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Rheum Flashcards

1
Q

What is ankylosing spondylitis(AS)

A

Inflammatory condition mainly affecting the spine that causes progressive stiffness and pain

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2
Q

Conditions associated with HLA B27 gene

A

Seronegative spondyloarthropathy to include reactive arthritis and psoriatic arthritis

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3
Q

Key joints affected in AS

A

Sacroiliac joints

Joints of the vertebral column

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4
Q

Presentation of AS

A

Gradual symptoms
Lower back pain and stiffness and sacroiliac pain
Worse with rest and improves with movement
Worse at night and in the morning

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5
Q

Key complication of AS

A

Vertebral fractures

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6
Q

Conditions associated with AS

A

Systemic symptoms such as weight loss and fatigue
Chest pain(costovertebral joints affected)
Ethesitis
Anaemia
Anterior uveitis
IBD

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7
Q

Test used to support diagnosis of AS

A

Schober’s test

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8
Q

IX for AS

A

CRP and ESR
HLA B27
Spine X-ray and sacrum
MRI

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9
Q

What might MRI of spine show in AS

A

Bone marrow oedema early in the disease

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10
Q

X-ray features of AS

A 
Squaring of vertebral bodies 
Subchondral sclerosis and erosions 
Syndesmophytes 
Joints/ligaments ossification 
Fusion of facet, sacroiliac and costovertebral joints
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11
Q

Mx of AS

A

NSAIDs
Steroids for flares
Anti-TNF meds(etanercept)
Monoclonal antibodies

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12
Q

General mx of AS outside NSAIDs and steroids

A 
Physio 
Exercise 
Smoking cessation 
Bisphosphonates 
Treatment of complications 
Surgery occasionally
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13
Q

What is rheumatoid arthritis(RA)?

A

Rheumatoid arthritis is an autoimmune condition that causes chronic inflammation of the synovial lining of the joints, tendon sheaths and bursa

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14
Q

RA genetic associations

A

HLA DR4

HLA DR1

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15
Q

Antibodies present in RA

A

Rheumatoid factor

Anti-ccp(sensitive to RA)

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16
Q

Presentation of RA

A

Symmetrical distal polyarthropathy

Pain 
Swelling 
Stiffness 
Fatigue 
Weight loss
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17
Q

Joints affected by RA

A

MCP and PIP joints in the hands

Can also present with larger joints affected such as the knees, shoulders and elbows.

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18
Q

What is palindromic rheumatism

A

involves self limiting short episodes of inflammatory arthritis with joint pain, stiffness and swelling typically affecting only a few joints.
The episodes only last 1-2 days and then completely resolve

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19
Q

What is atlantoaxial subluxation

A

The axis (C2) and the odontoid peg shift within the atlas (C1). This is caused by local synovitis and damage to the ligaments and bursa around the odontoid peg of the axis and the atlas.

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20
Q

What can atlantoaxial subluxation lead to

A

SCC

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21
Q

Signs of RA in the arthritis

A

Z shaped deformity to the thumb
Swan neck deformity (hyperextended PIP with flexed DIP)

Boutonnieres deformity (hyperextended DIP with flexed PIP)
Ulnar deviation of the fingers at the knuckle (MCP joints)
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22
Q

What is boutonnieres deformity due to

A

Is due to a tear in the central slip of the extensor components of the fingers

In RA

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23
Q

Extra-articular manifestations of RA

A 
Pulmonary fibrosis 
Bronchiolitis obliterans 
Felty's syndrome 
Secondary sjogren's syndrome 
Anaemia of chronic disease
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24
Q

Wrist syndrome associated with RA

A

Carpel tunnel syndrome

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25
Eye manifestations of RA
Episcleritis and scleritis
26
IX in RA
Rf anti-CCP CRP and ESR X-rays
27
X-ray changes in RA
Joint destruction and deformity Soft tissue swelling Periarticular osteopenia Boney erosions
28
Scoring system used to assess RA
DAS28 - swollen joints, tender joints, ESR/CRP result Useful in monitoring disease activity and response to treatment Also HAQ questionnaire to assess response to treatment
29
Factors causing worse prognosis in RA
``` Younger onset Male More joints and organs affected Presence of RF and anti-CCP Erosions seen on xray ```
30
Mx of RA
Steroids | NSAIDs/COX-2 inhibitors
31
NICE advice for DMARDs in RA
1st - Methotrexate, leflunomide or sulfasalazine 2nd - 2 of above in combo 3rd - Addition of TNF inhibitor(adalimumab)
32
What is co-prescribed with methotrexate
Folic acid 5mg
33
Notable side effects of methotrexate
``` Mouth ulcers and mucositis Liver toxicity Pulmonary fibrosis Bone marrow suppression and leukopenia Teratogenic ```
34
Notable side effects of leflunomide
Peripheral neuropathy Teratogenic HTN
35
Notable side effects of sulfasalazine
Temporary male infertility (reduced sperm count) | Bone marrow suppression
36
Notable side effects of anti-TNF drugs
Vulnerability to severe infections and sepsis | Reactivation of TB and hepatitis B
37
Notable side effects of hydroxychloroquine
Nightmares and reduced visual acuity
38
Notable side effects of rituximab
Night sweats and thrombocytopenia
39
What type of hypersensitivity reaction is SLE
Type 3 hypersensitivity reaction
40
Most common disease course in SLE
It often takes a relapsing-remitting course, with flares and periods where symptoms are improved.
41
SLE presentation
``` Fatigue Weight loss Arthralgia Myalgia SOB Raynaud's phenomenon Mouth ulcers ```
42
Type of rash associated with SLE
Photosensitive malar rash. This is a “butterfly” shaped rash across the nose and cheek bones that gets worse with sunlight.
43
IX in SLE
``` Autoantibodies FBC(normocytic anaemia) CRP and ESR Immunoglobulins Urinalysis and urine protein-creatinine ratio ```
44
Autoantibodies present in SLE
Anti-nuclear antibodies(ANA) Anti-double stranded DNA(anti-dsDNA) - specific
45
Criteria for diagnosis of SLE
SLICC Criteria or the ACR Criteria for establishing a diagnosis involves confirming the presence of antinuclear antibodies and establishing a certain number of clinical features suggestive of SLE
46
CVS complications of SLE
Cardiovascular disease - HTN, CAD Pericarditis
47
Complications of SLE
``` Infection Anaemia of chronic disease Interstitial lung disease Lupus nephritis Recurrent miscarriage VTE ```
48
1st line treatments for SLE
NSAIDs Steroids (prednisolone) Hydroxychloroquine (first line for mild SLE) Suncream and sun avoidance for the photosensitive the malar rash
49
Options for SLE mx if first line haven't worked
Rituximab is a monoclonal antibody that targets the CD20 protein on the surface of B cells Belimumab is a monoclonal antibody that targets B-cell activating factor
50
Most common causes of drug-induced lupus
Procainamide | Hydralazine
51
Adverse effects of hydroxycholroquine
Bull's eye retinopathy
52
Crystals present in pseudo gout
Crystal arthropathy caused by calcium pyrophosphate crystals - AKA chonedrocalcinosis
53
Presentation of pseudogout
Hot swollen stiff painful joint - knee, shoulders, wrists and hips Can affect multiple joints Can be asymptomatic
54
What does aspirated fluid show in CPPD
No bacterial growth Calcium pyrophosphate crystals Rhomboid shaped crystals Positive birefringent of polarised light
55
How does pseudo gout appear on x-ray
Chondrocalcinosis - It appears as a thin white line in the middle of the joint space caused by the calcium deposition Also LOSS L – Loss of joint space O – Osteophytes S – Subarticular sclerosis S – Subchondral cysts
56
Mx of CPPD
``` NSAIDs Colchicine Joint aspiration Steroid injections Oral steroids ``` Joint washout(arthrocentesis) in severe cases
57
What is discoid lupus
Discoid lupus erythematosus is a non-cancerous chronic skin condition. It is more common in women and usually presents in young adults between ages 20 to 40.
58
Populations in which discoid lupus is more likely
It is more common in darker-skinned patients and smokers.
59
What is discoid lupus associated with
It is associated with an increased risk of developing systemic lupus erythematosus, however this risk is still below 5%. Rarely the lesions can progress to squamous cell carcinoma (SCC) of the skin.
60
Presentation of discoid lupus
The lesions typically occur on the face, ears and scalp. They are photosensitive, meaning that they are made worse by exposure to sunlight. They are associated with scarring alopecia (hair loss in affected areas that does not grow back) and hyper-pigmented or hypo-pigmented scars.
61
Appearance of discoid lupus
``` Inflamed Dry Erythematous Patchy Crusty and scaling ```
62
Diagnosis of discoid lupus
Skin biopsy to confirm diagnosis
63
Mx of discoid lupus
Sun protection Topical steroids Intralesional steroid injections Hydroxychloroquine
64
Patterns of psoriatic arthritis
Symmetrical polyarthritis Asymmetrical pauciarthritis Spondylitic pattern
65
Signs of psoriatic arthritis
Plaques of psoriasis on the skin Pitting of the nails Onycholysis (separation of the nail from the nail bed) Dactylitis (inflammation of the full finger) Enthesitis
66
Psoriatic arthritis associations
``` Eye disease (conjunctivitis and anterior uveitis) Aortitis (inflammation of the aorta) Amyloidosis ```
67
Screening tool for psoriatic arthritis
PEST tool - high score --> rheum referral
68
xray changes in psoriatic arthritis x-rays
``` Periostitis Anklyosis Osteolysis Dactylitis Pencil-in-cup appearance ```
69
What is arthritis mutilans
most severe form of psoriatic arthritis. This occurs in the phalanxes. There is osteolysis (destruction) of the bones around the joints in the digits. This leads to progressive shortening of the digit. The skin then folds as the digit shortens giving an appearance that is often called a “telescopic finger”.
70
Mx of arthritis arthritis mutilans
NSAIDs for pain DMARDS (methotrexate, leflunomide or sulfasalazine) Anti-TNF medications (etanercept, infliximab or adalimumab) Ustekinumab is last line (after anti-TNF medications) and is a monoclonal antibody that targets interleukin 12 and 23
71
Most common cause of reactive arthritis
Chalmydia | Gonorrhea commonly causes gonococcal septic arthritis
72
Reactive arthritis associations
Bilateral conjunctivitis (non-infective) Anterior uveitis Circinate balanitis is dermatitis of the head of the penis Can't see, pee or climb a tree
73
Mx of reactive arthritis
NSAIDs Steroid injections into the affected joints Systemic steroids may be required, particularly where multiple joints are affected DMARDs or anti-TNF meds for recurrent cases
74
Auto-antibodies present in systemic sclerosis
ANA Anti-centromere in limited cutaneous systemic sclerosis Anti-scl-70 antibodies in diffuse cutaneous systemic sclerosis
75
Specific examination technique for systemic sclerosis
Nailfold capillaroscopy
76
Mx of systemic sclerosis
MDT Steroids Immunosuppressants
77
Non-med mx of systemic sclerosis
Avoid smoking Gentle skin stretching to maintain the range of motion Regular emollients Avoiding cold triggers for Raynaud’s Physiotherapy to maintain healthy joints Occupational therapy for adaptations to daily living to cope with limitations
78
Medical mx of systemic sclerosis
Nifedipine can be used to treat symptoms of Raynaud’s phenomenon Anti acid medications (e.g. PPIs) and pro-motility medications (e.g. metoclopramide) for gastrointestinal symptoms Analgesia Antibiotics Antihypertensives Treatment of pulmonary artery hypertension Supportive management of pulmonary fibrosis

General practice (26 decks)

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