Rheumatology Flashcards
MOA bisphosphonates
inhibits bone resorption by osteoclasts
What is Churg Strauss syndrome?
small- medium vessel vasculitis
asthma + eosinophilia
Criteria for Churg-Strauss syndrome
4+ of…
asthma eosinophilia paranasal sinusitis pulmonary infiltrates vasculitis on histology polyneuropathy or mononeuritis multiplex
Features hereditary haemochromatosis
high iron
Diabetes CCF DCM (reversible with Rx) Cirrhosis Hypogonadism Pseudogout Bronze/ Slate grey skin (reversible)
Inheritance hereditary haemochromatosis
AR
HFE gene mutation
Ix hereditary haemochromatosis
ferritin >1000
genetic testing
Features of PMR
pelvic and shoulder muscle stiffness
(DON’T get proximal muscle pain)
fever, anorexia, weight loss
Ix for PMR
normocytic anaemia
ESR can be >50
High CRP
Rx for PMR
Prednisolone
Condition seen in 30% PMR patients
GCA
Features GCA
Visual disturbances Headache Temporal tenderness Jaw claudication TIAs
Features of PCP pneumonia
Drug that is RF for PCP
post exertional hypoxia
dry cough, fever, weight loss
Drug RF = anti=TNF
Define Raynaud’s
Pallor digits
Then colour change (cyanosis, erythema)
MOA of Raynaud’s
vasospasm without endothelial damage
Types of Raynaud’s
primary
secondary
When to suspect secondary Raynaud’s e.g. connective tissue disease
Onset >30 Painful ASYMMETRICAL episodes ANA positive ulcers/gangrene/ischaemia digits abnormal nail fold capillaries episodes last > 1 hour
Drug that interacts w azathioprine (purine synthesis inhibitor)
Allopurinol (gout)
- xanthine oxidase inhibitor
- xanthine oxidase breaks down azathioprine
- Azathioprine toxicity -> pancytopenia
Osteomalacia Ix
Low Ca
Low Phos
Low Vit D
High ALP (increased osteoblast activity, released f/ bone)
Most likely underlying metabolic cause gout
decrease renal excretion urate
Serum urate level that increases risk of gout
> 7
SLE Ab
ANA
anti ds-DNA
anti-centromere Ab
limited cutaneous systemic sclerosis (CREST)
Anti-Scl-70
diffuse cutaneous systemic sclerosis
Anti Ro and Anti La
Sjogrens
Anti-Jo-1
Dermatomyositis
Anti histone Ab
Drug-induced lupus
Features Takayasu’s arteritis
Large vessel vasculitis
Normally young Japanese women
Signs/Sx Takayasu’s arteritis
Limb claudication on exertion
CP
Systemic Sx - weight loss, fatigue, fever, myalgia
Artery commonly affected in Takayasu’s arteritis
Branches of aorta
Commonly subclavian artery
Rx Takayasu’s arteritis
Glucocorticoids
Methotrexate and azathioprine
Tocolizumab MOA and indication
anti-IL6 monoclonal Ab
Moderate- severe RA and not responded to DMARD/TNF antagonist
Atabacept MOA
cytotoxic T cell antigen 4 (CTLA 4) homologue
Examples anti TNF-alpha agents
infliximab adalimumab etanercept golimumab certolizumab
Indications anti-TNF alpha agents
RA psoriatic arthritis ankylosing spondylitis Crohn's juvenile idiopathic arthritis
Rituximab MOA and indication
Anti CD-20
RA and haem malignancies
Anakinra MOA and indications
anti-IL 1 Ab
RA and adult onset still’s disease
Risk acute lymphoblastic leukaemia and treatment of disease
avascular necrosis of femoral head
2 drugs associated w/drug induced lupus
Hydralazine
Quinidine
Procainamide
Risk with zolendronic acid (bisphosphonate)
jaw osteonecrosis
RA spinal complication
Atlanto-axial subluxation
Low C4 and rheumatoid factor positive
Cryoglobulinaemia
Rx for ankylosing spondylitis
NSAIDs and PT
Ab causing neonatal lupus (and complete HB)
Anti Ro
Anti Jo1 Ab
Dermatomyositis
Polymyositis
First line for prevention steroid induced osteoporosis
Bisphosphonate e.g. alendronic acid
Blood monitoring for methotrexate dose change
Every 2 weeks for 6 weeks
Then monthly until dose + disease stable for 1 year
Drug induced lupus features
Lower incidence nephritis
No skin involvement
Anti-histone Abs
Drugs causing drug induced lupus
Procainamide, hydralazine , minocycline
anti-TNF agents, statins
Conditions associated w/ iritis
Reiter’s
Behcets
Psoriatic arthropathy (20%)
IBD
Proteinuria + diarrhoea in RA. What do you Ix for? What is Ix?
Secondary (AA) amyloidosis (complication of RA) -> nephropathy
Ix = Biopsy (GI/ rectum) and histology
Blood that suggest polymyositis rather than PMR
Raised CK
Rx for <65 year old on steroids if osteoporotic/have fragility fracture
Bisphosphonates
Rx psoriatic arthritis
DMARD
MOA systemic sclerosis
Increased fibroblast activity + fibrosis in different organs
Chronic AI disease
GI problems in systemic sclerosis (limited and diffuse cutaneous)
Malabsorption + malnutrition
Anywhere from mouth to anus
Due to dysmotility because of infiltration of intestinal wall w/ fibrous tissue
Conditions associated w/ anterior uveitis
AS, reactive arthritis, IBD, sarcoidosis, Behcets
Malar rash seen in
SLE, pellagra (niacin), dermatomyositis
What is discitis? Features?
Inflammation vertebral disc space often due to infection
Insidious onset pain, locally tender worsening on activity (NOT STIFFNESS)
What is spondylolisthessis
Movement of vertebra due to instability
Pain worse on activity (as with OA)
May be associated w nerve root compression
PD drugs:
Selegeline MOA
MAO inhibitor
stop DA breakdown in synapse
Pt with PD
Starts drooling
Mx?
glycopyrronium
Levodopa for PD
Normally given with which drug?
carbidopa/ benserazide
(decarboxylase inhibitor)
stops peripheral metabolism to DA
SE of levodopa
dyskinesia on off effect dry mouth anorexia palpitations postural drop psychosis
PD drugs
bromocriptine, cabergoline, ropinirole, apomorphine
MOA?
dopamine receptor agonist
SE of dopamine receptor agonists
e.g bromocriptine, cabergoline, ropinirole, apomorphine
fibrosis
cardiac, petroperitoneal, pulmonary
Rx for drug - induced parkinsonism
procyclidine, benzotropine, trihexyphenidyl (benzhexol)
Antimuscarinics
stop tremor + rigidity
block cholinergic receptors
