Random Flashcards
Cutaneous manifestations of dermatomyositis
- Gottrons papuls
- Red, violacious erythemas (V-sign, Shawl sign, Holster sign)
- Mechanic’s hands
- cutanous calcinosis
- heliotrope rash
- erythroderma
- nailfold abnormalities
Causes of subcutaneous nodules
- RA
- Gout
- Rheumatic fever
- sarcoidosis
Causes of dactylitis
- Ank spond
- Psoriatic arthritis
- IBD-related arthritis
- reactive arthritis
- undiff. spondyloarthrits
Hand deformities in RA
- Ulnar deviation
- subcutaneous nodules
- Z deformity of thumb
- Boutonniere’s deformity
- Swan-neck deformity
Biological agents to treat RA
- TNF inhibitors
- IL-6 inhibitor
- B-cell depletion
- Co-stimulation modulation
DMARDS
- methotrexate
- sulfasalazine
- chloroquine
- lefluonomide
X-ray findings in RA
- uniform joint space narrowing
- periarticular osteopenia
- juxta-articular bony erosions
- sub-luxation and gross deformities
- peri-articular soft tissue swelling
- capsular erosions
X-ray findings in OA
- joint space narrowing
- osteophytes
- subchondral cysts
- subchondral sclerosis
- fibrillated cartilage
- early cartilage loss
Nail manifestations in psoriatsis
- pitting
- onycholysis
- subungual hyperkeratosis
Differentials of OA
- ank spond
- avascular necrosis
- RA
- psoriatic arthritis
- gout
- psuedogout
Clinical features of diffuse systemic sclerosis
- severe ILD
- renal involvement
- diffuse skin involvement
- anti-topoisomerase Ab
- short duration of Raynauds
Clinical features of limited systemic sclerosis
- isolated pumonary hypertension
- no renal involvement
- limited skin involvement
- anti-centromere Ab
- long duration of Raynauds
Drug used for renal involvement of systemic sclerosis
ACE-inhibitor
Autoantibodies specific to systemic sclerosis
- anti-centromere antibody SCL70
- anti-topoisomerase
6 types of systemic involvement of systemic sclerosis
- GIT (oesoph dysmotility, microstomia)
- Pulm (ILD, PHPT)
- Cardiac (pericarditis)
- renal (scleroderma renal crisis)
- musculoskeletal (arthralgia)
- vascular (Raynauds)
- cutaneous (progressive skin fibrosis)
6 systemic manifestations of idiopathic inflammatory myositis
- Constitutional
- Skeletal (prox muscle weakness, pharyngeal weakness, weak neck flexors)
- skin (DM)
- lungs (ILD)
- cardiac (carditis, CMO)
- joints (arthritis)
- GIT (GORD)
Differentials of proximal muscle weakness
- genetic muscle disorders (muscular dystrophies)
- congenital myopathies
- neuropathies (SMA, MG, GBS)
- metabolic (storage disease)
- endocrine (thyroid)
- infection
- drugs (AZT, steroids)
- granulomatous disease
Causes of Raynaud’s phenomenon
- Idiopathic (primary)
- scleroderma
- SLE
- Sjogrens
- RA
- dermatomyositis
- drugs (Bblock, sulfasalazine)
Differentials for gout
- CPPD
- BCPC
- septic arthritis
- reactive arthritis
Bedside test for renal flare in SLE
Dipstix - proteinuria and haematureia
Clinical findings for APS
- tendency to thrombosis, recurrent fetal loss, thrombocytopenia, false positive tests for syphilis
- Ab: anti-cardiolipin, anti-glycoprotein1, anti glycoprotein B2, anti-lupus coag
Treatment of APS
long-term anticoagulation with Warfarin
Definition of osteoporosis
Generalised bone disease characerised by decreased bone mass and deterioration of bone micro-architecture, resulting in increased fracture risk
Primary OP
bone loss related to decline in gonadal function associated with aging
Secondary OP
bone loss that results due to a variety of conditions that adversely impact bone metabolism
Causes of secondary OP
- endocrine - thyrotoxicosis, cushings
- hypogonadal (anorexia, turners)
- drugs (glucocorticoids)
- haematological malignancy (MM, thalassemia)
- GIT (IMB, malabsorption)
- Neurological (Parkinsons)
- other (RA, AS, SLE, CRF)
Radiographic diagnosis of OP
Dexa score of -2.5 and below or T-score of -1 and below
Treatment of OP
Non-pharm
- prevention of falls
Pharm
- calcium and vit D supp
- bisphosphonates
- calcitonin
- strontium ranalate
- HRT
- selective oestrogen receptor modulator
SLICC immunological criteria
- anti-dsDNA
- anti-Sm
- positive Coomb’s test
- anti-phospholipid antibody
- ANA
- low complement
SLICC clinical criteria
- acute lupus rash
- chronic lupus rash
- oral ulcers
- arthritis
- thrombocytopenia
- haemolytic anaemia
- leucopenia
- serositis
- lupus nephritis
- non-scarring alopecia
- neurological
Things to exclude for FMS
- hypothyroidism
- hyperparathyroidism
- polymyalgia rheumatica
- early inflammatory arthritis
- parkinsonism
- myositis
- malignancies
Treatment of FMS
Non-pharm
- education
- aerobics
- CBT
Pharm
- TCAs
- SSRIs
- alpha 2 delta ligands
- tramadol and paracetamol
Commonest non-articular rheumatism at elbow
- tennis elbow (lateral epicondylitis - pain on wrist flexion)
- golfer’s elbow (medial epicondylitis - pain on wrist extension)
Commonest non-articular rheumatism at knee
Pre-patellar bursitis (housemaid’s knee)
New classification of JIA
- oligoarticular (persisten, extended)
- polyarticular (RF pos, neg)
- systemic
- enthesitis related
- psoriatic
- unclassified
Causes of primary large artery vasculitis
- GCU
- Takayasu’s
Causes of primary medium artery vasculitis
- classic PAN
- Kawasaki
Causes of secondary large artery vasculitis
- aortitis (RA)
- infection (syphilis, TB)
Treatment for primary vasculitis
- immunosuppression (steroids, MTX, biologicals)
- revascularisation
Acute treatment of gout
- NSAIDs
- colchicine
- if CI, steroids
Urate lowering therapies
- uricostatic (allopurinol)
- uricosuric (probenecid)
- uricolytic (pegloticase)
Prophylaxis of acute attacks during ULT
colchicine for 3-6 months
NSAIDS for 6-12 weeks
6 clinical syndromes of CPPD
- pseudogout
- OA-like
- RA-like
- OA- like with discrete acute attacks
- neuropathic type
- asymptomatic chondrocalcinosis
Crystals in CPPD joint aspirate
Positively bifringemnt
Treatment of CPPD
- NSAIDs
- IAI steroids
- colchicine (pseudogout)
- HCQ (chronic arthritis
Definition of Sjogrens
Chronic inflammatory disorder characterised by lymphocytic infiltrates in exocrine glands
Red flags for lower back pain
- age of onset <20 years or >50 years
- recent history of violent trauma
- constant progressive, non-mechanical pain
- thoracic pain
- past history of malignant tumour
- prolonged use of corticosteroids
- drug abuse, immunosuppression, HIV
- systemically unwell
- unexplained weight loss, night sweats
- widespread neurological symptoms
- structural deformity
- fever
Criteria for Sjogrens
- ocular symptoms
- oral symptoms
- ocular signs
- autoantibodies (ro, La)
- alivary gland involvement
- histopathology
What malignancy is Sjogrens associated with?
Non-Hodgkins lymphoma
Triad of Reiter’s syndrome
- urethritis
- conjunctivitis
- oligo-arthritis
Extra-articular features of reactive arthritis
- mucocutaneous lesions
- enthesitis
- conjunctivitis
- uveitis
- urethritis
- dactylitis
- carditis
Treatment of reactive arthritis
- NSAIDS
- IAI steroid
- mod/high dose steroids
- antibiotics if acute phase
- chronic = sulfasalazine
- physiotherapy
Side effects of long-term steroid use
- proximal myopathy
- diabetes
- cushings
- osteoporosis
- hypertension
- glaucoma
- cataracts
Side-effects of NSAIDs
- Reye’s syndrome
- sodium and water retention
- PUD
- interstitial nephritis
- bronchospasm
- transaminitis
Criteria for hypermobility syndrome
- hyperextension of knees >10
- thumb passively opposed to forearm
- little MCP extends >90 degrees
- elbow extension >10
- palms on floor
Causes of hypermobility syndrome
- hypermobility syndrome (AD)
- Ehlers Danlos
- Down’s syndrome
- osteogenesis imperfecta
- Marfans
- Marfanoid hypermobility syndrome
Gout X-ray findings
- preserved joint space
- rat-bitten punched out erosions
- overhanging sclerotic edges
- tophi
- no periarticular osteopenia
Spondyloarthritis disorders
- ankylosing spondyitis
- psoriatic arthritis
- reactive arthritis
- IBD-related arthritis
- undifferentiated spondyloarthritis
Axial features of spondyloarthritis
- inflammatory back pain
- ankylosis of the spine, vertebro-costal and sterno-costal joints
- abnormal posures
- risk of fracture
- sacroilitis
- arthritis of hip and shoulder
Extra-articular features of spondyloarthritidies
- enthesitis
- dactylitis
- acute anterior uveitis
- diarrhoea
- psoriases
- keratoderma blenorrhagicum
Treatment of axial spondyloarhtitis
- NSAIDs
- biologic DMARDs
Treatment of peripheral arthitis of spondyloarthritis
- NSAIDs
- synthetic DMARD
- biologic DMARDs
CASPAR criteria for psoriatic arthritis
An inflammatory articular disease with >3 of:
- psoriasis (current, present, fam Hx)
- typical nail dystrophy
- negative RF
- dactylitis
- juxtaarticular new bone formation
Ophthalmic manifestations of RA
- keratoconjunctivitis sicca
- scleritis and episcleritis
- keratitis
- retinal vasculitis
- scleromalacia
Pulmonary manifestations of RA
- pulmonary nodules
- interstitial lung disease
- pleural effusions
Felty’s syndrome
- neutropenia
- splenomegaly
- leg ulcers
Complications of RA
- accelerated atherosclerosis
- lymphoma
- FMS
- medication-related
BCP crystals
- carbonate-substituted hydroxyapetite
- tricalcium phosphate
- otacalcium phosphate
Associations with BCP deposition disease
- Milwaukee shoulder syndrome
- OA
- calcific tenditiis
- limited SS
- dermatomyositis
- mixed crystal deposition disease
- chronic renal failure
- hypercalcaemia
3 types of idiopathic inflammatory myopathy
- polymyositis
- dermatomyositis
- inclusion body myositis
Management of IIM
- corticosteroids
- immunosuppressive agents
- IVIG
Complications of Raynaud’s phenomenon
- fingertip pits and digital ulcers
- gangrene
- osteomyelitis
- digital amputation
Treatment of pulmonary arterial hypertension in systemic sclerosis
- calcium channel blockers
- endothelin receptor antagonist (bosentan)
- phosphodiesterase 5 inhibitor (sildenafil)
- prostacyclin analogue inhalers
