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Revision > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What auto-antibodies are found in SLE?

What is the initial test?

A

Anti- dsDNA
Anti-smith

Initial test - ANA *** very sensitive.

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2
Q

What auto-antibodies are found in drug induced Lupus? E.g. Hydralazine

A

Anti-histone

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3
Q

What auto-antibodies are found in systemic sclerosis

A

Anti-scl70

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4
Q

What auto-antibodies are found in CREST syndrome/ limited sclerosis?

A

Anti-centromere

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5
Q

What auto-antibodies are found in polymyositis?

A

Anti-Jo1

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6
Q

What auto-antibodies are found in Sjogren’s disease

A

Anti-Ro

Anti-La

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7
Q

What auto-antibodies are found in primary biliary cirrhosis?

A

Anti- mitochondrial

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8
Q

What auto-antibodies are found in autoimmune hepatitis?

A

Anti-Smooth muscle

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9
Q

What auto-antibodies are found in Churg strauss, Ulcerative colitis and primary sclerosis group cholangitis?

A

pANCA

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10
Q

What auto-antibodies are found in wegeners granulomatosis?

A

cANCA

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11
Q

What auto-antibodies are found in Coeliac disease?

A

Anti-tissue transglutaminase (TTG)
Anti - gliadin
Anti- endomysial

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12
Q

What auto-antibodies are found in Rheumatoid arthritis?

A

ANA

Can be found in many other auto-immune diseases
It is also the initial one found in SLE

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13
Q

Screening test & confirmatory test of SLE?

A

ANA - screening, more sensitive

Anti-dsDNA - specific
= can be used for disease monitoring ( but its not present in all patients*
)

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14
Q

What is SLE?

A

Multisystem autoimmune disorder
Women >men
Typically appears early adulthood

Remember - +ve ANA, -be ANCA, raised ESR
+/- proteinuria & hematuria - depends on renal involvement
Painful joints and morning stiffness

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15
Q

C3 C4 use in SLE?

A

C3 C4 - complement levels - LOW during active disease

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16
Q

What is chronic fatigue syndrome?

Features seen?

A

> /= 4 months of disabling fatigue that affects physical or mental function >50% of the time in absence of other cause

Women > Men

Features =
Sleep problems - lack/excessive
Muscle/joint problems
Headaches

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17
Q

Investigation for chronic fatigue syndrome?

A 
FBC
U&E
LFT
Glucose
TFT
ESR CRP
CK 
Ferritin
Coeliac screening 
Urinalysis
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18
Q

Management of chronic fatigue syndrome

A

Cognitive behaviour therapy * very effective

Graded excercise therap

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19
Q

What is polymyositis?

What are its features?

A

It’s an inflammatory myopathy
Features=
Symmetrical and diffuse muscle weakness = PROXIMAl>DISTAL
Common problems - rising from chair, combing hair, lifting objects, getting out of bath, climbing stairs

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20
Q

Lab investigations for polymyositis

DX??

A

Creative Kinase - elevated
Anti-Jo1 antibodies

DX- Muscle biopsy

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21
Q

Labs for polymyalgia rheumatica

A

CK - normal
ESR >30 ** initial test
CRP > 6

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22
Q

Features of polymyalgia rheumatica

A

Aching and stiffness - proximal
- difficulty getting out of bed, getting up from chair, raising arm above head

50% have temporal arteritis***

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23
Q

Treatment of polymyalgia rheumatica

A

Prednisolone

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24
Q

What is Sjögren’s syndrome?

A

Autoimmune disorder affects EXOCRINE glands = dry mucosal surfaces

F>M (9:1)

Can be primary or secondary
Secondary = SLE, RA

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25
Q

Features of Sjögren’s syndrome

A

Dry eyes - keratoconjunctivitis sicca
= itchy eyes, sandy
= SCHIRMER’s test = decreased tear prod
= Rose Bengal stain - may show corneal ulceration 2ry to dry eyes

Dry mouth - difficulty swallowing food
Recurrent parotitis - BILATERAL enlarge the of parotid glands

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26
Q

Investigations of Sjögren’s syndrome

A 
Schirmer’s test
Rose Bengal stain 
Rheumatoid factor * positive in 100% patients 
ANti- RO (SSA)70%
Anti-LA (SSB) 30%
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27
Q

Management of Sjögren’s syndrome

A

No cure.

Artificial saliva and tears - HYPERMELLOSE DROPS

28
Q

What is systemic sclerosis (SCLERODERMA)

A

Unknown ethology
Hardened sclerotic skin + connective tissue
F>M (4:1)

2 types
Limited - CREST
Diffuse

29
Q

What is Raynaud’s phenomenon?

Management?

A

Raynaud’s - pale digits, hands
=due to ischemia — blue when exposed to cold
Due to deoxygentaion - they then become red.

Management -
Nifedipine- only drug licences to treat raynauds

30
Q

What is CREST syndrome?

A

Subtype of scleroderma - affects FACE + DISTAL LIMBS

Calcinosis,Raynauds,Esophageal dysmotility,Sclerodactyly,Telangectasia

Raynauds first - slow onset and progression therefore other CREST seen later.

SCL-70 antibodies negative
ANA +ve (mostly)
Associated with anti-centromere antibodies

31
Q

What is diffuse scleroderma?

A 
Affects TRUNK + PROXIMAL LIMBS
Rapid/ fast progression
Poor prognosis 
SCL -70 POSITIVE 
ANA +ve
32
Q

Complications and most common cause of death in diffuse systemic sclerosis

A

Most common cause of death - respiratory involvement
= 80%
- ILD, Pulmonary arterial hypertension (PAH)

Other complications -
Renal disease, HTN

33
Q

What is giant cell arteritis?

Features?

A

Temporal cell arteritis - arterial inflammation
LARGE vessel vasculitis
Sometimes associated with PMR (50%)

Features?
>55 y/o
Rapid onset - < 1 month
Headache, blurry vision , jaw claudication, scalp tenderness

34
Q

Investigations for temporal arteritis

How do you confirm the diagnosis?

A

Raised ESR , CRP may be elevated
Dx - temporal artery biopsy

note - CK and EMG = normal

35
Q

Treatment temporal arteritis

A

High dose Prednisolone
Urgent ophthalmic review

Added on med -
aspirin - decrease stroke and visual loss
Bisphosphonates - high doses of steroids can cause osteopenia and osteoporosis

36
Q

Features of gout

A

Gout - form of inflammatory arthritis

Main features- pain swelling erythema
70% of presentation affect 1st MTP - big toe - podagra
Others - ankle wrist knee

37
Q

Medications that can cause gout

A

Thiazides diuretic - bendroflumethiazide
Loop diuretics - furosemide
Alcohol

38
Q

How do you diagnose gout

A

Synovial fluid aspiration and analysis
= negative birefringent

*send for culture only if feverish

Serum Uric acid - normal/low in acute gout
- measure 4-6 weeks after acute stage is relieved

39
Q

Management of acute attack of gout

Long term management

A

1st line - NSAID - ibuprofen, Naproxen
2nd line - Colchicine

Long term -after 2 weeks of acute attack
Allopurinol + NSAIDs + colchicine

40
Q

When should you think of septic arthritis?

A

Mono arthritis - single joint involvement (knee common, shoulder)
+ fever, pain, swelling, limited movement, hotness

+ RF = DM steroid HIV RA

41
Q

Commonest causative organism of septic arthritis?

A

Staph aureus

42
Q

Commonest causative organism of septic arthritis in young sexually active ?

A

N.Gonorrhoea

43
Q

Diagnosis of septic arthritis

A

Aspiration of synovial fluid - culture + sensitivity

Blood culture

44
Q

Management of septic arthritis?

A

** IV antibiotic 1 week until BC negative and swelling resolves
Oral antibiotics 4 weeks

Flucloxacillin - 4-6 weeks = 1st line

If allergic to penicillin - Clindamycin

If organism is Gonorrhoea - Cefotaxime, Ceftriaxone

Not responding — repeated percutaneous aspiration

45
Q

What is reactive arthritis?

A

Seronagtive spondyloarthritis
Asymmetric
= migratory oligoarthritis of LL (knees. Ankles)
+ back pain
+ extraarticular features - Reiters triad + skin (maculopapular rash)

Young adults, typically no fever
Follows STI or GI infection (dysentery cell illness)

46
Q

Reiters triad

A

Extraarticular features of reactive arthritis

  • conjunctivitis, uveitis
  • urethritis
  • arthritis

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

47
Q

Management of reactive arthritis
Symptomatic
Persistent disease

A

-Symptomatic - analgesia, NSAIDs, intractable-articulate steroids
= symptoms rarely last > 10 months
-Sulfasalzine+ methotrexate for persistent disease

48
Q

What is De Quervain’s disease?

A

Gamer thumb/mummy thumb
Pain under root of thumb

Common after pregnancy - RSI of extensor pollicis brevis +abductor pollicis longus

49
Q

Tennis elbow

A

Lateral epicondylitis

Wrist extension affected

50
Q

Golfer’s elbow

A

Medial epicondylitis

Finger flexors and pronation are affected
- baseball,construction,plumber injury

51
Q

Features of Churg Strauss/ Eosinophilic Granulomatosis w/ polyangiitis

A

Asthma + nasal polyps+allergic rhinitis
Eosinophilia
+other organs = purpurin, glomerluonephritis, HF, skin nodules

52
Q

Lab and imaging findings Churg Strauss

A

CT - ground glass attenuation

Eosinophilia
Raised ESR CRP IgE
**pANCA

53
Q

Features of Wegener’s granulomatosis / Granulomatosis w/ polyangiitis

A

URT - sinusitis/ nasal septum perforation/epistaxis/nasal crusting
+ hematuria/hemoptysis

Bleeding = nose, lung, kidney

*** c-ANCA

54
Q

Rheumatoid arthritis - management

A

DMARD mono therapy - methrotrexate +/- short course prednisolone

NSAIDs for severe joint pain

55
Q

Feature of ankylosing spondylitis

A

Morning stiffness
Uveitis (painful eye)
Low back pain - worse in morning, improves with excercise
Tenderness of SI joint

56
Q

ankylosing spondylitis
To diagnose -
Treatment

A

NSAIDs — 1st line
Anti-TNF - 2nd line

Dx - X-RAY of SI joint **

57
Q

Lab investigations ankylosing spondylitis

A

Raised WBC ESR
+/- Anemia

HLA-B27 - positive in 10%, has strong association

58
Q

ankylosing spondylitis - associations

A

Anterior uveitis

Aortic regurgitation

59
Q

What is Schober’s test?

A

assesses the amount of lumbar flexion

60
Q

Features of Sarcoidosis

A

Erythema nodosum. - tender red nodules over shins
Bilateral hilar lymphadenopathy - common on CXR
Polyarthralgia
Hypercalcemia,fever.

> 2 or more = consider sarcoidosis

61
Q

3 Syndromes associated with sarcoidosis

A

1.Lofgren’s - acute form of sarcoidosis
= bilateral hilar lymphadenopathy + erythema nodosum, fever, polyarthralgia
-excellent prognosis

  1. Mikulicz - parotid enlargement + lacrimal gland enlargement
    = dry mouth, face swelling
    - due to sarcoidosis, TB, lymphoma
  2. Heerfordt’s syndrome
    Uveoparotid fever - parotid enlargement + fever + uveitis 2ry to sarcoidosis
62
Q

Diagnostic criteria of Rheumatic Fever

A

RF - immunological reaction to recent strept pyogene infection (2-6 is)

Criteria =
2 major or
1 major + 2 minor

Evidence of recent strept infection - raised antibodies /+ throat swab/+ group A strept antigen test

63
Q

Major criteria of RF (5)

A 
Erythema marginatum - pink annular rash trunk limbs
=seen in 10% children, rare in adults
Sydenham chorea - late
Poly arthritis 
Pancarditis
Subcutaneous nodules

** J♥️NES

64
Q

Minor criteria of RF (4)

A

Raised ESR CRP
Fever
Arthralgia
Prolonged PR

65
Q

Labs in RF

A

raised ESR - most likely to be abnormal
Most SPECIFIC = ASO antibodies (antistreptolysin O antibodies)
- the most appropriate test

66
Q

Management of RF

A

Antibiotics - Oral penicillin V
Anti-inflammatory- NSAIDs 1st line
Treatment of complications

Revision (31 decks)

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