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Rheumatology Flashcards

1
Q

What are the antibodies associated with rheumatoid arthritis?

A

Rheumatoid Factor, Anti-CCP

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2
Q

What are the antibodies associated with SLE and Drug-induced Lupus?

A

ANA

Anti-DSDNA, Anti-Sm, Anti-phospholipid

Drug-induced lupus: Anti-histone antibodies

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3
Q

What are the antibodies associated with Sjogren’s Syndrome?

A

ANA

Anti-Ro and Anti-La

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4
Q

What are the antibodies associated with Anti-phospholipid syndrome?

A

Anti-cardiolipin, Lupus anticoagulant and Anti-B2 glycoprotein 1

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5
Q

What are the antibodies associated with Systemic Sclerosis?

A

ANA

Anti-centromere, Anti-RNA polymerase III, Anti- Scl 70

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6
Q

What are the antibodies associated with Dermatomyositis and Polymyositis?

A

ANA

Anti-Jo1 in both

Anti-Mi2 in polymyositis

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7
Q

What is the blood marker associated with seronegative inflammatory arthritis?

A

HLA-B27

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8
Q

What are the 4 types of seronegative inflammatory arthritis?

A

Psoriatic Arthritis

Reactive Arthritis

Enteropathic Arthritis

Ankylosing Spondylitis

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9
Q

What is the classic pattern of joint involvement in seropositive arthritis?

A

Symmetrical
Small joint
Polyarthritis

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10
Q

What is the classic pattern of joint involvement in seronegative arthritis?

A

Asymmetrical
Larger joint
Mono/oligo arthritis

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11
Q

What is the classic pattern of joint involvement in crystal arthropathy?

A

Asymmetrical
Small-Large joint
Monoarthropathy

Most commonly affecting 1st MTP joint first and moving proximally with disease progression.

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12
Q

What is the classic pattern of joint involvement in Osteoarthritis?

A

Symmetrical
Large and Small Joint
Oligo/Polyarthritis

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13
Q

What would you expect to find on examination in Rheumatoid Arthritis?

A 
Rheumatoid Nodules
Ulnar Drift
Boutonneire Deformity
Swan neck Deformity
Palmar Subluxation
Joint Stiffening, Swelling
Hammer Toe Deformity
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14
Q

What would you expect to find on examination in lupus?

A 
Butterfly/Malar Rash or Discoid Rash
Raynaud's
Photosensitivity
Non-scarring alopecia
Oral Ulcers
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15
Q

What drugs are associated with causing lupus?

A 
Sulfa-drugs
Phenytoin
Isoniazid
Methyldopa
TNFa inhibitors
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16
Q

What would you expect to find on examination in Sjogren’s Syndrome?

A 
Dry eyes and Dry mouth
Raynaud's
May also have vaginal dryness
Vasculitic rash
Parotid gland swelling
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17
Q

What is Schirmer’s Test?

A

Test used in Sjogren’s syndrome to measure tear production.

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18
Q

What are the key symptoms of anti-phospholipid syndrome?

A 
Recurrent vascular thrombosis / unprovoked VTE
Recurrent Miscarriage
Livedo Reticularis
Prolonged APTT
Thrombocytopenia
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19
Q

What would you expect to find on examination in dermatomyositis?

A 
Heliotrope Rash
Gottron's Papule's
Shawl sign over upper chest
Holster sign on lateral thigh
Periungal erythema

Raynaud’s and photosensitivity

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20
Q

What would you expect to find on examination in polymyositis?

A

Heliotrope Rash
Raynaud’s
Proximal muscle weakness
Dysphagia/aspiration

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21
Q

What would you expect to find on examination in systemic sclerosis?

A 
Raynaud's
Thickening of skin over fingers
Taught, shiny skin with pigment change
Sclerodactyl
Oesophageal involvement - dysphagia, GORD/dyspepsia
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22
Q

What would you expect to find on knee aspiration of gout?

A

Negatively birefringent, yellow, needle shaped crystals

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23
Q

What would you expect to find on joint aspiration in pseudo gout?

A

Weakly positively birefringent, blue, rhomboid shaped crystals - calcium pyrophosphate

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24
Q

What would you expect to see on joint x-ray in a person with osteoarthritis?

A

Loss of joint space
Osteophytes
Subchondral cysts
Subcondral sclerosis

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25
What would you expect to see on joint x-ray in gout?
First presentation- probably NAD Chronic disease- periarticular erosion ``` joint effusion is an early sign well-defined 'punched-out' erosions relative preservation of joint space until late eccentric erosions no periarticular osteopenia soft tissue tophi may be seen ```
26
What is the management for osteoarthritis?
Conservative: weight loss, exercise, assistive devices and aids 1. Paracetamol 2. Topical NSAIDs - > oral 3. Intra-articular steroid injection 4. Joint replacement
27
What would you expect to see on x-ray in rheumatoid arthritis?
Loss of joint space Erosions Periarticular osteopenia Joint deformity
28
Which DMARD is safest in pregnancy?
Sulfasalazine
29
What is the management for Gout?
1. NSAIDs to settle acute attack + PPI a. Colchicine if renal impairment b. Oral steroids also alternative 2. Allopurinol long term (initiated 2w after acute attack settles) + colchicine cover <6m a. Febuxostat = alternative in renal impairment Lifestyle advice: reduction in red meat and alcohol consumption, stop smoking, exercise/lose weight Medication review e.g. stopping thiazides
30
What is the management of pseudogout?
Oral NSAIDs and PPI Intra-articular steroid injection Systemic steroids
31
What are the associated symptoms with reactive arthritis?
Conjunctivitis and Urethritis Can't see, can't pee, Can't climb a tree
32
What are the symptoms associated with ankylosing spondylitis?
Lower back pain and stiffness - worst on waking, better with activity Anterior Uveitis / Iritis Usually presents in late teens/early 20s
33
What is the test for ankylosing spondylitis?
Schober's test
34
Which condition is most commonly associated with polymyalgia rheumatica?
Giant cell arteritis
35
Where does polymyalgia rheumatic most commonly affect?
Shoulders Neck Pelvic Girdle Worse with movement and interrupt sleep
36
Which test discriminates between myositis and polymyalgia rheumatica?
Creatine Kinase - levels raised in true myositis, not in PR
37
What are the key symptoms of GCA?
Scalp tenderness Jaw claudication Visual disturbance (unilateral) Amaurosis Fugaux
38
What is the diagnostic test for GCA?
Temporal artery biopsy
39
What is the management for GCA?
High dose oral prednisolone IV methylprednisolone if visual changes developing PPI + bisphosphonates to protect stomach and bones.
40
What are the key symptoms of takayasu's arteritis?
``` Limb claudication on exertion Dizziness on upper limb exertion Unequal BP in the arms Absent pulses Associates with aortic regurgitation ```
41
What are the key symptoms of Kawasaki Disease?
``` Child <4/5yo >5 day history of fever Strawberry tongue Vasculitic rash- polymorphic, maculopapular, erythematous Conjunctivitis Unilateral cervical lymphadenopathy ```
42
What is the management for Kawasaki disease?
IVIG + high dose aspirin Z score determines whether aspirin continued Only scenario where aspirin is given to children
43
What is the classic triad of EGPA?
Eosinophilia Granulomatous inflammation Vasculitis ie. associated with asthma, allergic rhinitis, sinusitis
44
What is the classic triad of GPA/Wegener's?
Nasal symptoms, haemoptysis and haematuria Upper respiratory tract, lower respiratory tract and glomerulonephritis URT: nasal crusting, epistaxis, otorrhoea/otalgia, ulcers, saddle nose LRT: SOB, cough, haemoptysis, dyspnoea GN: haematuria
45
What are the 4 key symptoms of HSP?
Purpuric Rash Abdominal Pain Arthritis/arthralgia Glomerulonephritis
46
Which conditions are associated with C and P-ANCA?
C-ANCA: GPA/Wegener's | P-ANCA: EGPA, microscopic polyangiitis, Ulcerative colitis, Primary sclerosing cholangitis
47
What are the systemic features associated with ankylosing spondylitis?
``` The A's: Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis and cauda equina syndrome peripheral arthritis (25%, more common if female) ```
48
What is the management for anti-phospholipid syndrome?
Aspirin low-dose = primary thromboprophylaxis Secondary= lifelong warfarin with target INR 2-3
49
What are the common adverse effects of azathioprine?
bone marrow depression nausea/vomiting pancreatitis increased risk of non-melanoma skin cancer Thiopurine methyltransferase (TPMT) test may be needed to look for individuals prone to azathioprine toxicity
50
What are the common features of Behcet's syndrome?
Oral ulcers + genital ulcers + anterior uveitis thrombophlebitis and deep vein thrombosis arthritis neurological involvement (e.g. aseptic meningitis) GI: abdo pain, diarrhoea, colitis erythema nodosum
51
What are adverse effects of bisphosphonates?
Risk of gastritis Increased risk of jaw osteonecrosis Increased risk of femoral shaft fractures acute phase response: fever, myalgia and arthralgia may occur following administration
52
What is denosumab?
Second-line treatment for OA | It is a human monoclonal antibody that prevents the development of osteoclasts by inhibiting RANKL
53
What is Ehler-Danlos Syndrome?
autosomal dominant connective tissue disorder that mostly affects type III collagen Features: elastic, fragile skin joint hypermobility: recurrent dislocation easy bruising aortic regurgitation, mitral valve prolapse and aortic dissection subarachnoid haemorrhage angioid retinal streaks
54
What is Marfan's syndrome?
Autosomal dominant connective tissue disorder- defect in FBN1 gene which codes for fibrillin.
55
What are the features of Marfan syndrome?
``` Tall stature High-arched palate Arachnodactyly Pectus excavatum Scoliosis Flatfoot (pes Planus) Dilation of aortic sinuses, aortic aneursym, aortic regurge Mitral valve prolapse in 75% Repeated pneumothoraces Blue sclera ```
56
What are the prescribing considerations for methotrexate?
Taken weekly Folic acid should be taken alongside 5mg weekly FBC, U&E and LFTs need to be regularly monitored- weekly until stabilised, then every 2-3m Avoid prescribing alongside trimethoprim or cotrimoxazole In the case of methotrexate toxicity, folinic acid should be given
57
What is osteogenesis imperfecta?
Disorders of collagen metabolism resulting in bone fragility and fractures Type 1 = most common Autosomal dominant inheritance ``` presents in childhood fractures following minor trauma blue sclera deafness secondary to otosclerosis dental imperfections are common ```
58
What is osteomalacia?
Softening of the bones due to low vitamin D levels -> decreased bone mineral content ``` Causes: Vit D deficiency (diet/malabsorption/lack of light) CKD Anticonvulsants Liver cirrhosis ```
59
What are symptoms of osteomalacia?
bone pain bone/muscle tenderness fractures: especially femoral neck proximal myopathy: may lead to a waddling gait Bloods show: low vis D, calcium, phosphate but raised ALP and PTH Translucent bands on x-ray
60
How is osteomalacia managed?
Vitamin D supplements | Calcium supplements
61
How do you assess patients with osteoporosis?
If >75 and have a fragility fracture- start bisphosphonate without need for DEXA If <75, DEXA scan should be arranged and used in a FRAX score
62
How should osteoporosis be managed?
DEXA scan and FRAX score if appropriate Vitamin D and calcium supplementation should be offered to all women unless confident it is unnecessary Alendronate = first line If can't tolerate: risedronate or etidronate Strontium ranelate and raloxifene are recommended if patients can't tolerate bisphosphonates HRT can also help reduce risk of post-menopausal osteoporosis
63
What are features of polymyositis?
``` proximal muscle weakness +/- tenderness Raynaud's respiratory muscle weakness interstitial lung disease: e.g. fibrosing alveolitis or organising pneumonia dysphagia, dysphonia ```
64
What is first line treatment for Raynaud's?
Nifedipine
65
What triad of features make up Felty's syndrome?
RA + splenomegaly + low WCC

Finals Revision (23 decks)

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