Rheumatalogy

Question 1

Symptoms/signs of SLE

Answer 1

Mild - skin malar rash, hair, joints, lymphadenopathy

Moderate - lungs and heart haem

Severe
Kidneys and brain

SLE
Glomerulonephritis
Pleurisy and pleural effusion
Pericarditis with pericardial effusion

Question 2

Antibodies for SLE

Answer 2

Anti-dsDNA is more specific for lupus

Can also look at ANA - Ro, La, Sm, RNP

Question 3

SLE CRP ESR

Answer 3

CRP NORMAL

ESR high

Question 4

What tests do you do for SLE?

Answer 4

FBC
Urinalysis - more sensitive for inflammatory nephritis
and creatinine and urea 
LFTs
CXRs
Lung function
ECG
Echo

Question 5

Mild SLE treatment

Answer 5

Hydroxychloroquine

Question 6

Moderate/severe treatment for SLE

Answer 6

Prednisolone

Question 7

Name some other drugs used for suppression of moderate/severe disease

Answer 7

Mycophenolate mofetil

Azathioprine

Question 8

Primary Sjogren’s syndrome

Answer 8

Inflammatory infiltration and destruction of exocrine glands -
lacrimal glands and salivary glands

Causing dryness of eyes and mouth

Question 9

Signs in sjogren’s

Answer 9

Enlarged parotid glands
Dry mouth
No saliva pooling when you ask pt to move tongue upwards
Dry eyes

Question 10

Diagnosis of Sjogrens - which antibodies do you look for?

Answer 10

ANA positive
ENA postiive (anti-Ro, anti-La)
RF positive

Question 11

What are Ro and La

Answer 11

Ribonuclear proteins

Question 12

Which part of the body do you biopsy

Answer 12

Foci of lymphocytic infiltrates in lip gland biopsy

Question 13

Treatment for Sjogren’s

Answer 13

Tear substitues
Saliva substitutes
Pilocarpine (cholinergic agonist to stimulate saliva)

Question 14

Complication with sjogren’s

Answer 14

Increased risk of lymphoma due to B cell activity

Question 15

Which muscles are more m

Answer 15

Proximal muslces more invovled than distal muslces

Question 16

Which muscles are more involved in polymyositis?

Answer 16

Proximal muslces more involved than distal muslces

Question 17

Idiopathic inflammatory myositis signs

Answer 17

Gottron's papules
over MCP and PIP joints purpley/red thickening
Shawl sign 
Shawl sign 
Heliotrope rash
Mechanic's hands

Question 18

Antibodies for scleroderma

Answer 18

ANA:

• anti-centromere Ab
• anti-topoisomerase antibody (Scl70)

Question 19

Pathological features of scleroderma

Answer 19

Fibroblast activation
Fibrosis
Th2 and Th17 inflammation
Fibrosis
Vascular disease

Question 20

Signs of scleroderma

Answer 20

Calcinosis
Raynauld's 
Esophageal dysmotility (fibrosis)
Sclerodactyly (tightening of skin due to fibrosis)
Telangiectasia

Question 21

Limited cutaneous systemic sclerosis features

Answer 21

Primary pulmonary HTN

Anticentromere staining

Question 22

Diffuse cutaneous systemic sclerosis features

Answer 22

Interstitial lung disease
Scleroderma kidney/renal crisis
Anti-Scl70 staining

Question 23

Management of scleroderma

Answer 23

Pred
Steroid sparing agents

Nifedipine for Raynaud’s if vascular disease (vasodilation)

Question 24

Systemic symptoms of vasculitis

Answer 24

Myalgia
Fever
Weight loss
Fatigue
Arthralgia

Question 25

Systemic vasculitis classification

Answer 25

Large vessel

Question 26

Large vessel vasculitis

Answer 26

Aorta/branch of aorta GCA Takayasu arteritis

Question 27

Medium vessel vasculitis

Answer 27

Kawasaki | Polyarteritis nodosa

Question 28

Small vessel vasculitis

Answer 28

ANCA-associated to neutrophils | Immune complex vasculitis

Question 29

Mixed vessel vasculitis

Answer 29

Behcet's disease - to both artery and vein

Question 30

Presentation/features of takayasu arteritis

Answer 30

Upper limb claudication / right arm crampy pain CNS disease if carotid involvement HTN if renal artery stenosis not granulomatous

Question 31

Epidemiology of takayasu arteritis

Answer 31

Young women from 'east'

Question 32

What is GCA

Answer 32

Inflammation and ischemia | Aorta and branches

Question 33

Scan for GCA

Answer 33

FDG PET scan to look for inflammation

Question 34

Symptoms of GCA

Answer 34

Tender temporal region plus headache Artery to masseter involvement- jaw claudication Opthalmic/retinal/ciliary arteries - visual loss

Question 35

Investigations for GCA

Answer 35

Raised ESR and CRP Abnromal temp artery ultrasound scan - halo sign Temporal artery biopsy

Question 36

Treatment for GCA

Answer 36

High dose pred - 40-60mgs/day start before biopsy

Question 37

Where is the inflammation in PMR?

Answer 37

Bursitis - subacromial, trochanteric | Synovitis - shoulder, hip, other joints

Question 38

Investigation findings for PMR

Answer 38

Raised ESR and CRP | Normal CK

Question 39

Presentation of PMR

Answer 39

Stiff arms/limbs Tender over trochanteric/subacromial bursea Restricted movement Worse in morning

Question 40

Treatment for PMR

Answer 40

Pred 15 mgs

Question 41

What is polyarteritis nodosa? What can you get with it?

Answer 41

Rare inflammation of middle sized arteries in middle aged men. ``` GI tract Coronary arteries Renal arteries Skin - palpable nodules Nerves - mononeuritis multiplex ```

Question 42

Complications of Polyarteritis nodosa?

Answer 42

Aneurysms Note also association with hep B (treat with pred + steroid sparing agent + treat hep B)

Question 43

What is small vessel vasculitis associated with?

Answer 43

Anti neutrophil cytoplasmic antibodies

Question 44

Types of small vessel vasculitis

Answer 44

Microscopic polyangiitis GPA - granulomatosis with polyangiitis eGPA - Eosinophilic granulomatosis with polyangiitis

Question 45

Symptoms of small vessel vasculitis

Answer 45

``` Sinusitis Nose bleeds Collapse of nose septum Pulmonary haemorrhage due to nodules glomerulonephritis ```

Question 46

Example of immune complex vasculitis

Answer 46

IgA disease

Question 47

Symptoms of IgA disease

Answer 47

``` Purpuric rash often triggered by URTI Arthritis Glomerulonephritis Abdo pain Self limiting ```