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Rheum Quiz Mushkies Flashcards

1
Q

How can you classify rheumatological conditions?

A
  1. Arthritides
  2. Vasculitides
  3. Connective Tissue Disease
  4. Metabolic Bone Disease
  5. Soft tissue disease
  6. Viral/infective conditions
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2
Q

What are the Arthritides?

A

1, Osteoarthritis

  1. Rheumatoid Arthritis
  2. Crystal Arthritis
  3. Spondyloarthritis
  4. Septic Arthritis
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3
Q

How can you classify the vasculitides?

A

Large Vessel
Medium Vessel
Small Vessel
Mixed vessel e.g. Behcets

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4
Q

What are the Large Vessel vasculitides?

A

GCA and Takayasu’s Arteritis

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5
Q

What are the Medium Vessel vasculitides?

A

PAN and Kawasaki’s Disease

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6
Q

What are the Small Vessel vasculitides?

A

ANCA associated and Immune complex mediated

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7
Q

What are the ANCA positive small vessel vasculitides?

A
  1. cANCA = GPA

2. pANCA = eGPA and MPA

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8
Q

What are the immune complex mediated small vessel vasculitides?

A
  1. IgA vasculitis (HSP)
  2. Cryoglobulinaemic vasculitis
  3. Anti-C1q vasculitis
  4. Anti-GBM
  5. SLE/RhA vasculitis
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9
Q

How can you classify metabolic bone disease?

A
  1. Osteoporosis

2. Osetomalacia

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10
Q

How can you classify soft tissue diseases?

A
  1. Fibromyalgia
  2. Bursitis
  3. Tendinopathy
  4. Neural compression
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11
Q

How can you classify viral/infective diseases in rheumatology?

A
  1. Hep B/C
  2. Parvovirus
  3. Lyme arthritis
  4. Rheumatic fever
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12
Q

How can you classify the management of gout?

A

Acute and Chronic

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13
Q

What are the 6 steps for the management of acute gout?

A
  1. Analgesics
  2. NSAIDS
  3. Colchicine 500mcg BD
  4. Prednisolone 15-30mg OD 5 days
  5. Inject affected joint with steroid perpation
  6. Splint joint
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14
Q

What is the management of chronic gout?

A
  1. Conservative = low purine diet, weight loss
  2. XO inhibitor = Allopurinol/Febuxostat
  3. Uricosuric agents = Probenecid
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15
Q

How can you classify osteoarthritis?

A
  1. Nodal
  2. Large joint
  3. Forefoot
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16
Q

How can you classify the crystal arthritides?

A
  1. Gout

2. Pseudogout

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17
Q

How can you classify the spondyloarthropathies?

A

Seropositive and Seronegative

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18
Q

What are the seropositive spondyloarthropathies?

A

Positive RhF or Positive CCP –> e.g. Rheumatoid Arthritis

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19
Q

What are the seronegative spondyloarthropathies?

A
  1. Ankylosing spondylitis
  2. Psoriatic arthritis
  3. Reactive arthritis
  4. Enteropathic arthritis
  5. JIA
  6. Isolated acute anterior uveitis
  7. Undifferentiated spondyloarthropathy
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20
Q

How can you classify connective tissue diseases?

A

Inherited and Non-Inherited

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21
Q

What are the inherited connective tissue diseases?

A
  1. Ehlers-Danlos

2. Marfan syndrome

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22
Q

What are some non-inherited connective tissue diseases?

A
  1. SLE
  2. Sjogrens
  3. Systemic Sclerosis
  4. Immune mediated myositis
  5. Mixed connective tissue disease
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23
Q

What are the investigations for Rheumatoid Arthritis?

A
  1. Acute phase marker
  2. RhF
  3. Anti-CCP (most specific)
  4. Radiology - X-ray, US, MRI
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24
Q

What are the 6 medical axes for management of rheumatoid arthritis?

A
  1. Analgesics
  2. NSAIDS
  3. Steroids
  4. Conventional synthetic DMARDs
  5. Targeted synthetic DMARDs
  6. Biological DMARDs
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25
Q

What are the different types of DMARDs?

A
  1. Conventional synthetic
  2. Targeted synthetic
  3. Biological
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26
Q

What are 4 conventional synthetic DMARDs used for RhA?

A
  1. Methotrexate (weekly)
  2. Sulphasalazine
  3. HCQ
  4. Leflunomide
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27
Q

What are 2 targeted synthetic DMARDs used for RhA?

A
  1. Tofacitinib

2. Baricitinib

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28
Q

When would you use DMARDs to treat RhA?

A

DAS > 5.1

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29
Q

What are the 4 classes of biologic DMARD you could use to treat RhA?

A
  1. Anti-TNFa
  2. Anti-CD20
  3. IL6 receptor Ab
  4. CTLA4-Ig
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30
Q

What are some Anti-TNFa antibodies?

A

Infliximab, Adalimumab. Certolizumab, Golimumab, Etanercept

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31
Q

What is an anti-CD20 antibody?

A

Rituximab

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32
Q

What is an IL-6 receptor Ab?

A

Tocilizumab

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33
Q

What is a CTLA4-Ig inhibitor?

A

Abatacept

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34
Q

What are some indications for anti-TNFa antibodies?

A
  1. RhA
  2. Ankylosing spondylitis
  3. Psoriasis and Psoriatic Arthritis
  4. IBD
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35
Q

How can you manage Ankylosing Spondylitis?

A
  1. NSAIDs e.g. naproxen

2. Biologic DMARD (BASDAI >4/10)

36
Q

What biologic DMARDs can be used to treat Ankylosing Spondylitis?

A
  1. Anti-TNF agents

2. Anti-IL17A agents e.g. Secukinumab

37
Q

What hand changes might you see with Psoriatic arthritis?

A
  1. Small joint arthritis involving the PIP and DIP joints
  2. Dactylitis of thumb
  3. Nail changes
38
Q

What are the psoriatic nail changes>

A 
DOPS
Discoloration
Onycholysis
Pitting
Subungual hyperkeratosis
39
Q

What is the new ASAS classification of the spondyloarthritides?

A
  1. Axial spondyloarthritis (includes Ankylosing Spondylitis)

2. Peripheral spondyloarthritis (includes Psoriatic, Enteropathic and Reactive)

40
Q

How does one diagnose axial spondyloarthritis?

A
  1. Pts <45 y/o with at least 3m of back pain
  2. Must have sacroiliitis on imaging (XR/MRI) + 1 other feature OR
  3. HLA B27 + 2 other features
  4. ‘other features’ = inflammatory back pain, arthritis, enthesitis, uveitis, dactylitis, psoriasis, colitis, CRP, NSAID response, FHx of Spondyloarthropathies, HLA B27
41
Q

How does one diagnose peripheral spondyloarthritis?

A
  1. Pts < 45 y/o with only peripheral features
  2. Must have arthritis/enthesitis or dactylitis
    • 2 other features (1 of or 2 of)
  4. 1 of: inflammatory back pain, arthritis, enthesitis, dactylitis, FHx of SA
  5. 2 of: uveitis, psoriasis, colitis, HLA B27, prior infection, sacroiliitis on imaging
42
Q

What are the 6 medical axes for management of Psoriatic arthritis?

A
  1. Analgesics
  2. NSAIDs
  3. Steroids
  4. Conventional synthetic DMARDs
  5. Targeted synthetic DMARDs
  6. Biological DMARDs
43
Q

What are 4 conventional synthetic DMARDs you could use to treat PsA?

A
  1. Methotrexate
  2. Leflunomide
  3. Sulfasalazine
  4. Azathioprine
  5. Ciclosporine
44
Q

What targeted synthetic DMARDs could you use to treat PsA?

A

Apremilast

45
Q

`What biologic DMARDs could you use to treat PsA?

A
  1. Anti-TNFa
  2. Ant-IL17A (Secukinumab)
  3. Anti-IL12&23 (Ustekinumab)
46
Q

How does reactive arthritis present?

A
  1. Large joint oligoarthritis following infection with specific organisms
47
Q

What organisms typically cause reactive arthritis?

A
  1. CHLAMYDIA
  2. Shigella
  3. Salmonella
  4. Yersinia
  5. Campylobacter
48
Q

What are 2 skin rashes associated with reactive arthritis?

A

Keratoderma blenorrhagicum or circinate balanitis

49
Q

What is the management of reactive arthritis?

A
  1. Conservative = rest, splinting, NSAIDs
  2. Inject affected joint with steroids
  3. DMARD for ongoing disease (if arthritis >3m, mostly methotrexate/sulphasalazine)
  4. TNFa blockers may be effective but are not NICE approved for reactive arthritis
50
Q

What is osteoporosis?

A

Progressive systemic skeletal disease characterised by:
1. Low bone mass
2. Microarchitectural deterioration of bone tissue
With subsequent increase in:
1. Bone fragility
2. Susceptibility to fractureHow

51
Q

How can you classify management of osteoporosis?

A
  1. Primary prevention

2. Secondary prevention

52
Q

When would you use primary prevention for osteoporosis?

A
  1. According to FRAX (NOGG threshold) +/- consideration of BMD
53
Q

When would you use secondary prevention for osteoporosis i.e. post-fragility fracture?

A
  1. > 75y/o
  2. According to FRAX (NOGG threshold)
  3. T score < 2.5 (?<1.5 if vertebral fracture or hip fracture)t
54
Q

What does NOGG stand for?

A

National Osteoporosis Guideline Group

55
Q

What does FRAX stand for?

A

Fracture risk assessment tool

56
Q

How can you classify the medical management of osteoporosis?

A

Oral medications vs. Parenteral medications

57
Q

What oral medications can be used to treat osteoporosis?

A
  1. Bisphosphonates
  2. Strontium Ranelate (now rarely used due to risk of CV events)
  3. Hormone based
58
Q

What are some examples of bisphosphonates?

A
  1. Alendronate
  2. Risendronate
  3. Ibandronate
  4. Etidronate
59
Q

What are some hormone-based medications that can be used to treat osteoporosis?

A

Classical HRT, Raloxifene

60
Q

What are some parenteral medications that can be used to treat osteoporosis?

A
  1. Bisphosphonates
  2. Anti-RANKL
  3. PTH analogue
61
Q

What is a parenteral bisphosphonate for osteoporosis?

A

IV Zoledronate

62
Q

What is an example of an anti-RANKL agent?

A

SC Denosumab

63
Q

What is an example of a PTH analogue for treatment of osteoporosis?

A

SC Teriparatide

64
Q

How can you classify the complications of SLE?

A

Mild
Moderate
Severe

65
Q

What are 3 mild features of SLE?

A

Rash
Arthritis
Lymphadenopathy

66
Q

What are 3 moderate features of SLE?

A

Pleurisy
Pericarditis
Cytopenias

67
Q

What are 2 severe features of SLE

A

Lupus nephritis

CNS Lupus

68
Q

What is the ACR diagnostic criteria for SLE?

A

4/11 of SOAP BRAIN MD

  1. Serositis (pleuritis, pericarditis)
  2. Oral ulcers
  3. Arthritis
  4. Photosensitivity
  5. Blood (all can be low)
  6. Renal (proteinuria)
  7. ANA
  8. Immunologic (dsDNA)
  9. Neuro (psych, seizures)
  10. Malar rash
  11. Discoid rash
69
Q

What are SLICC criteria for diagnosis of SLE?

A
  1. Biopsy proven lupus nephritis with positive ANA/dsDNA OR
  2. 4 criteria including at least 1 clinical + 1 immunologic
  3. Clinical criteria = acute/chronic skin disease, alopecia, synovitis, serositis, nephritis, neuro, haemolytic anaemia, leukopenia, lymphopenia, thrombocytopenia
  4. Immunologic criteria = ANA, dsDNA, low C3/C4, anti-phospholipid
70
Q

How can you investigate and thus differentiate between connective tissue diseases?

A

If they are ANA +ive, seeing which further subtype is positive

  1. dsDNA
  2. ENA
  3. Cytoplasmic
71
Q

What does dsDNA represent?

72
Q

What are the subtypes of ENA?

A
  1. Ro, La, Sm, RNP
  2. SCL70
  3. Centromere (tRNA synthetase/Jo1)
73
Q

What condition is Ro, La +ive?

74
Q

What condition can be positive for any of Ro, La, Sm, RNP?

75
Q

What condition is SCL70 positive?

A

Diffuse cutaneous systemic sclerosis

76
Q

What condition is anti-centromere positive?

A

CREST (limited cutaneous systemic sclerosis)

77
Q

What condition is anti-centromere Ab positive?

78
Q

What is the medical management of SLE?

A

Handsome Penguins Activated Muffins Concerning Bad Rebels

  1. HCQ = skin, joints
  2. Prednisolone = pleural, cardiac, renal, neuro
  3. Azathioprine = pleural/cardiac relapse
  4. MMF = renal/relapsing disease
  5. Cyclophosphamide = renal/neuro
  6. Belimumab = active disease despite Tx
  7. Rituximab = active disease despite Tx, esp. renal
79
Q

What kind of vasculitis is GCA?

A

Large vessel, granulomatous vasculitis

80
Q

What arteries are affected by GCA?

A
  1. Temporal artery arising from external carotid
  2. Maxillary artery arising from external carotid
  3. Ophthalmic artery arising from internal carotid
  4. Central retinal artery arising from ophthalmic artery
81
Q

What are 3 symptoms of GCA?

A
  1. Temporal headaches
  2. Jaw claudication
  3. Visual symptoms
82
Q

What are the investigations for GCA?

A
  1. Bloods = raised ESR and CRP
  2. Temporal artery biopsy
  3. US scan temporal artery
  4. FDG PET scan
83
Q

What is the treatment of GCA?

A
  1. High dose prednisolone 40-60mgs
  2. Methotrexate
  3. Tocilizumab (under consideration by NICE)
84
Q

What does the c in cANCA stand for?

A

Cytoplasmic

85
Q

What are cANCA antibodies against?

A

The enzyme Proteinase 3

86
Q

What are pANCA antibodies against?

A

Myeloperoxidase

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