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Rheumatology Tania > rheuma 1 > Flashcards

rheuma 1 Flashcards

1
Q

arthropathy means

A

something wrong with joint

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2
Q

arthralgia is?

A

joint pain

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3
Q

extra articular features of Rheumatoid arthritis (6)

A 
raynauds
sicca (mucosal dryness)
interstitial lung disease
neuropathy 
vasculitis 
scleritis
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4
Q

Inflammatory conditions will have what features? (5)

A 
morning stiffness 
soft tissue swelling 
incr plasma viscosity 
incr ESR
Incr C-reactive protein
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5
Q

joint distribution of SLE

A

same as RA (but with out radiological findings)

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6
Q

drug associated with SLE

A

contraceptive pill

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7
Q

anti-nuclear antibody (ANA) ratio that indicates disease

A

1:160 or more

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8
Q

auto antibody that indicates SLE activity

A

anti dsDNA

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9
Q

auto antibody that is SLE specific

A

anti dsDNA

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10
Q

auto antibody Sm indicates what about SLE

A

neurological involvement

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11
Q

Ro in SLE indicates?

A

cutaneous manifestations

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12
Q

RNP auto antibody indicates?

A

scleroderma
raynauds
myositis

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13
Q

which 2 things can indicates high SLE activity

A

high anti-dsDNA antibodies and low C3/C4 levels

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14
Q

what is associated with late stages of SLE (4)

A

malar rash
seizures
pericarditis
nephritis

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15
Q

auto antibodies associated with SLE (4)

A

anti: dsDNA, Sm, Ro, RNP

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16
Q

treatment of SLE

A 
NSAIDS
analgesia 
chloriquine/hydroxychloroquine
steroids (short term) 
immunosuppression (DMARDS)
biologicals
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17
Q

what results will indicate someone with SLE

A

blood and protein in urine
ANA >1:160 (esp anti-dsDNA)
low C3/C4

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18
Q

buzzword: recurrent foetal loss or thrombosis or livedo reticularis

A

anti-phospholipid syndrome

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19
Q

treatment of anti-phospholipid syndrome

A

life long anti-coagulation

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20
Q

what is sjogrens?

A

lymphocytes destroy exocrine glands (mostly salivary and lacrimal)

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21
Q

Buzzwords: dry eyes/dry mouth

A

sjogrens

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22
Q

what is keratoconjunctivitis sicca

A

dry eyes

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23
Q

what is xerostoma

A

dry mouth

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24
Q

test for tear production?

A

schirmers test

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25
Q

types of scleroderma

A

limited

diffuse/systemic

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26
Q

limited scleroderma also known as?

A

CREST syndrome

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27
Q

CREST stands for?

A

Calcinosis (calcium deposition in skin)
Raynauds (vaso spasm)
Esophageal dysmotility
Sclerodactyly (thickenening & tightening of skin on fingers
Telangiectasia (spider veins usually around eyes and nose)

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28
Q

treatment for scleroderma

A

calcium channel blockers
prostacyclin (platelet inhibitor/vasodilator)
ACE inhibitors
immunosuppression

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29
Q

what is scleroderma and pathophysiology?

A

autoimmune, resulting in incr collagen synthesis which it turn leads to thickening of skin, t cell activation, small artery damage (raynauds), pulmonary hypertension (fibrosis due to collagen deposition)

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30
Q

synovium is derived from?

A 
hyaluronic acid (mucin)
lubricin (glycoprotein)
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31
Q

what produces synovial fluid?

A

fibroblasts

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32
Q

synovium contains few cells, which are these?

A

mononuclear leucocyctes

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33
Q

Normal synovium WBC and polymorphs

A

<25/mm polymorphs

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34
Q

synovial colours:
yellow -
opaque -
red -

A

cause:
inflammation (crystals etc)
septic
trauma

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35
Q

WBC in septic synovium

A

> 100 000

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36
Q

WBC in inflamed synovium

A

2000-75000

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37
Q

cartilage zones from deepest to superficial

A

calcified > deep > middle > superficial

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38
Q

articular cartilage is made up of?

A

70% ECM
20% water
10% proteoglycans
type 2 cartilage

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39
Q

which zones of cartilage has highest proteoglycan concentration?

A

middle & deep

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40
Q

ECM = ____% of cartilage volume?

A

98% (for load bearing)

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41
Q

markers of cartilage degeneration

A

serum and synovial keratin sulphate

type 2 collagen in synovial fluid

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42
Q

what cytokines stimulate proteolytic enzymes and inhibit proteoglycan synthesis

A

TNF alpha

IL-1

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43
Q

cytokines that promote cartilage growth

A

TGF-beta
IGF-1
(promote proteoglycan synthesis and counteracts IL-1)

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44
Q

HLA associated with RA

A

HLA-DR4 and DR1

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45
Q

what cells are found in synovium in RA (3)

A

macrophages
fibroblasts
multi nucleated giant cells

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46
Q

pathophysiology of RA

A

synovial membrane (pannus) expands actively invading and eroding surrounding bone and cartilage

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47
Q

In RA, _____ classification used, and must be ___

A

EULAR/ACR and 6/10

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48
Q

RA specific auto antibody

A

anti-CCP (cyclic citrullinated peptide)

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49
Q

RA treatment

A

DMARDS + steroids to cover ‘lag’ phase

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50
Q

DMARD examples

A 
methotrexate
sulfasalazine
lefunoamide
hydroxychloriquine
gold
pencillamine
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51
Q

Types of biologicals

A 
TNF inhibitors
B-cell depletion 
IL-1 inhibitors
IL-6 inhibitors
disruption of T cell co-stimulation

**end in -mab or -cept

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52
Q

what is vascultis

A

presence of leucytes and immune complexes in vessel walls with reactive damage to mural structures

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53
Q

examples of large vessel vasculitis (2)

A

takayasu

giant cell

54
Q

examples of medium vessel vasculitis

A

PAN

kawasaki’s

55
Q

example of small vessel vasculitis

A

churg-strauss
wegeners (granulomatosis with polyangiitis)
microscopic pollyangitis

56
Q

which form of vasculitis is ANCA possitive?

A

small vessel (wegneres, churg-strauss)

57
Q

how do you differentiate between different small vessel vasculitis

A

microscopic polyangitis = no granulomas
churg strauss syndrome = granulomas + asthma/eosinphils
wegeners + granulomas NO asthma/eosinophils

58
Q

ANCA is

A

anto neutrophil cytoplasmic Ab - auto antibody of IgG against cytoplasm of neutrophils

59
Q

P-ANCA staines

A

perinuclear staining

60
Q

C-ANCA STAINS

A

cytoplasmic staining

61
Q

what does LOSS stand for in OA

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

62
Q

pathophysiology of OA

A

loss of matrix, release of cytokines including IL-1, TNF, and mixed metalloproteinases and protoglandins by chondrocytes

63
Q

Joints affected by OA

A 
DIP
base of thumb
c-spine
1st CMC (trapeziummetacarpal joint)
weight bearing joints (hip, knee, lower back)
64
Q

heberedian nodes found where

A

DIP

65
Q

Bouchards nodes found where

A

PIP

66
Q

Where may hip OA pain be felt

A

groin, knee, lower back

67
Q

treatment of OA

A

analgesics
NSAIDS
pain modulators (gabapentin, amtriptyline)
intra-articular steroids/hyaluronic acid
arthroscopic wash out
soft tissue trimming
joint replacement

68
Q

gout crystals are described as?

A

negatively bifringent needle shaped

69
Q

what causes high uric acid

A

beer, red meat, corn syrup, seafood = inc purine synthesis

renal failure, heart failure, diuretics = reduced urate excretion

70
Q

join affected by gout

A

1st MTP > ankle > knee

71
Q

what can diuretics cause

A

chronic tophaceous gout

72
Q

what do you treat acute gout with

A

NSAIDS, colchicin, steroids

73
Q

what do you use for gout prophylaxis

A

allopurinol (xanthine oxidase inhibitor)

** requires cover with NSAIDS cos it takes 2-4 wks to work**

74
Q

pseudo gout crystals

A

calcium pyrophosphate crystals positive bifringent, envelope shaped

75
Q

what is Milwaukee shoulder

A

hydroxyapatite deposition in and around joint causing release of collagens, serine proteases, Il-1

76
Q

who gets Milwaukee shoulder

A

woman 50-60yrs

77
Q

treatment for Milwaukee shoulder

A

NSAIDS, intra-articular steroids, physio

78
Q

2 types of inflammatory arthritis

A

RA

sero-neg arthropathies

79
Q

list sero negative arthropathies (4)

A

ankylosing
psoriatic
reactive
inflam bowel disease arthritis

80
Q

list ser-positive arthropathies (5)

A 
RA
SLE
Scleroderma 
vasculitis
Sjogrens
81
Q

RA usually affects which joints

A

hands
feet
cervical spine

symmetrical polyarthropathy

82
Q

x-ray features of RA

A

hypotrophic: loss of joint space, periarticular erosion

83
Q

enthesitis is

A

inflam at site where tendon attaches to bone

84
Q

arthropathies associated with what genetics

A

HLA-B27

85
Q

what are the “A’s” of anchylosing (6)

A 
axial arthritis
anterior uveitis 
aortic regurgitation 
apical fibrosis
achilles tendonitis 
plAntar fasciitis
86
Q

bussword: pencil in cup

A

psoriatic arthritis

87
Q

features of psoriatic

A

asymmetric sacroilitis
nail involvmant (pitting and onycholysis)
dactylitis
enthetitis

88
Q

usual organisms associated with reactive arthritis

A

chlamydia
salmonela
shigella
yersinia

** infection + HLA-B27**

89
Q

reiters triad

A

arthritis, uveitis, urethritis (cant see, cant pee, sore knee)

90
Q

3 types of muscle disease

A

dystrophies
myopathies
neurogen

91
Q

what would indicate muscle disease

A

weakness, high creatine kinase, atrophy

92
Q

CK levels in:
dystrophies
myopathies
neurogen

A

dystrophies 200-300 x normal
myopathies 20-30
neurogen 2-5

93
Q

examples of inflammatory muscle diseases (4)

A

polymyositis
dermatomyositis
inclusion body myositis
polymyalgia rheumatica

94
Q

what causes:
symmetrical proximal muscle wasting
gotrons sign (mcp scaly eruption)
shawl sign (red over upper back/shoulders)

A

dermatomysoitis

95
Q

dermatomyositis auto Ab

A

ANA & anti-Jo-1

96
Q

what causes asymmetrical distal muscle wasting

A

inclusion body myositis (these seen in biopsy)

more common in men

97
Q

who gets polymyalgia

A

> 50yrs

98
Q

features of polymyalgia rheumatica

A 
shoulder & girdle pain 
fatigue
fever
weight loss
associated with temperal arteritis
99
Q

which muscle disease is associated with increased incidence of malignancy

A

dermatomyositis

ovarian, breast, stomach, lung, bladder

100
Q

mutation of dystrophin gene =

A

duchennes

101
Q

cell mediated CD8+

segmental fibre necrosis

A

polymyositis

102
Q

what happens in duchennes

A

dystrophin mutation. altered anchoring of actin cytoskeleton to basement membrane = fibre tears and uncontrolled calcium entry into cells

103
Q

dystrophy of type 1 muscle cells
central nuclei
ring fibres

A

becker muscular dystrophy (less sever form of duchennes)

104
Q

types of class 2 HLA in human cells

A

HLA-DR, HLA-DQ, HLA-DP

105
Q

Types of class 1 HLA

A

A/B/C

106
Q

HLA for goodpastures

A

HLA-DR2

107
Q

HLA- DR3 FOR

A

graves and SLE

108
Q

HLA for type 1 diabetes

A

DR3/4

109
Q

HLA for RA

A

DR4

110
Q

SLE is a type ___ hypersensitivity condition

A

type 3 hypersensitivity

111
Q

anti-centromere Ab

A

CREST scleroderma

112
Q

anti-Jo-1 Ab

A

polymyositis, dermatomyositis (esp with interstitial lung disease)

113
Q

anti-RNP Ab

A

mixed connective tissue disease & SLE

114
Q

anto-La Ab

A

Sjogrens and SLE

115
Q

anti-smith Ab

A

very specific for SLE

116
Q

anti-Scl70

A

diffuse scleroderma especially if sever organ involvement

117
Q

which antigens are extra cellular and show a speckled appearance

A

Ro and La

shows SLE and sjogrens

118
Q

biopsy in someone with SLe will show what

A

neutrophil, macrophage and immune complexes (IgG)

119
Q

RA is what type of hypersensitivity

A

type 4 (CD4+, macrophages, B cells, IL-1, TNF)

120
Q

goodpastures is what type of hypersensitivity

A

type 2

121
Q

which conditions can you give infliximab

A

RA, crohns, psoriatic arth, ankylosing

122
Q

what is rheumatoid factor

A

Ab against Fc region of IgG = immune complexes

123
Q

examples of NSAIDS

A

naproxin
diclofenac

these can damage kidneys

124
Q

what drug is teratogenic

A

methotrexate - stop 3 months prior to pregnancy in both sexes

125
Q

what disease do you use hydroxychloraquine in

A

SLE, SJOGRENS, RA

** rare retinopathy**

126
Q

who dont you give anti TNF to

A

Tb
pulmonary fibrosis
heart failure

127
Q

side affects of colchicine

A

diarrhoea and vomiting

128
Q

allopurinol works how

A

inhibits xanthine oxidase that turns xanthine into uric acid

129
Q

side affects of allopurinol

A

rash

inhibits warfarin metabolism

130
Q

what do you give to people who cannot tolerate allopurinol

A

febuxostat

131
Q

side affects of corticosteroids (10)

A 
weight gain 
muscle wasting 
skin atrophy 
osteoporosis
diabetes hypertension 
cataracts
glaucoma
fluid retention 
adrenal suppression 
avascular necrosis of femoral head

Rheumatology Tania (2 decks)

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