Rheumatology 1 Flashcards
What factors indicate a poor prognosis in rheumatoid arthritis?
rheumatoid factor positive anti-CCP antibodies poor functional status at presentation X-ray: early erosions (e.g. after < 2 years) extra articular features e.g. nodules HLA DR4 insidious onset
What side effects are seen in the following DMARDs used to treat rheumatoid arthritis:
- methotrexate
- sulphasalazine
- leflunomide
- hydroxychloroquine
- prednisolone
- Myelosuppression
Liver cirrhosis
Pneumonitis
2. Rashes Oligospermia Heinz body anaemia Interstitial lung disease
- Liver impairment
Interstitial lung disease
Hypertension
mnemonic: LEFt climbing a HILl with side effects
- Retinopathy
Corneal deposits
5. Cushingoid features Osteoporosis Impaired glucose tolerance Hypertension Cataracts
What extra-articular features are seen with ankylosing spondylitis?
Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis and cauda equina syndrome
ank. spond. = the As
ANCA associated vasculitis
- What is the target of
a) cANCA
b) pANCA - What types of vasculitis are associated with
a) cANCA
b) pANCA
- a) serine proteinase 3 (PR3)
b) myeloperoxidase (MPO) - a)
- granulomatosis with polyangiitis (90%)
- microscopic polyangiits (40%)
b)
1. microscopic polyangiits (75%)
2. eosinophilic polyangiitis (50%)
3. granulomatosis with polyangiits (25%)
Azathioprine
- What are its side effects?
- What drug can it interact with (and hence needs a lower dose prescribed)?
- Is it safe in pregnancy?
1.
- bone marrow suppression
- pancreatitis
- nausea and vomiting
- increased risk of non-melanoma skin cancer
- allopurinol
- yes
Behcet’s Syndrome
- Who is it most common in?
2.
a) What is the classic triad of symptoms?
b) What else can be seen?
- eastern european young men with a positive family history
- a)
- oral ulcers
- genital ulcers
- anterior uveitis
mnemonic: the OG is UV, rays, which you would go to eastern europe for
b)
- DVT / thrombophlebitis
- neuro and GI involvement
- arthralgia
- erythema nodosum
Bisphosphonates
- What is their mechanism of action?
- When are they given?
- What are their possible side effects?
- inhibit osteoclasts
- prevention of osteoporosis
- hypercalcaemia
- Paget’s
- pain from bony mets
- osteonecrosis of the jaw
- oesophagitis / oesophageal ulcer
- increased risk of atypical stress fracture of proximal humerus
- acute phase just after starting: fever, myalgia, arthralgia
(oesophageal reactions most common with alendronate)
What bone lab values will be seen with
- primary hyperparathyroidism
- secondary hyperparathyroidism (e.g. CKD)
- decreased phosphate, raised Ca, PTH + ALP
2. decreased Ca, raised phosphate, PTH + ALP
What would you associate with the following benign bone tumours
- osteoma
- giant cell tumour
- benign overgrowth of bone (often in skull)
2. “double bubble” or “soap-bubble” appearance in epiphysis of long bone
What would you associate with the following malignant bone tumours
- osteosarcoma
- Ewing’s sarcoma
- chondrosarcoma
- most common primary malignant bone tumour
XR: ‘sunburst’ appearance and Codman triangle from periosteal elevation - severe pain in pelvis and long bones
XR: “onion skin” appearance - tumour of cartilage
Drug-induced lupus
- What drugs can cause it
a) most common
b) others - What antibodies are seen?
- a)
- procainamide
- hydralazine
b)
- phenytoin
- isoniazid
- minocycline
- anti-histone (80-90%)
NOTE:
- anti-ANA 100% +ve
- anti-dsDNA will be -ve
Ehlers-Danlos
- What is it?
- What clinical features are seen?
- connective tissue disorder causing defect in type 3 collagen + therefore increased tissue elasticity
- elastic skin + easy bruising
- joint hyper mobility
- aortic regurgitation / mitral valve prolapse / aortic dissection
- subarachnoid haemorrhage
What should you suspect if pain over pubic symphysis radiating down medial thighs +/- waddling gait in pregnant woman
pubic symphysis dysfunction
Hydroxychloroquine
- What SEs are seen?
- What monitoring is required?
- Is it safe in pregnancy?
- bulls eye retinopathy
(severe + permanent vision loss) - baseline ophthalmology examination with annual checks
- YES
THINK: it is the treatment of choice in SLE which is general diagnosed in women of child-bearing age
