus?

A

it is consumed by the autoimmune process

23
Q

what effect would active lupus have on double stranded DNA and complement?

A

low complement

high dsDNA

24
Q

1st and 2nd line tests if kidney involvement in lupus?

A
  1. urinalysis

2. renal biopsy

25
Q

treatment for severe lupus?

A

IV cyclophosphamide
IV steroids
hydroxychloroquine

  1. rituximab if cyclo not working
26
Q

what does cyclophosphamide do?

A

potent immunosuppressant

27
Q

is raynauds pathological if it appears in older ages?

A

yes, usually secondary to something

28
Q

what would you suspect in a patient with shiny, tight hands and raynauds?

A

systemic sclerosis

29
Q

secondary presentations of systemic sclerosis

A

telangiectasia
raynauds
pulmonary fibrosis
pulmonary hypertension

30
Q

what is diffuse systemic sclerosis?

A

SS affecting any skin especially trunk and internal organs

31
Q

what is limited systemic sclerosis?

A

SS only affecting knees, face, arms,

32
Q

what would you hear on auscultation of pulmonary fibrosis in SS?

A

bilateral crackles in lung bases

33
Q

investigations for SS

A
anti-CCP
anti-Scl-70
HRCT chest
ECHO
Pulm function test
34
Q

what CT disease is oesophageal dysmotility common in?

A

systemic sclerosis

35
Q

treatment for raynauds?

A
  1. calcium channel blockers
  2. suldenifil
  3. phosphocycline