Rheumatology Flashcards
MTX MOA?
Inhibits dihydrofolate reductase
give some SEs of MTX
mucositis myelosuppression pneumonitis pulmonary fibrosis liver fibrosis folate deficiency
What drugs should you avoid prescribing with MTX?
Trimethoprim + Co-trimoxazole –> Risk of marrow aplasia
High dose aspirin –> risk of MTX toxicity (by reducing excretion)
What is discoid lupus characterised by?
Follicular keratin plugs - when lesiosn peeled off skin looks like “carpet tack”
Scarring + scarring alopecia
Common in face, neck, scalp
Antibodies in limited vs diffuse systemic sclerosis
Limited: anti-centromere
Diffuse: anti-Scl-70
What antibodies in RA?
Anti-CCP
Give a common side effect of MTX therapy?
mucositis
Polymyositis antibodies
Anti-Jo-1
Dermatomyositis antibodies
Anti-Mi-2
low serum calcium, low serum phosphate, raised ALP and raised PTH - what condition?
Osteomalaxia
What might be seen on XR in pseudogout
Chondrocalcinosis of the knee (linear calcifications of the meniscus + articular cartilage)
Antibodies associated with Sjogrens
RF
Anti Ro
Anti La
Ankylosing spondylitis features
A's: Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis
How does dural ectasia present and what is it associated with?
Ballooning of dural sac at lumbosacral level
Back pain, urinary incontinence, headaches, leg pains
Associated with marfan’s syndrome
Pesudogout joint aspirate
Positively birefringent rhomboid shaped crystals under light microscopy
calcium pyrophosphate
What cells secrete the majority of tumour necrosis factor?
Macrophages
What might you see on the palms/soles in someone with reactive arthritis?
waxy yellow/brown papules on palms and soles (keratoderma blenorrhagica)
commonest cause of osteomyelitis in general? What about in patients with sickle cell disease
S Aureus
Salmonella
What is anti-RNP associated with?
Mixed connective tissue disease
RNP - raynaoud, N swollen hands No synovitis, P Pain in musces + joints
Dactylitis and DIP joint swelling indicate what?
Psoriatic arthritis
In patient’s allergic to aspirin, what else might they react to?
Sulfasalazine (5-ASA)
What joints are characteristically affected in the hand in osteoarthritis?
Carpometacarpal + DIPJs
What is the minimum steroid intake a patient should be taking before they are offered osteoporosis prophylaxis?
7.5mg or more each day for 3 months
What collagen is defected in Ehler-Danlos syndrome?
Type 3
What collagen is defected in osteogenesis imperfecta?
Type 1
What collagen is defected in goodpasture’s?
Type 4
What protein is effected in marfan’s syndrome?
Fibrillin 1
What antibody is highly sensitive for SLE?
what antibodies are highly specific for
Sensitive: ANA (therefore good rule out test) - has low specificity
Specific: ant dsDNA + anti Sm
How does anikinra work?
IL-1 inhibitor
Restless leg syndrome drug treatment + MoA
Ropinirole (dopamine agonist)
Poor prognosis RA
rheumatoid factor positive anti-CCP antibodies poor functional status at presentation X-ray: early erosions (e.g. after < 2 years) extra articular features e.g. nodules HLA DR4 insidious onset
When are topical NSAIDs indicated in OA?
Knee or hand involvement
What rheumatological drug might patients be allergic to if they are allergic to aspirin?
Sulfasalazine
Antibodies in sjogren’s?
anti Ro + La
HLA in RA?
DRB1 04:01
In RA what Ix is best for detecting early disease/synovial inflammation?
Colour doppler US (detects earlier than MRI)
EXAM Q: What part of the nephron does PTH act on?
Proximal tubule
decreases phosphate reabsorption
Gout vs pseudogout radiological features?
Pseudogout: chondrocalcinosis (white lines)
Gout vs pseudogout birefringment + microscopy?
Gout: negative + needle shaped of uric acid crystals
Pseudogout: rhomboid crystals + weakly positive. Calcium pyrophosphate crystals
In thrombocytopaenia in SLE, what drug should be used?
Hydroxychloroquine
Calcium level in osteomalacia?
Low
Systemic sclerosis + chronic diarrhoea –> what is this likely to be? What is the treatment?
small intestine bacterial overgrowth syndrome
Metronidazole
In reactive arthritis what might you see on the palms and soles?
Keratoderma blennhoragiccum
3 antibodies seen in antiphospholipid syndrome?
Lupus anticoagulant
Anti-cardiolipid
anti-B2 glycoprotein
Felty syndrome triad
RA
Splenomegaly
Low wcc
