RHEUM Flashcards
pANCA main target
myleoperoxidase
anti nuclear antibodies (ANA)- what condition
dermatomyositis
Dermatomyositis treatment
predisolone
pANCA and cANCA
(p)ANCA - (C)hurg-Strauss.
(c)ANCA - G(P)A.
wrong way round
Treatment termporal arteritis
ASAP prednisolone glucocorticoid
- even before temporal aa biopsy
SLE affects fetus in pregnancy?
causes fetal bradycardia
how to take bisphosphonates
take 30 mins before food and sit up for 30 mins after
old man, bone pain, raised ALP=== what condition?
pagets disease
anti ro- which condition
SLE
Marfan syndrome affected gene
fibrillin
low calcium
low phosphate
raised ALP and raised PTH
osteomalacia
CFs
widespread bone pain, proximal myopathy
golimumab=?MOA
TNF ALPHA antagonist
tumour necrosis factor alpha
MABS= type of TNF inhibitor
anti tnf meds= (4)
I AGE
infliximab, adalimumab, golimumab, etaercept
bulls eye retinopathy with which type of DMARD ?
hydroxychloriquine
most common cause of gout ?
decreased renal excretion of uric acid
Lesch-Nyhan syndrome
Lesch-Nyhan syndrome
hypoxanthine-guanine phosphoribosyl transferase (HGPRTase) deficiency
x-linked recessive therefore only seen in boys
features: gout, renal failure, neurological deficits, learning difficulties, self-mutilation
drug induced lupus– HOW is it different to normal SLE
renal and neuro symptoms unlikely
DEXA SCAN INTERP:
t and z sore
T score: based on bone mass of young reference population – GENERAL
T score of -1.0 means bone mass of one standard deviation below that of young reference population
Z score is adjusted for age, gender and ethnic factors
T score
> -1.0 = normal
-1.0 to -2.5 = osteopaenia
< -2.5 = osteoporosis
T-score of - 2.5 SD or below
BUT GIVE oral bisphosphonate whilst waiting for DEXA scan
reactive arthritis management
NSAIDS
INTRA ART STEROIDS
hydroxychloriquine affect eyes
severe or perm RETINOPATHY- flashes, floaters
PREDISPOSITIONs of pseudogout
Positively bifringent rhomboid crystals
haemochromatosis
hyperparathyroidism
low magnesium, low phosphate
acromegaly, Wilson’s disease
DOUBLE CONTOUR sign
Urinary hydroxyproline - Paget’s disease of bone.
Urinary porphobilinogen - acute intermittent porphyria
Urinary uroporphyrin - porphyria cutanea tarda
Urinary coproporphyrin - Dubin-Johnson syndrome
Urinary hydroxyproline - Paget’s disease of bone.
Urinary porphobilinogen - acute intermittent porphyria
Urinary uroporphyrin - porphyria cutanea tarda
Urinary coproporphyrin - Dubin-Johnson syndrome
what type of cell secretes TNF
macrophages
OA features LOSS
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis
periarticular osteopenia specific to ?
RA
polyarteritis nodosa
cfs
antibody
CANCA
medium vasculitis
ass’d with hep b and middle aged men
mononeuritis multiplex= multiple nerve trunks affected
allergic to aspirin may also be allergic to ?
sulfasalzine
azathioprine in pregnancy and breasfteeding
safe to use
, mesalazine and sulfasalazine (with folic acid)
treatment raynauds
first line- nifedipine
if this CI or not tolerated;
IV prostacyclin
first XR finding on ANK SPON
syndesmophytes= first sign
late sign= bamboo spine
bradycardia heart block newborn from mum with sle
anti ro
early onset SLE assd with def in what complement
C4
all lab criteria to diagnose antiphospholipid syndrome:
need to be twice at least 12 weeks apart
familial mediterranean fever
aut rec
turkish armenian arabic
Features - attacks typically last 1-3 days
pyrexia
abdominal pain (due to peritonitis)
pleurisy
pericarditis
arthritis
erysipeloid rash on lower limbs
Management
colchicine may help
RANK ligand inhibitor eg
denosumab
complications of pagets
Complications
deafness (cranial nerve entrapment)
bone sarcoma (1% if affected for > 10 years)
fractures
skull thickening
high-output cardiac failure
mycophenolate mofetil MOA
Inosine-5’-monophosphate dehydrogenase inhibitor
SLE treatment
hydroxyhloriquine
which DMARD is safe in pregnancy anc breastfeeding
sulfasalazine
stills disease
Features
arthralgia
elevated serum ferritin
rash: salmon-pink, maculopapular
pyrexia
typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash
lymphadenopathy
rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative
Management
NSAIDs should be trialled for at least a week before steroids are added.
steroids
if symptoms persist, the use of methotrexate, IL-1 or anti-TNF therapy can be considered
ANAKINRA= IL1
bisphosphonates moa
inhibit osteoclasts
syndesmophytes in ANK SPON = ?
Syndesmophytes (ossification of outer fibres of annulus fibrosus) are a feature of ankylosing spondylitis
is RF usually positive or negative in stills disease
negative RF
widening of the wrist joints due to an excess of non-mineralized osteoid at the growth plate
===?
rickets
marfan syndrome chr affected
cfs
defect in what/???
A defect of the glycoprotein structure which usually wraps around elastin= fibrillin
chr 15
common bowel problem in systemic sclerosis
bacterial overgrowth
homogentisic acid in urine = ?
Alkaptonuria (ochronosis) autosomal recessive disorder of phenylalanine and tyrosine metabolism caused by a lack of the enzyme homogentisic dioxygenase (HGD)
Alkaptonuria is generally a benign and often asymptomatic condition. Possible features include:
pigmented sclera
urine turns black if left exposed to the air
intervertebral disc calcification may result in back pain
renal stones
Tx= high dose vit c
hydroxychloriquine retinopathy symptoms
flashes, photophobia, decreased visual acuity
caused by
central depigmentation, speckled rings, hyperpigmentation,
fibromyalgia how many tender points out of 18 needed
11/18 for diagnosis
which TB medication can cause drug induced lupus
isoniazid
LOW Ca and LOW phosphate
and
HIGH ALP and HIGH PTH
osteomalacia
tennis elbow= and which mm affected
lateral epicondyle
EXTENDOR CARPI radialis brevis affected
double contour sign. = ?
gout
pregnancy and infliximab
stop infliximab at 16 weeks
which joint condition is associated with polycythaemia
GOUT
