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Y2 - MSK > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is the presentation of psoriatic arthritis?

A 
Mono or polyarthritis
Starts asymmetrical but progresses to be virtually indistinguishable from RA
Unilateral or bilateral sacroiliitis
DIPs
Dactylitis
Nail dystrophy
Arthritis mutilans
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2
Q

What is the appearance of psoriatic arthritis on x-ray?

A

Erosions

DIPs: pencil in cup appearance

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3
Q

What is the treatment for psoriatic arthritis?

A

NSAIDs
For persistant synovitis - DMARDs/TNF-alpha
For local synovitis - intra-articular steroid injection
If severe: ciclosporin (immunosuppressant)

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4
Q

What percentage of psoriasis patients have psoriatic arthritis?

A

10%

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5
Q

What should be avoided in psoriatic arthritis?

A

Hydroxychloroquine

Oral steroids

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6
Q

What percentage of IBD patients have enteropatric arthritis?

A

10-15%

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7
Q

In which IBD can enteropatric arthritis persist even when the IBD is well controlled?

A

CD

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8
Q

What is the presentation of enteropatric arthritis?

A

Symmetrical
Lower limb joints
Spondyloarthritis

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9
Q

What is the treatment for enteropatric arthritis?

A

Treat IBD
NSAIDs
For mono-arthritis: intra-articular steroid injection

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10
Q

How is the quality of bone described in osteoporosis?

A

Decreased bone mass
Decreased mineral density
Increased porosity

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11
Q

What is classed as osteoporosis?

A

Bone mineral density >2.5 standard deviations below peak mean value of young adults

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12
Q

What are the risk factors for osteoporosis?

A 
Female sex
Elderly
Corticosteroids
Early menopause
Smoker
Alcohol abuse
Low weight
Hyperthyroidism
CKD
Malignancy
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13
Q

What are phosphate and calcium levels in osteoporosis?

A

Both normal

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14
Q

What is the investigation done in osteoporosis?

A

DEXA scan

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15
Q

What is the management for osteoporosis?

A 
Bisphosphonates (alendronate)
Vit D supplements
Calcitrol
Denusumab
Zoledronic acid
Strontium
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16
Q

What is the onset of ankylosing spondylitis?

A

Episodic

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17
Q

What is the clinical test for ankylosing spondylitis?

A

Schoeber’s test

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18
Q

What is the treatment for ankylosing spondylitis?

A

Analgesia (NSAIDs then anti-TNF)
Physio
For peripheral disease: DMARDs

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19
Q

What is seen on x-ray in ankylosing spondylitis?

A

Bamboo spine
Sacroiliitis
Loss of definition and fusion of SI joints

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20
Q

What are the systemic symptoms of ankylosing spondylitis?

A 
Amyloidosis
Acute Anterior uveitis
IgA nephropathy
Apical lung fibrosis
Aortic dysfunction, Arrhythmia
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21
Q

What is osteomalacia?

A

Decreased mineralisation of bone

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22
Q

What is OA?

A

Progressive degeneration of joints with age

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23
Q

What are the joints most commonly affected by OA in order?

A

Knees
Hips
Hands

24
Q

How does OA manifest in the hips?

A

Fixed flexion external rotation deformity

Trendelenberg gait

25
How does OA manifest in the knees?
Locking Giving way Effusion
26
What is the management for OA?
``` Pain relief (1. oral paracetamol or topical NSAIDs 2. oral NSAIDs 3. opiates - codeine/morphine) Intra-articular steroid injection Physio Weight management (if indicated) Aids and devices Joint replacement ```
27
What is the pathogenesis of RA?
Autoantibodies to Fc portion fo IgG (RF) and CCP
28
What are risk factors for RA?
``` HLA Family history F>M 30-50 years Smoking Other autoimmune conditions ```
29
Which joints are commonly affected in RA?
``` Small joints of hands and feet (not DIPs) Shoulder Elbow Knees Ankle ```
30
What can be seen on US/MRI in RA?
Synovitis | Early erosions
31
How specific is RF in RA, and why is it useful?
70% | Titre is proportional to disease activity
32
Describe the pathology of RA.
Thickened and hyper plastic synovium (pannus) causes boggy swelling at joints and tendons Pannis damages underlying cartilage Thin cartilage exposes bone which is also damaged Increased permeability of vessels causes joint effusions
33
On what factors is RA classified?
Joint involvement (the more the higher the likelihood) Serology (the more positive the higher the liklihood) CRP/ESR (raised means more likely) Duration of symptoms (>6 weeks means more likely)
34
What DAS28 score indicates active disease?
>5.1
35
What is the management for RA?
1. Methotrexate 2. Other DMARD 3. Biologic (anti-TNF, infliximab, if DAS28 >5.1 and tried 2 DMARDs)
36
What are the complications of RA?
Septic arthritis | Amyloidosis
37
What drives inflammation in RA?
T ad B cells TNF-alpha IL-6
38
What is reactive arthritis?
Arthritis following infection caused by persistent antigenic material from bacterial driving inflammation
39
What organisms commonly cause reactive arthritis?
Salmonella Shigella Yersina enterocolitica
40
What are the risk factors for reactive arthritis?
M>F | HLA B27
41
What is the presentation of reactive arthritis?
``` Acute Days-weeks after infection Symmetrical Lower limbs Enthesitis Dactylitis Conjunctivitis Acute anterior uveitis Sacroiliitis Skin lesions ```
42
What are the common features of spondyloarthropathies?
Sacroiliitis Uveitis Enthesitis Dactylitis
43
What is the management of reactive arthritis?
NSAIDs | Treat persisting infection with antibiotics
44
What is septic arthritis?
Joint infection, can cause articular destruction
45
How does septic arthritis occur?
Direct, local or haematogenous spread
46
What are risk factors for septic arthritis?
``` Joint damage (RA) Surgery Age >80 Prosthetic joint Immunosuppression IVDU DM ```
47
What is the presentation of septic arthritis?
Fever Joint pain (red, hot, swollen) Reduced RoM Mono-articular (often knees)
48
What organisms commonly cause septic arthritis?
Staph aureus Neisseria gonorrhoea E. coli Pseudomonas
49
What investigations are done for septic arthritis?
``` Sexual health screen Bloods: blood culture LFTs U&Es CRP FBC Lactase ```
50
What is the management for septic arthritis?
Antibiotics | Joint aspiration, culture, gram stain, sensitivities
51
What antibiotic would be used for gram positives?
Flucloxacillin
52
What antibiotic would be used for penicillin allergy?
Clindamycin
53
What antibiotic would be used for MRSA?
Vancomycin
54
What antibiotic would be used for gram negatives, gonococcal?
Ceftriaxone
55
What are the sepsis 6 for management?
``` O2 Empirical antibiotics IV fluids Blood culture Lactate Urine output ```

Y2 - MSK (9 decks)

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