Rheumatology Flashcards
Which crystal is deposited in gout?
Monosodium urate
Which crystal is deposited in pseudogout?
Calcium pyrophosphate dihydrate
Name some of the cases of gout
- Renal impairment
- Malignancy
- Hypertension
- Alcohol
- Drugs
- Hypothyroidism
- Severe psoriasis
What is Lesch Nyan syndrome and how does it present?
- X linked HGPRT deficiency
- Intellectual disability
- Aggressive and impulsive behaviour
- Self mutilation
- Gout
- Renal disease
How can an acute flare up of gout be managed?
- NSAIDs
- Colchicine
- Steroids
Give examples of drugs that lower uric acid
- Allopurinol
- Febuxostat
- Uricosuric agents e.g. sulphinpyrazone
- Canakinumab
How can pseudogout be managed?
- NSAIDs
- I/A steroids
How does polymyalgia rheumatica present?
- Sudden onset of shoulder +/- pelvic girdle stiffness
- F>M
- ESR > 45
- Anaemia
- Malaise, weight loss, fever or depression
- Arthralgia/synovitis
How is polymyalgia rhemumatica managed?
- Prednisolone 15mg per day initially
- 18-24 month course
- Bone prophylaxis
What result on a DXA scan is found in osteoporosis?
Name some of the endocrine causes of osteoporosis
- Thyrotoxicosis
- Hyper and hypoparathyroidism
- Cushings
- Hyperprolactinaemia
- Hypopituitarism
- Early menopause
Name the rheumatic causes of osteoporosis
- Rheumatoid arthritis
- Ankylosing spondylitis
- Polymyalgia rheumatica
Name the GI causes of osteoporosis
- IBD
- PBC, CAH, Alcoholic cirrhosis and viral cirrhosis
- Chronic pancreatitis, Coeliac disease, Whipples disease, short gut syndrome and ischaemic bowel
Name some medications which cause osteoporosis
- Steroids
- PPI
- Anti-epileptics
- Aromatase inhibitors
- GnRH inhibitors
- Warfarin
Name the management options for osteoporosis
- HRT
- SERMs
- Bisphosphonates
Name some of the side effects of bisphosphonates
- Oesophagitis
- Iritis/uveitis
- ONJ
- Atypical femoral shaft fratures
- Denosumab
- Teriparatide
Name some of the non -pharmacological management options for osteoporosis
- Thermotherapy
- Electrotherapy
- Aids and devices
- Manual therapy
Name some of the pharmacological management options for osteoporosis
- Paracetamol and NSAIDs
- Topical NSAIDs and capsaicin (knee and hand)
- Intra-articular injections (steroids, hyaluronic acid)
Name the changes seen on an x-ray in someone with osteoarthritis
- Loss of joint space
- Osteophytes
- Subchondral cyst
- Subchondral sclerosis
Name the criteria for SLE
- Malar rash
- Discoid rash
- Photosensitivity
- Oral ulcers
- Arthritis in >1 joint
- Pleurisy/pericarditis
- Proteinuria or cellular casts in urine
- Seizures or psychosis
- Low WCC, platelets, lymphocytes and haemolytic anaemia
- Anti ds-DNA, SM, cardiolipin, anticoagulant and low complement
- ANA
Name the complications of scleroderma
- Pulmonary hypertension
- Pulmonary fibrosis
- Renal crisis
- Small bowel bacterial overgrowth
Name the clinical features of Sjogren’s syndrome
- Dysphagia
- Abnormal oesophageal motility
- Interstitial lung disease
- Seizures
- Hemiplegia, ataxia and cranial nerve lesions
- Renal tubular acidosis
- Sensory neuropathy
- Mononeuritis multiplexo
Name the classification criteria for GCA
3 of the following
- Age > 50
- New headache
- Temporal artery redness/reduced pulsation
- ESR > 50
- Abnormal temporal biopsy
Name the types of ANCA associated vasculitis
- Wegener’s vasculitis
- Microscopic polyangiitis
- Eosinophillic granulomatosis with polyangiitis
What is Wegeners vasculitis and where does it affect?
- Necrotising granulomatous inflammation
- Upper and lower respiratory tract
Where does microscopic polyangiitis affect?
- Small vessels
- Necrotising glomerulonephritis is common
Which conditions is eosinophillic granulomatosis with polyangiitis associated with?
- Asthma
- Eosinophilia
Name the treatment options for multi-system autoimmune diseases
Mild: hydroxychloroquine
Moderate: Azathioprine, methotrexate and mycophenolate
Severe: Cyclophosphamide and rituximab
How does rheumatoid arthritis present?
- Morning stiffness
- Arthritis of hand joint
- Rheumatoid nodules
- Raised serum rheumatoid factor
Which x-ray changes can be seen in rheumatoid arthritis?
- Loss of joint space
- Erosions
- Osteopenia (soft bone)
- Soft tissue swelling
- Anti CCP antibodies, ACPA
How can rheumatoid arthritis be managed?
- NSAIDs
- DMARDs
- Biologics
- Oral/IM/IA steroids
How does ankylosing spondylitis present?
- Young males
- Inflammatory back pain
- Limitation of anterior-posterior and lateral planes of the lumbar spine
- Limitation of chest expansion
- Bilateral sacroiliitis
- Other features; achilles tendonitis, uveitis, cardiac disease etc.
How can ankylosing spondylitis be managed?
- Physiotherapy
- NSAIDs
- Sulfasalazine
- Anti-TNF
- Anti-IL-17
- Treatment of osteoporosis
- Joint replacements and spinal surgery
How does psoriatic arthritis present?
- Inflammatory pain and peripheral joint swelling
- Night pain in the axial skeleton and tendon insertions
- Psoriatic nail disease
- Conjunctivitis and anterior uveitis
How can psoriatic arthritis be managed?
- DMARDS
- Steroids
- Physio and OT
- Cyclosporine
- Anti-TNF
- Anti-IL-17 and IL-23
Name the three components of Reiter’s syndrome
- Arthritis
- Urethritis
- Conjunctivitis
How can reactive arthritis be treated?
- Acute: NSAID, joint injection and DMARDs
- Chronic: NSAIDs and DMARDs
How can enteropathic arthritis be managed?
- Sulfasalazine
- Steroids
- Methotrexate
- Anti-TNF
- Bowel resection
