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Rheum Flashcards

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1
Q

what hand joints are affected in osteoarthritis

A

DIP
carpometacarpal joint at base of thumb

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2
Q

x ray changes osteoarthritis

A

loss of joint space
osteophytes
subchondral cysts
subarticular sclerosis

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3
Q

signs of osteoarthritis on examination

A

crepitus on movement
effusions
enlargement of the joint
restricted ROM
herberdens nodes
bouchards nodes
squaring of base of thumb
weak grip

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4
Q

in osteoarthritis when do you get creptius

A

on movement

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5
Q

what is the typical pattern of bone pain in osteoarthritis

A

worse with movement and at the end of the day

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6
Q

how is osteoarthritis diagnosed

A

clinically

over 45 with pain worse with movement and no morning stiffness

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7
Q

osteoarthritis mx

A

conservative= weight loss, exercise, occupational therapy (walking aids etc)

medical= topical nsaids first line, then oral (plus PPI), sometimes intra articular steroids

surgical= joint replacement

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8
Q

how do NSAIDs cause hypertension

A

they block prostaglandins which are vasodilators

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9
Q

pain relief in osteoarthritis

A

paracetamol and opiates not recommended

nsaids for short term use

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10
Q

what antibody class is rheumatoid factor

A

IgM most often but can be others

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11
Q

rheumatoid arthritis antobodies

A

anti ccp
rheumatoid factor

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12
Q

what is felt on joint examination in rheumatoid arthritis

A

tenderness
synovial thickening

they feel boggy

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13
Q

boggy joint indicates

A

rheumatoid arthritis

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14
Q

rheumatoid arthritis hand signs

A

z thumb
swan neck deformity
boutonniere deformity
ulnar deviation of hands and MCP

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15
Q

swan neck deformity

A

flexed DIP
hyperextended PIP

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16
Q

boutonnieres deformity

A

hyperextended DIP
flexed PIP

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17
Q

what spine change can occur in rheumatoid arthritis

what does this mean

A

atlanto-axial subluxation

patients should have an assessment before general anaesthetic and intubation as it can cause spinal cord compression

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18
Q

extra articular manifestations of rheumatoid arthritis

A

pulmonary fibrosis
sjogrens syndrome
anaemia of chronic disease
carpal tunnel
eye conditions- scleritis, episcleritis, keratitis

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19
Q

suspected rheumatoid arthritis mx

A

urgent rheumatology referral (within 3 weeks)

start an nsaid and take bloods while waiting

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20
Q

x ray changes rheumatoid arthritis

A

periarticular osteopenia
bony erosions
soft tissue swelling
joint destruction

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21
Q

score used to measure functional ability in rheumatoid arthritis

A

HAQ

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22
Q

score used to monitor disease activity in rheumatoid arthritis

A

DAS28

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23
Q

mx of rheumatoid arthritis

A

cMARDs or dMARDs

  1. monotherapy
  2. combination therapy
  3. biologics
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24
Q

mildest dMARD for RA

A

hydroxychloroquine

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25
safest dMARDs for pregnancy
hydroxychloroquine sulfasalazine
26
TNF inihibitor biologic agents
adalimumab etanercept infliximab
27
methotrexate side effects
mouth ulcers liver toxicity bone marrow supression teratogenic
28
sulfasalazine side effects
orange urine reversible male infertility bone marrow supression
29
leflunomide side effects
hypertension peripheral neuropathy
30
hydroxycholorquine side effects
renal toxicity blue grey skin pigmentation hair bleaching
31
anti tnf medications side effects
reactivation of TB skin cancer
32
rituximab side effects
night sweats thrombocytopenia
33
psoriatic arthritis antibodies
it is seronegative
34
oligoarthritis number of joints
1-4
35
polyarthritis number of joints
more than 4
36
what joints does psoriatic arthritis mainly affect
axial skeleton DIP
37
what is arthritis mutilans
in psoriatic arthritis when the whole joint is destroyed telescoping (shortening) of the digits may be seen
38
signs of psoriatic arthritis
dactilytis nail pitting onycholysis psoriatic plaques
39
x ray sign psoriatic arthritis
pencil in cup seen in arthritis mutilans
40
mx psoriatic arthritis
nsaids steroids dmards biologics
41
x ray signs psoriatic arthritis
periostitis ankylosis osteolysis dactylitis
42
what is reactive arthritis
arthritis triggered by an infection usually a monoarthritis
43
how is reactive arthritis different to septic arthritis
there is no infection in the joint
44
reactive arthritis triad
cant see cant pee cant climb a tree conjunctivitis urethritis arthritis
45
reactive arthritis mx
treat the triggering infection nsaids steroid injection or systemic steroids
46
ank spond autoantibodies
seronegative
47
different for an acute swollen joint
reactive arthritis septic arthritis gout pseudogout
48
joint pain in ank spond
lower back and buttock pain worse at night and may wake them in morning morning stiffness lasting 30 mins pain improves with activity
49
associated conditions to ank spond pnuemonic
anterior uveitis aortic regurg av block apical lung fibrosis anaemia of chronic disease
50
schobers test
mark 10cm above L5 and 5cm below get them to bend forward and touch toes distance <20cm= ank spond
51
x ray changes in ank spond
squaring of vertebral bodies fusion of joints subchondral sclerosis syndesmophytes ossification of ligaments, discs and joints
52
ank spond mx
medical 1. nsaids 2. anti tnf agents 3. secukinumab (monoclonal anitbodies) intra articular steroids physiotherapy avoid smoking exercise and mobilisation bisphosphonates
53
SLE symptoms
myalgia fever malar rash lymphadenopathy splenomegaly joint pain hair loss mouth ulcers fatigue weight loss SOB pleuritic chest pain raynauds oedema
54
FBC in SLE
anaemia of chronic disease low WCC and platelets
55
anti ds dna
SLE
56
anti centromere
limited cutaneous systemic sclerosis
57
anti ro and anti la
sjogrens
58
anti scl-70
systemic sclerosis
59
anti jo1
dermatomyositis
60
complications of SLE
cardiovascular disease pleuritis pulmonary fibrosis anaemia pericarditis lupus nephritis
61
SLE mx
1st line hydroxychloroquine nsaids steroids if more severe dmards biologics
62
dmard examples
mycophenolate mofetil methotrexate cyclophosphamide
63
what is discoid lupus
autoimmune skin condition photosensitive lesions that are inflamed, dry, erythematous and scaling they can cause scarring alopecia, hypo or hyper pigmentation
64
discoid lupus mx
sun protection topical steroids hydroxycholorquine
65
other name for systemic sclerosis
scleroderma
66
types of systemic sclerosis
limited cutaneous systemic sclerosis diffuse cutaneous systemic sclerosis- CREST plus internal organ involvement
67
describe scleroderma
hardening of the skin that makes it look tight and shiny
68
colour changes in raynauds
white then blue then red
69
raynauds mx
keep hand warm CCB- nifedipine
70
what drug worsens raynauds sx
beta blockers
71
systemic sclerosis antibodies
ANA postive limited= anti centromere diffuse= anti scl 70
72
what additional sx do you get in diffuse cutaneous systemic sclerosis
internal organ involvement heart= hypertension, CAD lung= pulmonary htn, pulmonary fibrosis kidney= scleroderma renal crisis
73
what condition is PMR associated with
GCA
74
PMR antibodies
none
75
pain in PMR
shoulder, neck, pelvic girdle worse in morning stiffness lasts 45 mins pain disrupts sleep pain somewhat eases with activity
76
PMR mx
15mg prednisolone daily follow up in 1 week continue for 1-2 yrs then wean off in a reducing regime
77
after how long does steroid dependancy occur
3 weeks
78
GCA sx
unilateral headache around temple and forehead jaw claudication blurred or double vision thick and tender temporal artery
79
what is seen in GCA on temporal artery biopsy
multinucleated giant cells
80
what is seen in GCA on US
halo sign stenosis of temporal artery
81
GCA mx
steroids 40-60mg prednisolone OD if no visual sx or jaw claudication 500-1000mg methylprednisolone OD if visual sx or jaw claudication start immediately if suspected to avoid vision loss
82
key complication of GCA
vision loss
83
complications of steroid use
weight gain diabetes osteoporosis
84
skin changes in dermatomyositis
grotton papules heliotrope rash affecting eyelids periorbital oedema photosensitive rash on back/shoulders/neck
85
polymyositis and dermatomyositis main sx
proximal muscle weakness
86
polymyositis/dermatomyositis diagnostic test
raised CK anti jo1 in polymyositis
87
polymyositis/dermatolyositis mx
corticosteroids

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