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rheum diagnostics Flashcards

1
Q

What blood tests do you do in rheumatology?

A

Full blood count FBC, urea & electrolytes (U & E), liver function tests (LFT), bone profile, erythrocyte sedimentation rate (ESR), C-reactive protein CRP

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2
Q

What is seen on FBC of inflammatory arthritis?

A

Low Hb (anaemia) or normal, MCV normal, WCC usually normal, platelet normal or increased

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3
Q

What is seen on FBC of osteoarthritis?

A

all normal

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4
Q

What is seen on FBC of septic arthritis?

A

Hb usually normal (acute), MCV normal, WCC increased (neutrophilic leucocytosis), platelet count normal or high if marked inflammation

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5
Q

What molecules are involved In urea & electrolytes? What can affect these?

A
  • Urea, creatinine, sodium, potassium.
  • High creatinine indicates renal problem.
  • Rheum diseases can affect kidneys eg. SLE lupus nephritis, vasculitis to nephritis, chronic inflammation leads to high levels of Amyloid A (SAA) protein, deposition in organs leads to organ damage AA amyloidosis.
  • NSAIDs can cause kidney problems
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6
Q

What molecules are involved in LFT? When can these be deranged?

A
  • Bilirubin, alanine aminotransferase (ALT), alkanine phosphatase ALP, albumin.
  • DMARDs can cause liver damage (methotrexate need regular blood tests every 8wks).
  • Low albumin can reflect liver or renal problems (increased leak in lupus nephritis).
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7
Q

What is included in the bone profile? When can these be deranged?

A
  • Calcium, phosphate, alkaline phosphatase ALP.
  • Paget’s disease of bone causes high ALP because abnormal bone turnover (bone pain, growth pain, fractures.
  • Osteomalacia (soft bones vitamin D deficiency): ALP normal or high, Calcium & phosphate normal or low.
  • Osteoporosis (low bone density): normal
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8
Q

What are ESR & CRP markers of? When are they deranged?

A
  • Inflammation.
  • ESR can be raised for other reasons eg. Elevated immunoglobulin levels, paraprotein (myeloma), anaemia, age.
  • CRP more specific for inflammation.
  • In SLE ESR more useful (ESR usually high but CRP normal), CRP only high in SLE if significant synovitis or inflammatory pleural or pericardial effusion.
  • Low index for infection suspicion
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9
Q

What antibodies are present in RA?

A
  • Rheumatoid factor (not specific for RA, can be in hep C or generally).
  • Anti-CCP antibodies: more specific than RF - associated with worse prognosis of RA
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10
Q

What are anti-nuclear antibodies ANA? When is it deranged? When do you order it?

A
  • Antibodies against nuclear component of cell.
  • Non-specific, can be in healthy population in low level and increases with age, sometimes transiently after infection.
  • High level ANA + correct clinical findings can point to autoimmune inflammatory diseases (SLE, sjorgen’s syndrome, scleroderma).
  • Only order if suspect it because can lead to anxiety as is non-specific
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11
Q

What are symptoms of SLE? FBC?

A
  • Arthritis, skin rash, mouth ulcers, kidney disease, haematological, pleural effusion, pericardial effusion.
  • Low lymphocytes and platelets
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12
Q

What are symptoms of sjorgen’s syndrome?

A

Dry eyes, dry mouth due to destruction of salivary and lacrimal glands, extra-articular features

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13
Q

What are symptoms of scleroderma?

A

Vasculopathy - raynauds, skin thickening, organ fibrosis

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14
Q

What are symptoms of polymyositis?

A

Muscle inflammation, weakness, high creatine kinase

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15
Q

What do you do if you suspect autoimmune connective tissue diseases? What diseases are included?

A

Order ANA.

-Includes SLE, sjorgens syndrome, scleroderma, polymyositis

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16
Q

How is ANA interpreted? What does a negative & a positive test mean? What do you do if its is positive?

A
  • Reported as maximal dilution at which still detectable eg. 1:80 weak, 1:1280 strong.
  • Negative test rules out SLE but positive test doesn’t mean SLE, but suggestive with right clinical & lab features.
  • If positive order other tests ENA (extractable nuclear antigens - panel of 5 antibodies)
17
Q

What is included in ENA (extractable nuclear antigens)?

A

Panel of 5 antibodies.
Ro (lupus & sjorgens), La (lupus & sjorgens), RNP (lupus or mixed connective tissue diseases), smith (lupus), jo-1 (polymyositis)

18
Q

What do dsDNA antibodies do? What are they associated with? Uses?

A

Antibodies against doubles stranded DNA, highly specific for lupus. Associated with renal involvement. Good for tracking lupus activity over time

19
Q

What happens to complement levels in lupus?

A

Low complement levels C3 & C4 in active lupus

20
Q

What is synovial fluid analysis? What are indications for it?

A

Aspirate fluid from joint. Diagnostic (for analysis) or therapeutic (relief or symptoms +/- concurrent steroid injection)

  1. suspected septic arthritis (gold standard, send for culture/gram stain + sensitivities)
  2. diagnose crystal arthritis
21
Q

What is seen in gout in synovial fluid analysis?

A

Under polarised light with microscope see needle shaped crystals negative birefringence

22
Q

What is seen in pseudogout in synovial fluid analysis?

A

under polarised light with microscope see rhomboid shaped crystals with positive birefringence

23
Q

What is seen in synovial fluid analysis for septic arthritis? What do you do?

A

Culture positive. Antibiotics + joint lavage

24
Q

What is seen in synovial fluid analysis for reactive arthritis? What do you do?

A

Synovial fluid sterile. No antibiotics or joint lavage

25
Q

What is 1st line imaging used in rheumatology and why?

A

X rays. Cheap, available

26
Q

What do CT scans offer?

A

more detailed bone imaging

27
Q

What do MRI scans offer? When are they best? disadvantages?

A

Best visualisation for soft tissue (tendons/ligaments).
Best for spinal imaging (cord & nerve roots).
Expensive & time consuming

28
Q

When is ultrasound best used?

A

Soft tissue. Good for smaller joints, less good for large/deep joints (knee/hip)

29
Q

What are x-ray features of osteoarthritis?

A

Joint space narrowing, osteophytes (bone spurs), subchondral cysts (bone cysts under cartilage), subchondral bony sclerosis (increased whitening)

30
Q

What do we see in imaging of RA? What imaging is used?

A
  1. X-ray: Soft tissue swelling, peri-articular osteopenia, bony erosions (only in established disease - treat before permanent damage), joint space narrowing.
  2. ultrasound - better for detecting synovitis. Synovial hypertrophy, increased blood flow seen as doppler signal, maybe erosions not seen in x-ray. Hands/wrists + clinical assessment for early RA
  3. MRI - yes but expensive/time consuming
31
Q

What is seen in gout x-ray?

A

Juxta-articular rat bite erosions at MPTJ of toe

32
Q

What is seen in psoriatic x-ray?

A

Asymmetry, sparing of MCPJ but involvement of intraphalangeal joints

33
Q

Why can MRI be used for femoral head?

A

Avascular necrosis - bone infarction due to impaired blood supply

BRS (81 decks)

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