Rheum

Question 1

Common clinical features of SLE

Answer 1

Constitutional:
- LOW, LOA , Fever

Joints:
- distal poly-arthritis, arthralgia
- symmetrical - fingers, carpals, knee

Skin:
- Malar / Butterfly rash
- Raynaud phenomenon
- Maculopapular rash (photosensitivity)
- Discoid rash
- Periungual telangiectasia

Question 2

Complications of SLE

Answer 2

Infections:
- Bacterial - skin, lungs, UTI
- Viral - VZV, CMV, HPV

CVS diseases:
- AMI, stroke, anti phospholipid syndrome

Others:
- Libman-Sacks endocarditis
- Pancytopenia
- Non-Hodgkin Lymphoma
- Osteonecrosis
- ILD, pulmonary HTN

Question 3

General principles of SLE treatment

Answer 3

Pharmacological
- long term immunosuppressants
- NSAIDs
- mild to severe: hydroxychloroquine, IV / oral glucocorticoid +/- immunosuppressant

Non-pharm
- lifestyle modification - reduce atherosclerosis risk
- avoid UV light

Question 4

Clinical features of RA (Hx + PE)

Answer 4

Articular symptoms
Hands
- symmetrical, insidious onset
- pain worse at rest, relieved on movement
- worse in morning

• Ulnar deviation of fingers at MCPJ
• Swan neck deformity (hyperextended PIPJ, hyperflexed DIPJ), Boutonniere deformity (opp swan neck), Z-thumb
• prominent ulnar head
• warmth, tenderness over joints

Elbows
- RA nodules

Eyes
- episcleritis
- dry

Mouth
- dry mouth
- parotidomegaly
- oral ulcers

Question 5

PE signs of Gout

Answer 5

Hands
- asymmetrical joint deformities
- Guttering + Gouty tophi on extensor surface
- stigmata of CLD: nail clubbing, Dupuytren’s contracture, Palmar erythema

Question 6

Investigation workup for gout

Answer 6

• Joint aspiration: polarised light microscopy, culture, gram stain, AFB smear, FEME
• XR
• FBC, U/E/Cr, urine dipstick, UFEME, LFT,

Question 7

Mimics of SLE

Answer 7

ANCA-associated vasculitides
RA
Infective endocarditis
Sjogren syndrome
Dermatomyositis
Parvovirus B19
Hep C
HIV

Question 8

Diagnostic lab markers for SLE

Answer 8

• Anti-nuclear Ab
• anti-dsDNA
• anti-phospholipid Ab

Question 9

Diagnostic lab markers for RA

Answer 9

Rheumatoid factor
Anti-CCP (better)

Question 10

Diagnostic lab markers for Spondyloarthritis

Answer 10

HLA-B27

Question 11

Diagnostic lab markers for scleroderma

Answer 11

anti-centromere
anti-topoisomerase
anti-Scl-70

Question 12

Diagnostic lab markers for Sjogren’s syndrome

Answer 12

anti-SSA
anti SSB

Question 13

What arthritic disorder is associated with IBD

Answer 13

spondyloarthritis

Question 14

What are the two common systemic sclerosis subtypes

Answer 14

limited and diffuse

Question 15

How is cutaneous distribution different between limited and diffuse systemic sclerosis

Answer 15

limited
- neck, face, distal limbs

diffuse
- trunk, face, extremities

Question 16

extracutaneous manifestations of limited systemic sclerosis

Answer 16

pulmonary arterial HTN
GI involvement - bloating, constipation

Question 17

extracutaneous manifestations of diffuse systemic sclerosis

Answer 17

scleroderma renal crisis - sudden onset of HTN, pulmonary oedema, encephalopathy, microangiopathic haemolytic anaemia

cardiac pathology

ILD

Question 18

Difference in onset of systemic symptoms between limited and diffuse systemic sclerosis

Answer 18

limited
- gradual
- occurs after Raynaud phenomenon

diffuse
- rapid
- occurs together with Raynaud phenomenon

Question 19

What are the components of CREST syndrome in systemic sclerosis

Answer 19

Calcinosis cutis - small white calcium deposits on pressure points of extremities

Raynaud phenomenon

Esophageal hypo-motility - dysphagia, GERD, heartburn

Sclerodactyly - red-blue discolouration of skin, edema, fibrosis with waxy appearance, limited ROM

Telangiectasia

Question 20

What autoimmune diseases is Sjogren syndrome?

Answer 20

rheumatoid arthritis, SLE, systemic sclerosis, polymyositis, PBC

Question 21

physical signs of Psoriatic arthritis

Answer 21

Cutaneous
- psoriatic plaques (scalp, ears, elbow, umbilicus, back, sacrum, knees, soles)

Joints
- asymmetrical oligoarthropathy
- affecting PIPJ, MTPJ, DIPJ, spine
- inflammatory: warm, tender, swollen, erythematous (active)
- morning stiffness >30min
- worse at rest, relieved on movement

Eyes
- anterior uveitis

Nails
- (POOH) Pitting, Onycholysis, Oil drop sign, Hyperkeratosis

Fingers
- dactylitis (sausage digits)

Enthesitis
- e.g. Achilles tendon

Question 22

Main associated medical condition with psoriatic arthritis

Answer 22

Atherosclerosis
risk factors: HTN, HLD, DM