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HYMS Y5 > RHEUM > Flashcards

RHEUM Flashcards

1
Q

Blood results consistent with polymyalgia rheumatica?

A

CRP + ESR = high

CK + anti-CCP = normal

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2
Q

Antibodies associated with limited cutaneous systemic sclerosis?

A

anti-centromere

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3
Q

Antibodies associated with diffuse cutaneous systemic sclerosis?

A

Anti-Scl-70

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4
Q

Antibodies associated with drug induced lupus?

A

Anti-histone antibodies

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5
Q

What happens to APTT in antiphospholipid syndrome?

A

Prolonged APTT

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6
Q

Spinal XR findings in ankylosing spondylitis?

A

Squaring of lumbar vertebrae
Subchondral erosions
Sclerosis

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7
Q

Management of acute flares of rheumatoid arthritis?

A

PO prednisolone OR IM methylprednisolone

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8
Q

Early XR findings in rheumatoid arthritis?

A

Loss of joint space
Juxta-articular osteoporosis
Soft tissue swellings

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9
Q

Late XR findings in rheumatoid arthritis?

A

Periarticular erosions

Subluxation

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10
Q

What is the only non-inflammatory arthritis?

A

OA.

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11
Q

List 3 seropositive causes of arthritis.

A 
RA
SLE
Scleroderma
Vasculitis'
Sjogren's syndrome
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12
Q

List 3 seronegative causes of arthritis.

A

Psoriatic arthritis
Reactive arthritis
Enteric arthritis
Ankylosing spondylitis.

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13
Q

List the main cause of infective arthritis.

A

Septic arthritis.

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14
Q

List the 2 types of crystal induced arthritis.

A

Gout

Pseudogout

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15
Q

What is meant by the term ‘spondyloarthropathies’?

A

A group of related chronic inflammatory conditions that tend to affect the axial skeleton and have certain shared clinical features.

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16
Q

Name 3 of the spondyloarthropathies.

A

Ankylosing spondylitis
Psoriatic arthritis
Enteric arthritis
Reactive arthritis

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17
Q

Name 3 features that spondyloarthropathies tend to have in common.

A

1) Seronegative
2) HLA27 positive
3) Axial arthritis (spine + sacroiliac joints)
4) Enthesitis (inflammation at tendon/ ligament insertion sites.
5) Dactylitis (inflammation of an entire digit)

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18
Q

List 3 of the extra-articular joint manifestations which can be associated with spondyloarthropathies.

A 
Iritis
Oral ulcers
Psoriaform rashes
IBD
Aortic valce incompetence
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19
Q

In which patients are extra-articular manifestations of rheumatoid arthritis more likely?

A

In those with high titres of RF and anti-CCP as these create abnormal IgG, citrullinated type 2 collagen + vimentin.

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20
Q

Lung manifestations of RA?

A

Pulmonary fibrosis/ bronchiolitis obliterans

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21
Q

Skin manifestations of RA?

A

Rheumatoid nodules

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22
Q

Cardiac manifestations of RA?

A

CVD
IHD
Pericarditis
Pericardial effusion

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23
Q

Eye manifestations of RA?

A

Scleritis
Episcleritis
Cataracts 2o to steroid treatment

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24
Q

MSK manifestations of RA?

A

Carpal tunnel syndrome
Tendon ruptures
Frozen shoulder
De Quervain’s tenosynovitis

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25
Q

What is Felty’s syndrome?

A

RA + neutropenia + splenomegaly.

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26
Q

What is Sicca syndrome?

A

secondary sjogren’s syndrome.

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27
Q

What is Caplan’s syndrome?

A

RA + pulmonary fibrosis + pulmonary nodules.

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28
Q

What is anti-phospholipid syndrome?

A

A disorder associated with anti-phospholipid antibodies where the blood becomes prone to clotting, causing a hypercoaguable state.

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29
Q

Anticardiolipin antibodies?

A

Antiphospholipid syndrome.

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30
Q

Anti-beta-2 glycoprotein I antibodies?

A

Antiphospholipid syndrome

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31
Q

What is systemic sclerosis?

A

An autoimmune inflammatory and fibrotic connective tissue disorder.

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32
Q

What are the 2 types of systemic sclerosis?

A

Limited cutaneous

Diffuse cutaneous

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33
Q

Features of limited cutaneous systemic sclerosis?

A

CREST syndrome:

Calcinosis
Raynaud's phenomenon
Oesophageal dysmotility
Sclerodactyly
Telangiectasia
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34
Q

Features of diffuse cutaneous systemic sclerosis?

A

Features of CREST syndrome PLUS effects on internal organs:

HTN
CAD
Pulmonary HTN
Pulmonary fibrosis
Glomerulonephritis
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35
Q

What is Sjogren’s syndrome?

A

An autoimmune condition affecting exocrine glands + leading to symptoms of dry mucous membranes (eyes, mouth, vagina).

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36
Q

What is primary Sjogren’s syndrome?

A

Occurs in isolation.

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37
Q

What is secondary Sjogren’s syndrome?

A

Occurs secondary to another disease (SLE or RA).

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38
Q

Anti-Ro + Anti-La antibodies?

A

Sjogren’s syndrome.

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39
Q

Special test for Sjogren’s syndrome?

A

Schirmer test (if <10mm = significant).

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40
Q

What is polymyositis?

A

Chronic inflammation of the muscles.

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41
Q

What is dermatomyositis?

A

Chronic inflammation of the skin + muscles.

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42
Q

Diagnostic investigation for polymyositis/ dermatomyositis?

A

CK (often >1000).

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43
Q

Anti-Jo-1 antibodies?

A

Polymyositis (sometimes dermatomyositis).

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44
Q

Anti-Mi-2 antibodies?

A

Dermatomyositis

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45
Q

Dermatomyositis antibodies?

A

Anti-Mi-2

ANA

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46
Q

What is vasculitis?

A

Inflammatory disorders for the blood vessels characterised based upon the size of the blood vessels that they affect.

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47
Q

List 3 small vessel vasculitis’.

A

Henoch-Schonlein Purpura
Eosinophilic granulomatosis with polyangiitis
Microscopic polyangiitis
Granulomatosis with polyangiitis

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48
Q

List 3 medium vessel vasculitis’.

A

Polyarteritis nodosa.
Eosinophilic granulomatosis with polyangiitis.
Kawasaki disease.

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49
Q

List 2 large vessel vasculitis’.

A

GCA

Takayasu’s arteritis.

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50
Q

ESR + CRP in vasculitis.

A

Elevated.

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51
Q

pANCA associated vasculitis’?

A

Microscopic polyangiitis.

Eosinophilic polyangiitis with granulomatosis.

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52
Q

cANCA associated vasculitis’?

A

Granulomatosis with polyangiitis.

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53
Q

What is Marfan’s syndrome?

A

Autosomal dominant connective tissue disorder.

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54
Q

Where is the defect in Marfan’s syndrome?

A

On the gene coding for fibrillar 1.

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55
Q

Renal failure ± SOB ± haemoptysis?

A

Microscopic polyangiitis.

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56
Q

Enteric arthritis is associated with what conditions?

A

IBD
GI bypass surgery
Coeliac disease.

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57
Q

When does enteric arthritis usually improve?

A

Upon treatment of the underlying bowel disease.

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58
Q

What can be used for resistant cases of enteric arthritis?

A

DMARDs.

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59
Q

Define osteoarthritis.

A

Non-inflammatory arthritis described as ‘wear and tear’ within synovial joints.

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60
Q

Most common aetiology of OA.

A

Genetic factors + overuse + injury.

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61
Q

3 causes of secondary OA.

A 
Joint disease
Obesity
Occupation
Injury
Haemochromatosis
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62
Q

5 risk factors for development of OA.

A 
Increasing age
Obesity
Female sex
Certain occupations
Trauma/ injury
Exercise stresses
Joint misalignment
Joint laxity
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63
Q

Joints most common affected by OA.

A

Hips, knees, small joints of hands.

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64
Q

5 general features of OA?

A

1) Joint pain + stiffness worsened by activity.
2) Deformity, swelling + reduced function/ ROM.
3) Asymmetrical distribution across joints.
4) Gelling of joints after rest.
5) Background ache in joint at rest.
6) Instability.
7) Warmth + tenderness if synovitis.
8) Pain ± crepitus on movement.

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65
Q

Which parts of the hands are commonly affected by OA?

A

Carpals
DIPJs
PIPJs
Thumb MCP joint

**NOTE: other MCPs are not involved.

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66
Q

Signs of OA on the hands?

A

1) Squaring at base of thumb.
2) Bouchard’s nodes at PIPJs.
3) Heberden’s nodes at DIPJs.
4) Mucoid cysts adjacent to joint on dorsal surface (can cause nail ridging).

**Potential wasting of thenar muscles.

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67
Q

How is OA pain in the hands typically exacerbated?

A

Pinching/ strong grip actions.

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68
Q

Where will the pain be in OA of the hip?

A

Deep pain in anterior groin on walking/ climbing stairs.

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69
Q

Where is pain referred to in OA of the hip?

A

Lateral thigh + buttock

Anterior thigh + knee.

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70
Q

Movement most affected by OA of the hip?

A

Internal rotation with hip flexion.

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71
Q

Features of advanced OA in the hip?

A

Trendelenberg gait.

Fixed flexion external rotation deformity.

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72
Q

What would suggest patellofemoral involvement in OA of the knee?

A

Pain worse on walking upstairs and even more so on walking downstairs.

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73
Q

When can diagnosis of OA be clinical?

A

If patient is >45, has typical activity related pain + no morning stiffness is present.

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74
Q

Bedside investigations for OA?

A

History
Examination
Weight + BMI

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75
Q

Blood investigations for OA?

A

CRP can be slightly elevated.

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76
Q

Imaging investigations for OA?

A

Plain XR if diagnostic uncertainty/ to exclude other diagnoses.

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77
Q

Signs of OA seen on XR?

A 
Loss of joint space
Osteophyte formation
Subarticular sclerosis (increased density of bone along joint line)
Subchondral cysts (fluid filled holes in bone)
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78
Q

Conservative management of OA?

A 
Education
Weight loss
Physiotherapy to improve surrounding muscle strength
Local heat/ cold packs
Occupational therapy
Orthotics
79
Q

Medical management of OA?

A

1st = regular paracetamol + topical NSAID/ topical capsaicin.

2nd = regular paracetamol + oral NSAID (+PPI)

3rd = weak opioid adjunct

4th = intra-articular steroid injection.

80
Q

Surgical management of OA?

A

Joint replacement in severe cases

OR

Arthroscopic lavage + debridement if history of locking.

81
Q

Define rheumatoid arthritis.

A

Autoimmune condition causing a chronic systemic inflammatory disease characterised by a symmetrical, deforming + peripheral polyarthritis.

82
Q

Peak onset of rheumatoid arthritis?

A

Age 30-50

83
Q

Who is RA more common in?

A

3x more common in women.

84
Q

Aetiology of RA?

A

Autoimmune process caused by the presence of a predisposing gene + environmental trigger (smoking/ specific pathogen).

85
Q

Predisposing gene present in RA?

A

HLADR4 and/or HLADR1

86
Q

Typical clinical picture of patients with RA?

A

A distal, symmetrical poly arthritis ± inflammation of tendons and bursa.

87
Q

Joints affected by RA?

A

Wrists, ankles, MCP + PIP joints are main ones

**Can affect any synovial joint though.

88
Q

Onset of RA?

A

Rapid + overnight

OR

Over months to years

OR palindromic

89
Q

3 typical symptoms of RA?

A

Pain, swelling + stiffness in small joints of hands + feet.

90
Q

When is pain worse in RA?

A

Worse at rest + during periods of inactivity.

91
Q

Description of the feeling of joints in RA?

A

Swelling causes a boggy sensation around joints.

92
Q

Describe the pattern of joint stiffness in patients with RA?

A

Early morning stiffness lasting <1 hour.

93
Q

Associated symptoms of rheumatoid arthritis?

A

Fatigue
Weight loss
Flu-like symptoms
Muscle aches + weakness

94
Q

5 signs seen on examination of a patient with rheumatoid arthritis in the hands?

A

1) Positive MCP/MTP joint squeeze test.
2) Ulnar deviation of wrists + fingers.
3) Volar subluxation of wrists + fingers.
4) Z-deformity of thumb.
5) Boutonnière deformity
6) Swan neck deformity

95
Q

Risk factors for RA?

A 
Increasing age
Smoking
HLADR4/1 genes
FHx
Female sex
96
Q

Blood investigations in RA?

A 
FBC
U&Es
LFTs
RF
Anti-CCP
CRP + ESR
97
Q

Imaging investigations in RA?

A

Plain XR of hands + feet - to determine disease severity.

USS/MRI to confirm and evaluate synovitis (have a greater sensitivity for detecting bony erosions).

98
Q

XR findings in patients with RA?

A

Soft tissue swelling
Juxta-articular osteopenia
Decreased joint space
Erosion of bone/ subluxation

99
Q

How is RA diagnosis made?

A

Clinical diagnosis based upon American college of rheumatology criteria.

100
Q

Criteria for RA diagnosis according to American college of rheumatology?

A

1) Joints involved (more points for higher numbers and smaller joints involved)
2) Serology (RF + anti-CCP)
3) Inflammatory markers (ESR+CRP)
4) Duration of symptoms (>/< 6 weeks)

**A score of 6 or more indicates RA.

101
Q

Why is it important to start treatment for RA ASAP?

A

Early treatment is associated with better outcomes.

102
Q

What scoring system + blood test can be used to measure RA disease activity?

A

DAS28 score + CRP.

103
Q

Which questionnaire measures functional ability in RA?

A

Health assessment questionnaire (HAQ)

104
Q

What is the general aim of management for RA?

A

To induce remission and to maintain remission through the minimal effective dose.

105
Q

Medical management of RA?

A

1st line = methotrexate/ sulfasalazine/ leflunomide.

2nd line = dual therapy with 2 of above.

3rd line = methotrexate + TNF-inhibitor (adalimumab/ infliximab/ enteracept).

4th line = methotrexate + rituximab.

106
Q

Surgical management of RA?

A

Used for very severe deformities

**Not often needed now due to early initiation of DMARDs.

107
Q

What should be prescribed alongside methotrexate?

A

5mg Folic acid

108
Q

2 important side effects of methotrexate?

A

Pulmonary fibrosis

Teratogenicity in pregnancy

109
Q

Which DMARDs are safe to use in pregnancy?

A

Sulfasalzaine (+5mg folic acid)

Hydroxychloroquine

110
Q

Main adverse effect of hydroxychloroquine?

A

Reduced visual acuity (macular toxicity).

111
Q

List 3 poor prognostic features of rheumatoid arthritis.

A

1) Younger onset.
2) Male.
3) Greater number of joints/organs affected.
4) Presence of RF and anti-CCP antibodies.
5) Erosions seen on XR.

112
Q

Why do women who are pregnant experience an improvement in RA symptoms?

A

Due to the higher natural production of steroids.

113
Q

What treatment should be offered in primary care for RA whilst the patient is waiting for a specialist appointment?

A

NSAIDs (+PPI)

114
Q

When should hydroxychloroquine be considered as mono therapy management in a patient with RA?

A

If they have very mild or palindromic disease.

115
Q

Define psoriatic arthritis.

A

A seronegative inflammatory arthritis associated with psoriasis.

116
Q

What percentage of people with psoriasis are affected by psoriatic arthritis?

A

10-20%.

117
Q

How long after skin psoriasis development does psoriatic arthritis occur?

A

psoriatic arthritis tends to develop 5-10 years after skin psoriasis.

118
Q

What percentage of people develop psoriatic arthritis but do not develop skin arthritis?

A

20% of those with psoriatic arthritis do not develop skin psoriasis.

119
Q

3 associations of psoriatic arthritis?

A 
Metabolic syndrome
CVD
IBD
Anxiety
Depression
120
Q

3 different patterns of psoriatic arthropathy?

A

Symmetrical poly arthritis
Asymmetrical pauciarthritis
Spondylitic pattern
Arthritis mutilans

121
Q

Which joints in symmetrical psoriatic poly arthritis are affected?

A

Similar to RA.

Hands, wrists, ankles + DIPJs.

MCPs less commonly affected.

**More common in women

122
Q

Which areas are affected by asymmetrical pauciarthritis?

A

Mainly digits and feet.

123
Q

How does spondylitic psoriatic arthritis present?

A

Back stiffness
Sacroiliitis
Atlanto-axial joint involvement

**More common in men

124
Q

What is arthritis mutilans?

A

Very rare form of arthritis causing complete joint destruction in phalanxes.

125
Q

What sign is seen in arthritis mutilans?

A

Telescopic finger (complete joint destruction in phalanxes)

126
Q

5 features of psoriatic arthritis?

A 
Psoriatic places on skin
Dactylitis
Night-time axial pain
Enthesitis
Acneiform rashes/ palmo-plantar pustulosos
Anterior uveitis
Aortitis
127
Q

3 nail changes seen in patients with psoriatic arthritis?

A

Pitting
Onycholysis
Subungual hyperkeratosis

128
Q

Bedside test used to screen for psoriatic arthritis?

A

Psoriasis epidemiological screening tool (PEST)

129
Q

Blood results seen in psoriatic arthritis?

A

RF + CCP commonly negative

CRP + ESR raised

130
Q

Bony changes seen on plain XRs in patients with psoriatic arthritis?

A 
Pencil in cup deformity
Erosive changes (osteolysis)
Ankylosis
Periostitis
Dactylitis
131
Q

Management used for psoriatic arthritis?

A

NSAIDs for pain
DMARDs (methotrexate/ sulfasalazine/ leflunomide)
Anti-TNF biologics

LAST LINE = ustekinumab (targets IL-12 + IL-23).

132
Q

What is the pencil in cup deformity?

A

Central erosions of the bone adjacent to the joint.

133
Q

Define reactive arthritis.

A

A condition where synovitis occurs in the joints as a reaction to a recent infective trigger.

134
Q

Causes of reactive arthritis?

A

Infection.

Normall GI, GU or STIs.

135
Q

Most common cause of reactive arthritis?

A

Chlamydia.

136
Q

What joint condition does gonorrhoea commonly cause?

A

A gonococcal septic arthritis.

137
Q

Reactive arthritis is associated with what gene?

A

HLAB27.

138
Q

Clinical features of reactive arthritis?

A

Acute monoarthritis affecting single joint in LL (commonly knee).

Joint tends to be warm, swollen + painful.

139
Q

Extra-articular features of reactive arthritis?

A

Bilateral conjunctivitis
Anterior uveitis
Circinate balantitis
Urethritis

140
Q

Way of remembering symptoms of reactive arthritis?

A

Can’t see
Can’t pee
Can’t stand on your knee

141
Q

Reactive arthritis differentials?

A

Gout
Septic arthritis
Pseudogout

142
Q

Bedside investigations for reactive arthritis?

A

Sexual health review.

143
Q

Blood investigations for reactive arthritis?

A

ESR + CRP (elevated)

Infectious serology

144
Q

Imaging investigations for reactive arthritis?

A

Plain XR may show enthesitis.

145
Q

Special investigations for reactive arthritis?

A

1) Stool culture if patient has diarrhoea.

2) Joint aspiration (gram staining, culture, sensitivity, crystal examination).

146
Q

Initial management of reactive arthritis?

A

Treat according to ‘hot joint’ policy:

1) Empirical antibiotics until septic arthritis excluded.
2) Aspirate joint for gram staining, culture, sensitivity + crystal examination.

147
Q

Further management of reactive arthritis?

**After septic arthritis has been excluded.

A

1) NSAIDs/ local steroid injections
2) Splint affected joints
3) Systemic steroids if multiple joints implicated.

148
Q

Management of reactive arthritis if persisting for >6 months?

A

1) DMARDs (methotrexate or sulfasalazine)

2) Anti-TNF biologics

149
Q

Oral ulcers + genital ulcers + anterior uveitis = ?

A

Bechet’s disease.

150
Q

Define ankylosing spondylitis.

A

A seronegative inflammatory condition mainly affecting the spine + SI joints, causing progressive stiffness and pain.

151
Q

Risk factors for ankylosing spondylitis?

A

HLAB27 gene

First degree family member affected.

152
Q

Typical presentation of ankylosing spondylitis?

A

Young man with gradual onset lower back pain that is worse during the night, stiff in the morning and relieved by exercise.

153
Q

What does ankylosing spondylitis cause?

A

Progressive loss of spinal movements in all directions (incl. decreased thoracic expansion).

154
Q

What posture is caused by ankylosing spondylitis?

A

Question mark posture.

**Kyphosis + neck hyperextension.

155
Q

Systemic symptoms of ankylosing spondylitis?

A

Weight loss + fatigue.

156
Q

Conditions associated with ankylosing spondylitis?

A 
Apical fibrosis
Anterior uveitis
Achilles tendonitis
Aortic regurgitation
AV node block
Amyloidosis
157
Q

Why is heart block associated with ankylosing spondylitis?

A

Due to fibrosis of the heart’s conductive system.

158
Q

How is ankylosing spondylitis diagnosed?

A

Diagnosis is clinical + supported by imaging.

159
Q

What specialist bedside test is used for ankylosing spondylitis?

A

Schober’s test

**distance of <20cm indicates lumbar restriction.

160
Q

Positive blood findings in ankylosing spondylitis?

A

FBC (normocytic anaemia)
ESR + CRP raised
HLAB27 positive

161
Q

1st line imaging in ankylosing spondylitis?

A

Plain XR spine + sacrum.

162
Q

XR findings suggesting ankylosing spondylitis?

A

Squaring of vertebral bodies
Subchondral sclerosis + erosions
Syndesmophytes

163
Q

What would an MRI show in ankylosing spondylitis?

A

Bone marrow oedema + destructive changes.

164
Q

Why are DEXA scans done in patients with ankylosing spondylitis?

A

Due to an increased risk of vertebral wedge fractures.

165
Q

Conservative management of ankylosing spondylitis?

A

Exercise, PT, smoking cessation.

166
Q

Medical management of ankylosing spondylitis?

A

1st line = NSAIDs
2nd line = TNF alpha blockers (adalimumab, intercept)
3rd line = Secukinumab.

**Acute flare Rx = corticosteroids.

**Bisphosphonates after DEXA if required.

167
Q

When might surgery be indicated for patients with ankylosing spondylitis?

A

If there are deformities of the spine or other joints.

168
Q

3 poor prognostic indicators in patients with ankylosing spondylitis?

A

ESR >30
Onset <16
Early hip involvement
Poor response to NSAIDs

169
Q

Most common cause of septic arthritis?

A

Staphylococcus Aureus

170
Q

Risk factors for septic arthritis?

A 
Pre-existing joint disease (RA)
DM
Immunosuppression
Chronic renal failure
Recent joint surgery
Prosthetic joints
IVDU
Age >80
171
Q

Clinical features of septic arthritis?

A 
Suspect in ANY inflamed joint
Single joint affected
Rapid onset of hot, red, swollen + painful joint
Stiffness and reduced ROM
Systemic symptoms
172
Q

XR findings in septic arthritis?

A

NAD

173
Q

Which patients with ?septic arthritis should be referred urgently to orthopaedics?

A

Patients with suspected septic arthritis in a prosthetic joint.

174
Q

Risk factors for gout?

A 
Male sex 
Obesity
Hyperuricaemia
High purine diet (meat, seafood)
Alcool
Diuretics
CVD
Kidney disease
175
Q

Potential XR findings in gout?

A

Often normal
Non-specific tissue swelling
Sibchondral cysts
Punched out lesions

176
Q

How is gout diagnosed?

A

Clinical diagnosis ± joint aspiration findings.

177
Q

Conservative gout management?

A 
Rest + limb elevation
Avoidance of trauma
Exposure of joint in cool environment
Ice packs 
Bed cage
Lifestyle measures (weight loss, exercise, reduce alcohol intake, increase fluid intake)
178
Q

Acute medical management of gout?

A

1st line = NSAIDs
2nd line = Colcichine (1st line if renal failure or heart disease)
3rd line = corticosteroids/ IM injection of corticosteroids.

179
Q

Prophylactic medical management of gout?

A

1st line = allopurinol

2nd line = Febuxostat

180
Q

Monitoring requirements in patients taking gout prophylaxis?

A

Serum uric acid level and renal function every 4 weeks at crate lowering therapy initiation.

**Once uric acid is in target range, check annually.

181
Q

Crystals found in gout?

A

Negatively birefringent
Needle shaped
Monosodium urate crystals

182
Q

Crystals found in pseudo gout?

A

Positively birefringent
Rhomboid shaped
Calcium pyrophosphate crystals

183
Q

XR findings in patients with pseudo gout?

A

Chondrocalcinosis is pathognomonic

Other XR changes may be similar to those in OA.

184
Q

Management of pseudo gout?

A

Cool packs + rest
NSAIDs + PPI ± colcichine/ corticosteroids
Joint aspiration/ washout if severe

185
Q

Define polymyalgia rheumatica.

A

An inflammatory condition that causes pain + stiffness in the shoulders, pelvic girdle and neck.

186
Q

Clinical features of polymyalgia rheumatica?

A

Bilateral shoulder pain that can radiate to the elbows.
Bilateral pelvic girdle pain.
Pain worse on movement + interferes with sleep.
Stiffness for at least 45 minutes in the mornings.

**NOTE: weakness is not a feature in polymyalgia rheumatica.

187
Q

Positive investigations in polymyalgia rheumatica?

A

CRP, ESR + Plasma viscosity normally high.

188
Q

How is polymyalgia rheumatica diagnosed?

A

Symptoms present for at least 2 weeks.
70% improvement in symptoms after 3-4 weeks steroid treatment.
Inflammatory markers return to normal after 3-4 weeks steroid treatments.

189
Q

Define systemic lupus erythematous.

A

Inflammatory autoimmune connective tissue disease causing chronic inflammation and subsequent tissue damage.

190
Q

Pathophysiology of SLE?

A

Anti-nuclear antibodies attack proteins within cell nuclei, generating an immune response.

191
Q

Which antibodies are present in SLE?

A

ANA (sensitive)
Anti-dsDNA (specific)
Anti-Smith (highly specific)

192
Q

Diagnostic criteria used for SLE?

A

SLICC/ ACR criteria

**Involve presence of ANA plus presence of a certain number of clinical features.

193
Q

Antibodies present in drug-induced lupus?

A

Anti-histone antibodies.

HYMS Y5 (11 decks)

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