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Rheumatology Flashcards

1
Q

Which condition are anti-histone antibodies associated with?

A

Drug-induced Lupus

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2
Q

Which condition are Anti-Scl-70 antibodies associated with?

A

Diffuse systemic sclerosis

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3
Q

Which condition are anti-centromere antibodies associated with?

A

Limited systemic sclerosis

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4
Q

Which condition are Anti-Ro antibodies associated with?

A

Sjorgen’s syndrome

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5
Q

Which condition are Anti-Jo-1 antibodies associated with?

A

Polymyositis

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6
Q

Which joints are most commonly affected by osteoarthritis?

A

Large joints - hip and knee

Carpometocarpal joints

PIP + DIP

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7
Q

What hand signs are seen in osteoarthritis?

A

Bouchard’s nodes (PIP)

Heberden’s nodes (DIP)

Squaring of the thumb

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8
Q

What are the 4 x-ray signs seen in osteoarthritis?

A

LOSS

Loss of Joint space

Osteophytes

Subchondral cysts

Subchondral sclerosis

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9
Q

How is osteoarthritis managed?

A

First line = oral paracetamol or TOPICAL NSAIDs

2nd line = oral NSAIDS/codeine (remember to co-prescribe PPI)

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10
Q

Which joints are affected by rheumatoid arthritis?

A

Symmetrical distribution

MCP and PIP

Never affects DIP - DIP will be osteoarthritis or psoriatic arthritis

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11
Q

What hand signs are seen in rheumatoid arthritis?

A

Z shaped deformity of the thumb

Swan neck deformity

Boutenniere’s deformity

Ulnar deviation

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12
Q

What x-ray changes are seen in rheumatoid arthritis?

A

Loss of joint space

Juxta-articular osteopororis

Soft tissue swelling

Boney erosions

Periarticular erosions

Subluxation

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13
Q

Which antibodies are associated with rheumatoid arthritis?

A

Rheumatoid factor (non specific but very sensitive)

Anti-CCP antibodies (very specific but not as sensitive)

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14
Q

How is rheumatoid arthritis managed?

A

1st line = DMARD (Methotrexate/Sulfasalazine/Hydroxychloroquine)

2nd line = combination of 2 DMARDs

3rd line = Methotrexate + Inflixamb/Adalimumab

4th line = Methotrexate + Rituximab

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15
Q

How are acute flares of rheumatoid arthritis managed?

A

IM Methylprednisolone

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16
Q

How is rheumatoid arthritis in pregnancy managed?

A

Hydroxychloroquine or Sulfasalazine or Azathioprine

Methotrexate is CI

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17
Q

What is the main adverse effect of Hydroxychloroquine and how is this monitored?

A

Retinopathy

Ophthalmology screening prior to starting and then annually

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18
Q

What is Felty syndrome? What triad is seen? How is it managed?

A

A rare variant of RA

Triad =

Highly active RA

Splenomegaly

Neutropaenia

Management = same as severe RA (methotrexate+pred), also needs to vaccinated against influenza and pneumococcal due to splenomegaly

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19
Q

How does psoriatic arthritis present? What nail changes are seen?

A

Symmetrical polyarthritis is most common but can be asymmetrical

SERONEGATIVE

Sacroilitis (inflammation of pelvis)

Can affect the DIP (unlike RA)

Dactylitis (swelling of the digits)

Nail changes = nail pitting and oncholysis

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20
Q

What x-ray change is seen in psoriatic arthritis

A

Pencil in cup appearance

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21
Q

How is psoriatic arthritis managed?

A

Same as RA

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22
Q

What infections commonly triggers reactive arthritis?

A

Gastroenteritis organisms

Chlamydia

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23
Q

How does reactive arthritis present and what is seen on joint aspiration?

A

Can’t see, can’t pee, cant climb a tree

Acute monoarthritis which presents within 4 weeks of initial infection

Dactylitis

Conjunctivitis and anterior uveitis (can’t see)

Balanitis (can’t pee)

Joint aspiration will be sterile and not grow any organisms

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24
Q

How is reactive arthritis managed?

A

Acute mono arthritis needs to be managed under local hot joint policy

Urgent joint aspiration (gram staining and C+S) to exclude septic arthritis

When reactive arthritis has been diagnosed it is treated w/ NSAIDs

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25
What is ankylosing spondylitis and how does it present?
HLA-B27 associated spondyloarthropathy (seronegative) Usually presents in young men Inflammation of the sacroiliac joints and the joints of the vertebral column Progresses to fusion of the joints Lower back pain and stiffness - inflammatory pattern (worse in morning, improves with movement) Reduced lateral flexion of the spine
26
What x-ray findings are seen in ankylosing spondylitis?
Spine X-ray: Squaring of the lumbar vertebrae Bamboo spine (later stages) Syndesmophytes Pelvic x-ray = Sacroilitis
27
What is the best diagnostic test for ankylosing spondylitis?
Pelvic x-ray showing sacroilitis
28
How is ankylosing spondylitis managed?
NSAIDs | Exercise/physio
29
What other organ systems can ankylosing spondylitis affect other than the spine and pelvis?
Chest pain due to fusion/inflammation of costosternal joints and costovertebral joints Plantar fasciitis Anterior uveitis Pulmonary fibrosis Inflammatory bowel disease Heart block
30
What is systemic lupus erythematosus? How does it present?
Inflammatory autoimmune connective tissue disorder Relapsing-remitting Photosensitive malar rash Arthralgia Myalgia Fever Fatigue Mouth ulcers Splenomegaly Lymphadenopathy
31
Which autoantibodies are associated with SLE?
Anti-nuclear antibodies (not as specific but more sensitive) Anti-dsDNA (more specific)
32
How is SLE managed?
1st line = Hydroxychloroquine (safe in pregnancy) can also try other immunnosuppressants - Methotrexate/Azathioprine
33
What is the association between SLE and complement levels?
Complement levels are usually low during active disease
34
What are complications of SLE?
Cardiovascular disease Recurrent miscarriage Antiphospholipid syndrome Lupus nephritis Pericarditis Pleuritis Anaemia of chronic disease
35
What is discoid lupus erythematosus and how does it present? How is it treated?
Chronic skin condition More common in women with darker skin Slightly increased risk of SLE Photosensitive lesions on the face/ears/scalp - lesions are inflamed dry/patchy/crusty Associated with scarring alopecia Management = topical steroids
36
What antibodies are associated with drug-induced lupus?
Anti-nuclear antibodies Anti-histone antibodies
37
What drugs most commonly cause drug induced lupus?
Procainamide Hydralazine Isoniazid Minocycline Phenytoin
38
What is systemic sclerosis and what are the two types?
Autoimmune inflammatory connective tissue disorder 2 types = Limited and Diffuse Limited = CREST Calcinosis Raynaud's Oesophageal dysmotility Sclerodactyly Telangiectasia + Scleroderma just on face and below elbows. Diffuse = Scleroderma which affects trunk and proximal limbs. Also affects cardiovascular (HTN and coronary artery disease), lungs (pulmonary HTN and pulmonary fibrosis) and the kidney (glomerulonephritis and scleroderma renal crisis)
39
What is seen on nail fold capillaroscopy in systemic sclerosis?
Abnormal capillaries Avascular necrosis Micro-haemorrhages
40
How can you differentiate Raynaud's which is secondary to systemic sclerosis and primary Raynaud's?
Nailfold capillaroscopy
41
Which autoantibodies are associated with systemic sclerosis?
Limited = Anti-centromere Diffuse = Anti-Scl-70
42
What is antiphospholipid syndrome and how can it present?
An autoimmune disorder characterised by - arterial and venous thrombosis and adverse pregnancy outcomes CLOT Clots (both venous and arterial) Livedo reticular (mottled lace like appearance of veins on lower limbs) Obstetric loss Thrombocytopaenia
43
What is seen on clotting bloods in antiphospholipid syndrome?
Prolonged APTT Low platelets
44
How is antiphospholipid syndrome managed?
Primary prophylaxis = Low dose Aspirin (75mg) --> In pregnancy this should be Aspirin + LMWH Secondary prophylaxis (when there has been an episode of VTE) = Lifelong warfarin (switch to LMWH during pregnancy and when trying to conceive).
45
What autoantibodies are seen in antiphospholipid syndrome?
Lupus anticoagulant Anticardiolipin antibodies Anti-beta-2 glycoprotein 1 antibodies
46
Which condition is associated with anticardiolipin antibodies?
Antiphospholipid syndrome
47
How can temporal arteritis/GCA present?
Headache (around temples) Jaw claudication Visual disturbances - amaurosis fugax, blurring, double vision, relative afferent pupillary defect Palpable temporal artery Tenderness around temporal artery Around 50% have symptoms of polymyalgia rheumatic - morning stiffness of the shoulders and pelvic girdle
48
What investigations should be conducted in temporal arteritis/GCA?
Raised ESR > 50 Temporal artery biopsy - shows multinucleated giant cells Other results which may be abnormal: Raised ALP Raised CRP Normocytic anaemia Raised platelets
49
How is suspected temporal arteritis/GCA managed?
Send for inflammatory markers 40mg prednisolone (start treatment before biopsy results are back) If jaw symptoms - 60mg prednisolone If visual symptoms - IV Methylprednisolone
50
How does polymyalgia rheumatic present? How is it managed?
Morning pain and stiffness of the shoulders, neck and pelvic girdle (including thighs) NO WEAKNESS - just pain!! Strong association with GCA Managed with 15mg prednisolone then tapered down
51
Which autoimunne connective tissue disorder causes a raised creatine kinase?
Polymyositis/ Dermatomyositis
52
How does polymyositis present?
Muscle pain, fatigue and WEAKNESS!! Muscle weakness of the shoulders and pelvic girdle
53
How does dermatomyositis present?
Gottron lesions (red or violet bumps that form on the knuckles/knees/elbows) Photosensitive rash on back/shoulders/neck Periorbital oedema Purple rash around eyes
54
What autoantibodies are associated with polymyositis and dermatomyositis?
Polymyositis --> Anti-Jo-1 Dermatomyositis --> Anti-Mi-2 and ANA
55
How is polymyositis and dermatomyositis diagnosed?
Clinical presentation + Elevated CK Autoantibodies Electromyography + Muscle biopsy
56
What condition is associated with a raised CK in malignancy?
Polymyositis (Can be a paraneoplastic syndrome in lung cancer)
57
What is the differential diagnosis of a hot swollen joint?
Septic arthritis Reactive arthritis Gout Pseudogout
58
Which joint is usually affected by gout?
1st MTP (base of big toe)
59
What is seen on joint aspiration in gout?
Monosodium urate crysals Needle-shaped Negatively bifringent of polarised light
60
How is gout managed?
Acute management = NSAIDs or Colchicine (Continue Allopurinol during acute attacks) Prophylaxis = Allopurinol (wait until initial acute attack has settled before prescribing for first time)
61
What is seen on joint aspiration in pseudo gout?
Calcium pyrophosphate Rhomboid shaped Weakly-positively bifringent to polarised light
62
What is seen on x-ray in psueodgout?
Chondrocalcinosis (calcium in the cartilage)
63
How is pseudo gout managed?
Manage acute attacks with NSAIDs or colchicine
64
What is Sjorgen's syndrome and how does it present?
Autoimmune conditions of the EXOCRINE glands Dry eyes, dry mouth, vaginal dryness
65
Which malignancy has an increased risk in Sjorgen's syndrome?
MALT Lymphoma
66
What autoantibodies are associated with Sjorgen's syndrome?
Rheumatoid factor Anti-nuclear antibodies Anti-Ro antibodies Anti-La
67
How can Sjorgen's syndrome be diagnosed?
Schirmer's test
68
How is Sjorgen's syndrome managed?
Artificial saliva/tears Vaginal lubricant
69
Which organisms most commonly cause Septic Arthritis and how does it present?
Staph aureus, but can also be Gonorrhoea in sexually active patients hot, red, swollen painful joint systemic symptoms - fever
70
What is Behcet's disease, how does it present?
Inflammatory conditon Triad = Recurrent oral ulcers and genital ulcers and Anterior uveitis Also... Erythema nodosum Morning stiffness + arthralgia
71
What is polyarteritis nodosa? How does it present?
Vasculitis which affects medium-sized vessels Fever, malaise, arthralgia Mononeuritis Livedo reticularis Haematuria Renal failure Necrotic ulcers
72
What conditions can cause secondary Raynaud's?
Systemic scleross Polycythaemia rubra vera SLE
73
How is Raynaud's managed?
Nifedipine
74
What are features of Marfan syndrome?
Tall stature High arched palate Pectus excavatum (sunken breastbone) Pes planus (flat foot) Dilation of the aortic sinuses - which can cause complications such as aortic regurg/aortic dissection/aortic aneurysm/mitral valve prolapse Upwards lens dislocation Dural ectasia
75
What are features of Ehler-Danlos syndrome?
Elastic/fragile skin Joint hypermobility Easy bruising Aortic regurg Aortic dissection Mitral valve prolapse Subarachnoid haemorrhage
76
What is osteoporosis and how is it diagnosed?
Low bone mineral density Bone mineral density can be calculated by doing a DEXA scan which gives a T score T score = -1 or more = normal, -1 to -2.5 = osteopenia, less than -2.5 is osteoporosis If a fracture in a pt aged 75 or older - treat as osteoporosis w/o scan
77
How is osteoporosis managed?
Bisphosphonates e.g. Alendronate Calcium + vitamin D
78
What are risk factors for osteoporosis?
Old age Post-menopause Low BMI Long term steroids Smoking
79
What is osteomalacia and what is the cause?
Defective bone mineralisation causing soft bones Due to insufficient vitamin D Insufficient vitamin D causes decreased calcium reabsorption Decreased calcium reabsorption causes secondary hyperparathyroidism which increases osteoclast action
80
How does osteomalacia present?
Fatigue bone pain Muscle weakness/aching Abnormal fractures
81
What investigations can be used to diagnose osteomalacia?
Low vitamin D Low calcium Low phosphate However calcium and phosphate may be normal if this has been compensated by a raised PTH Raised ALP
82
How is osteomalacia managed?
Vitamin D (colecalciferol)
83
What is Paget's disease?
Excessive osteoclast action and increased osteoblast action Uncontrolled bone turnover
84
What is seen on skull x-ray in Paget's disease?
Thickened vault Osteoporosis circumscripta (Cotton-wool appearance)
85
Which blood marker is raised in Paget's disease?
ALP Calcium and phosphate are normal
86
Bone disease: decreased calcium, decreased phosphate, increased ALP, increased PTH
Osteomalacia
87
Bone disease: increased calcium, decreased phosphate, increased ALP, increased PTH
Primary hyperparathyroidism
88
Bone disease: normal calcium, normal phosphate, increased ALP, normal PTH
Paget's disease
89
Which conditions are associated with pANCA ? (Not just rheum)
GPA Ulcerative colitis Primary sclerosing cholangitis

Medicine Finals (32 decks)

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