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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
Q

How does OA manifest in the knees?

A

Locking
Giving way
Effusion

26
Q

What is the management for OA?

A 
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
Q

What is the pathogenesis of RA?

A

Autoantibodies to Fc portion fo IgG (RF) and CCP

28
Q

What are risk factors for RA?

A 
HLA
Family history
F>M
30-50 years
Smoking
Other autoimmune conditions
29
Q

Which joints are commonly affected in RA?

A 
Small joints of hands and feet (not DIPs)
Shoulder
Elbow
Knees
Ankle
30
Q

What can be seen on US/MRI in RA?

A

Synovitis

Early erosions

31
Q

How specific is RF in RA, and why is it useful?

A

70%

Titre is proportional to disease activity

32
Q

Describe the pathology of RA.

A

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
Q

On what factors is RA classified?

A

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
Q

What DAS28 score indicates active disease?

A

> 5.1

35
Q

What is the management for RA?

A
  1. Methotrexate
  2. Other DMARD
  3. Biologic (anti-TNF, infliximab, if DAS28 >5.1 and tried 2 DMARDs)
36
Q

What are the complications of RA?

A

Septic arthritis

Amyloidosis

37
Q

What drives inflammation in RA?

A

T ad B cells
TNF-alpha
IL-6

38
Q

What is reactive arthritis?

A

Arthritis following infection caused by persistent antigenic material from bacterial driving inflammation

39
Q

What organisms commonly cause reactive arthritis?

A

Salmonella
Shigella
Yersina enterocolitica

40
Q

What are the risk factors for reactive arthritis?

A

M>F

HLA B27

41
Q

What is the presentation of reactive arthritis?

A 
Acute
Days-weeks after infection
Symmetrical
Lower limbs
Enthesitis
Dactylitis
Conjunctivitis
Acute anterior uveitis
Sacroiliitis
Skin lesions
42
Q

What are the common features of spondyloarthropathies?

A

Sacroiliitis
Uveitis
Enthesitis
Dactylitis

43
Q

What is the management of reactive arthritis?

A

NSAIDs

Treat persisting infection with antibiotics

44
Q

What is septic arthritis?

A

Joint infection, can cause articular destruction

45
Q

How does septic arthritis occur?

A

Direct, local or haematogenous spread

46
Q

What are risk factors for septic arthritis?

A 
Joint damage (RA)
Surgery
Age >80
Prosthetic joint
Immunosuppression
IVDU
DM
47
Q

What is the presentation of septic arthritis?

A

Fever
Joint pain (red, hot, swollen)
Reduced RoM
Mono-articular (often knees)

48
Q

What organisms commonly cause septic arthritis?

A

Staph aureus
Neisseria gonorrhoea
E. coli
Pseudomonas

49
Q

What investigations are done for septic arthritis?

A 
Sexual health screen
Bloods:
blood culture
LFTs
U&Es
CRP
FBC
Lactase
50
Q

What is the management for septic arthritis?

A

Antibiotics

Joint aspiration, culture, gram stain, sensitivities

51
Q

What antibiotic would be used for gram positives?

A

Flucloxacillin

52
Q

What antibiotic would be used for penicillin allergy?

A

Clindamycin

53
Q

What antibiotic would be used for MRSA?

A

Vancomycin

54
Q

What antibiotic would be used for gram negatives, gonococcal?

A

Ceftriaxone

55
Q

What are the sepsis 6 for management?

A 
O2
Empirical antibiotics
IV fluids
Blood culture
Lactate
Urine output

Y2 - MSK (9 decks)

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