Rheum Flashcards
what is HLA 27 associated with
ank spond
reactive arthritis
JIA
anterior uveitis
psoriatic arthritis
C-ANCA is associated with
Wegners granulomatosis
In a positive C-ANCA test you then need to test
PR3 (if negative then all insignificant)
In a positive P-ANCA test you also need to check
MPO (if negative then all insignificant)
What category of illness is ANCA associated with
vasculitis
What category of illness is ANA associated with
connective tissue disease such as SLE or sjogrens
Positive RF or anti CCP in RA suggests what
more severe disease/systemic complications more likely
Which arthritis has Hebden’s/Bouchards nodes
osteo
T score of -1.5-2.5 suggests
osteopenia
T score of -2.5 suggests
osteoporosis
Dactylitis is linked to what 3 conditions
spondyloarthritises
sarcoid
sickle cell
cardiac complications of ank spond
heart block
Aortic regurgitation
resp complication of ank spond
pulm fibrosis (apical)
what is the examination test for ank spond
schobers
What does MRI spine show in ank spond
BM oedema
XR findings of ank spond
bamboo spine
squaring of vertebral bodies
subchondral sclerosis and erosions
Syndesmphytes
ossification
joint fusion
what antibiotic must be avoided with MTX
trimethoprim (they will become pancytopenic)``
which medication require careful timing with the flu jab
rituximab
what other skin manifestation of lupus apart from malar rash
discoid rash in sun exposed areas
What are two quite specific lupus antibodies
anti smith
anti dsDNA
what other syndrome can SLE deveop
APL
diagnostic test for SLE other than bloods
skin biopsy
what medication should SLE avoid
oestrogen contraceptives
what is a potentially curative option in severe refractory SLE
stem cell transplant
Does PMR get true muscular weakness?
No it is due to pain
How should PMR respond to steroid
dramatically and quickly
first line rx in ank spond
NSAIDs
when to use mtx in ank spond
peripheral disease
other treatments in ank spond
joint steroids
biologics
surgery
joints mostly affected in psoriatic arthritis
DIPs
Sjogren’s antibodies
Ro
La
Dermatomyositis ab
JO1
Diffuse sclerosis ab
Scl70
rash associated with APL syndrome
livedo reticularis
FBC result in APL
low plt
Abs in APL synd
lupus anticoag
anticardiolipin
anti-B2 glycoprotein
Sjogrens has a 5-9x risk of what cancer
lymphoma
Test for sjogrens with paper
Schirmers
Antibody in limited systemic sclerosis (CREST)
anti-centromere
what type of sclerosis has a better prognosis
limited
Limited sclerosis associated with what heart issue
pulm htn
Medication options for Reynauds
Nifedipine
Iloprost for digital ulcers
Sildenafil
Fluoxetine
‘punched out’ erosions, tophi and joint effusions on XR
gout
Periarticular osteopenia on XR
RA
Acute gout mx
colchicine (continue allopurinol if taking)
When to offer allopurinol in gout
after first attack as urate lowering therapy
How do you decide allopurinol dose
Titrate until serum uric acid <300umol/L
weakly positive birefringemet rhombiod-shaped crystals on joint aspiration suggests what
pseudogout (calcium crystals)
Pseudogout rx
NSAIDs
steroids
When do you start bisphosphonates following fracture
> 75 with fragility frature- no need for DEXA first
<75 –> DEXA –> FRAX –> maybe start
How can you manage a severe RA flare
PO/IM steroids
Starting biologics (-mab) can have what adverse affect that requires CXR beforehand
reactivation of TB
How long should sx be present for chronic fatigue dx
3 months
Bad GI side effects on aledronate for osteoporosis - alternative?
risedronate or etidronate
Linear calcification of the articular cartilage on XR
Pseudogout- Chondrocalcinosis
Pagets rx
bisphosphonate
hydroxychloroquine side effect
retinopathy
Rx for OA if paracetamol not working
Topical NSAIDs if knee/hand
Oral if other
How to manage bone protection if a patient is taking the equivalent of prednisolone 7.5mg a day for 3 or more months
> 65 OR previous fragility fracture- aledronate
<65 –> DEXA –> Between 0 and -1.5- Repeat bone density scan in 1-3 years/Less than -1.5- offer bone protection.
Ensure vit D and Ca replete
methotrexate SE
myelosuppression
sulfasalazine SE
sperm low
Leflunomide SE
liver, lung disease
What rheum drug causes proteinuria
Penicillamine and Gold
can you use azathioprine in pregnancy
yes
Rash on soles of feet is associated with what
(keratoderma blenorrhagica)
Reactive arthritis
Osteoarthritis XR changes
LOSS (lossteoarthritis)
Loss of joint space
Osteophytes forming at joint margins
Subchondral sclerosis
Subchondral cysts
which rheum drug can exacerbate myaesthenia gravis
penicillamine
colchicine side effect
diarrhoea
Etanercept side effect
demyelination (‘intercepts the nerves’)
RA XR findings
LESS
Loss of joint space
Erosions
Soft tissue swelling
Soft bones (osteoporosis/ osteopenia)
oral ulcers, genital ulcers and anterior uveitis
behcets
