Rheumatological Red Flags

Question 1

Which vessels are typically effected in GCA?

Answer 1

Typically the proximal branches of the aorta

Question 2

What is the cause of pseudogout?

Answer 2

Calcium pyrophosphate crystals

Question 3

When do you suspect giant cell arteritis?

Answer 3

Caucasian men and women >55

New headache

Jaw claudication

Unexplained fever

Polymyalgia rheumatica type symptoms

Question 4

What are some clinical features sugestive of systemic inflammation?

Answer 4

Fatigue

Lethargy

Insidious onset

Question 5

What is the target of rituximab?

Answer 5

B cells

Question 6

Pathologically, how does GCA appear on biopsy?

Answer 6

Patchy

Giant cells

Destruction of elastic intima

Question 7

What are some causes of a severe monoarthritis?

Answer 7

Septic arthritis

Crystal arthritis

Subchondral bone lesion

Haemarthrosis

(palindromic rheumatism)

Question 8

What are the large vessel vasculitidies?

Answer 8

GCA

Takayasu

Question 9

What are the medium vessel vasculitidies?

Answer 9

Kawasaki’s

Polyarteritis nodosa

Question 10

What are the small vessel vasculitidies?

Answer 10

ANCA associated

• Wegener’s
• Microscopic polyangiitis
• Churg-Strauss

Immune Complex Associated

• Cryoglobulinaemia
• IgA
• Hypocomplementemic Urticarial Vasculitis (HUV)
• Anti-GBM (Good Pastures)

Question 11

What is Behcet’s? What are it’s characteristic manifestations?

Answer 11

Multisystem, variable size vasculitis

Aphthous ulcers, genital ulceration, and uvitis

Question 12

What is polymyalgia rheumatica? What is it associated with?

Answer 12

A chronic inflammatory disease of the elderly characterised by proximal myalgia’s, particularly of the shoulder girdle

Giant cell arteritis

Malignancy (paraneoplastic effect)

Question 13

What are some complications of GCA?

Answer 13

Ophthalmic artery - Blindness

Subclavian - Arm claudication

Coronary - Angina, infarction

Carotid - Stroke, TIA

Aorta - aneursym

Iliac - leg claudication

Renal - renovascular hypertension

Mesenteric - Bowel infarction

Question 14

What must be done in response to a GCA diagnosis?

Answer 14

Commense prednisolone 40-80mg

Temporal artery biopsy

Question 15

When should methotrexate be considered as an alternative therapy in GCA? What dose?

Answer 15

When long term, high dose (5-10mg) steroids are required and the risk of steroid side effects are high

7.5mg up to 20mg weekly

Question 16

What is the typical pattern of joint involvement in septic arthritis?

Answer 16

Single, large joints

Question 17

What are some important Ix for septic arthritis?

Answer 17

Joint effusion

Plain xray

MRI

FBE/Blood cultures

CRP

Question 18

What should be considered when managing septic arthritis?

Answer 18

Possible infective endocarditis

Deep abscess

Question 19

What is the impirical therapy for septic artheritis (prior to culture results)?

Answer 19

2g of Flucloxacillin 6 hourly IV

Arthroscopic Joint wash out

Question 20

With what signs and symptoms can small vessel vasculitidies present?

Answer 20

Fever, malaise, weight loss

Rash (palpable purpura)

Mylalgias, arthralgia

Nail fold infarct

Mononeuropathy multiplex (eg foot drop)

Haematuria, proteinuria

Diffuse alveolar haemorrhage

Upper respiratory tract infection

Question 21

What are some DDx for small vessel vasculitis?

Answer 21

Meningococcal

Straphylococcus endocarditis

Subacute infective endocarditis

Thrombocytopenic purpura

Arterial thrombosis

Question 22

What is Henoch-Schonlein purpura?

Answer 22

An IgA mediated, small vessel vasculitis that presents with palpable purpura in the lower limb

Question 23

What is cryoglobulinaemia? How are they classified?

Answer 23

Single or mixed immunoglobulins that undergo reversible precipitation at low temperatures

Essential, idiopathic

Secondary to another disease

Question 24

In which patient cohort might you suspect that a acute polyarthritis is attributable to infection?

Answer 24

Young person with multiple/new sexual partner - disseminated N. gonorrhea

Question 25

What are the typical agents of septic arthrits?

Answer 25

Staph aureas

Streptococcus pyogenes

N. gonorrhea

E. coli

Question 27

What are some DDx for a palpable purpritic rash?

Answer 27

Meningococcal meningitis

Staphylococcal bacteraemia

Subacute bacterial endocarditis

Drug reaction - OCP or Abx

Henoch-Schonlein purpura

TTP

Arterial thromboembolism

Question 28

How does Henoch Schonlein purpura present?

Answer 28

Fever

Anorexia

Headache

Purpura

Abdo pain and vomiting

Joint pain