Polyarthritis Tutorial

Question 1

what is polyarthritis?

Answer 1

arthritis affecting more than 1 joint

Question 2

differentials for RA?

Answer 2

psoriatic arthritis
CT disease (esp. lupus)

Question 3

investigations for RA?

Answer 3

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

Question 4

how could you differentiate RA from psoriatic arthritis using autoantibodies?

Answer 4

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

Question 5

how should you use ANA in clinical practice?

Answer 5

use its absence to rule out lupus

Question 6

early presentation of inflammatory arthritis on x ray?

Answer 6

soft tissue swelling
periarticular osteopenia (bone thinning)

Question 7

what does osteopenia look like on x ray and why?

Answer 7

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

Question 8

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

Answer 8

swollen PIP and MCP joints

Question 9

why is ultrasound a good investigation for RA?

Answer 9

picks up inflammation

Question 10

late presentation of RA on x ray?

Answer 10

erosion

Question 11

what would a low Hb and normal MCV indicate on FBC

Answer 11

anaemia of chronic disease

Question 12

why is methotrexate the preferred DMARD

Answer 12

only have to take it once a week

works within 6 weeks- quicker than others

Question 13

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

Answer 13

1. add sulfasalazine

2. add biologic id DAS >5.1

Question 14

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

Answer 14

if DAS >5.1

Question 15

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

Answer 15

DAS score

Question 16

do you need to stop drinking alcohol on methotrexate

Answer 16

no, but limit it to avoid hepatitis

Question 17

what conditions are biologics not suitable for

Answer 17

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

Question 18

2 main contraindications of biologics?

Answer 18

immunosuppression

reactivation of TB

Question 19

which condition is worsening pain when walking downhill common?

Answer 19

osteoarthritis

Question 20

is a serum ANA of 1 : 80 high or low

Answer 20

low, just past upper limit of normal

Question 21

should you use steroids in mild lupus?

Answer 21

no, only moderate

Question 22

why can complement be low in lupus?

Answer 22

it is consumed by the autoimmune process

Question 23

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

Answer 23

low complement

high dsDNA

Question 24

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

Answer 24

1. urinalysis

2. renal biopsy

Question 25

treatment for severe lupus?

Answer 25

IV cyclophosphamide
IV steroids
hydroxychloroquine

2. rituximab if cyclo not working

Question 26

what does cyclophosphamide do?

Answer 26

potent immunosuppressant

Question 27

is raynauds pathological if it appears in older ages?

Answer 27

yes, usually secondary to something

Question 28

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

Answer 28

systemic sclerosis

Question 29

secondary presentations of systemic sclerosis

Answer 29

telangiectasia
raynauds
pulmonary fibrosis
pulmonary hypertension

Question 30

what is diffuse systemic sclerosis?

Answer 30

SS affecting any skin especially trunk and internal organs

Question 31

what is limited systemic sclerosis?

Answer 31

SS only affecting knees, face, arms,

Question 32

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

Answer 32

bilateral crackles in lung bases

Question 33

investigations for SS

Answer 33

anti-CCP
anti-Scl-70
HRCT chest
ECHO
Pulm function test

Question 34

what CT disease is oesophageal dysmotility common in?

Answer 34

systemic sclerosis

Question 35

treatment for raynauds?

Answer 35

1. calcium channel blockers
2. suldenifil
3. phosphocycline