Rheumatology Flashcards
Signs of RA
- Swan Neck/Boutonniere deformity
- Z-thumb
- Squaring of thumb
- symmetrical PIP and MCP swelling/erythema
- Rheumatoid nodules
- Ulnar deviation
Systemic manifestations of RA
Eyes
- Keratoconjunctivitis Sicca
- Episcleritis
Lungs
- Pleural effusions
- Pulmonary nodules
- Interstitial lung disease
Heart
- Pericarditis
- Myocarditis
- IHD
Blood
- Anaemia of Chronic Disease
- Splenomegaly
X-ray findings of RA
Loss of joint space Bony erosions Subluxations Soft tissue swelling Periarticular osteopenia
Causes of carpal tunnel syndrome
Physiological
- Pregnancy
- Idiopathic
Endocrine
- Diabetes
- Acromegaly
- Hypothyroidism
Signs of Psoriasis
Nails
- Pitting
- Onycholysis
- Subungual Hyperkeratosis
Asymmetrical oligoarthritis
Dactylitis
Psoriatic plaques
Causes of acute monoarthritis
Infection (septic arthritis)
Inflammation (Gout/crystal arthropathy)
Trauma (haemarthrosis, ligament damage)
Mx of RA
Determined by DAS28 score
Conservative
- Weight loss
- Stop Smoking
- Exercise
- analgesia
Medical
- 1st line Methotrexate + short term prednisolone
- Other DMARDs
- Biologic therapy e.g. infliximab (indicated if not controlled on 2 DMARDs one of which must be MTX)
What is Felty’s syndrome
Complication of RA: RA + Splenomegaly + Neutropenia
What are the 4 seronegative spondylarthropathies?
- Ankylosing spondylitis
- Reactive arthritis
- Enteropathic arthritis
- Psoriatic arthritis
What features are common to seronegative spondylarthropathies?
HLA B27 predisposition (not useful for diagnosis)
Asymmetrical oligoarthritis
Enthesopathy
Axial arthritis e.g. sacroiliitis
Extra-articular features of Ankylosing spondylitis
Aortitis
Atlanto-axial subluxation
Apical lung fibrosis
Anterior uveitis
Mx of ankylosing spondylitis
Conservative
- Analgesia (NSAIDS) + Physiotherapy + Weight loss
Medical
- Biologics e.g. infliximab (MTX not very effective)
X-ray findings in Ankylosing spondylitis
Sacroiliitis
Bamboo spine
Syndesmophytes
Subchondral erosions
Squaring of lumbar vertebrae
Sclerosis
What is Arthritis Mutilans?
Severe inflammation causing joint destruction and deformity: A rare presentation of psoriasis
Features of reactive arthritis
Asymmetrical oligoarthritis
Urethritis
Conjunctivitis
Circinate balantis
Keratoderma blenorrhagica
Ix for reactive arthritis
○ HLA B27 ○ CRP/ESR may be raised ○ Antibody serology ○ Urate ○ Aspiration of fluid ○ Refer to GUM clinic for investigation
Mx of reactive arthritis
NSAIDS
Steroids (2nd line)
Gout risk factors
Increased urate production
- Increased cell turnover (haem malignancy, psoriasis)
- abnormal urate excretion (Lesch-nyhan syndrome)
Decreased renal urate excretion
- Drugs
- CKD
Mx of Gout
Acute episode NSAIDS max dose (+PPI) Colchicine Short course Steroids (don't stop allopurinol/febuxostat)
Prevention
- Allopurinol
- Febuxostat (2nd line)
Antibodies for: RA, SLE, Sjogrens, Systemic Sclerosis, Dermatomyositis
RA: RF, Anti-CCP SLE: Anti-dsDNA Sjogrens: Anti-Ro/La Systemic sclerosis: Anti-centromere, Anti-SCL70 Dermatomyositis: Anti-Jo1
SLE presentation (SOAPBRAINMD)
- Serositis
- Oral ulcers
- Arthritis
- Photosensitivity
- B
- Renal involvement
- ANA
- Immunologic phenomena
- Neurological dysfunction (cerebral lupus)
- Malar rash
- Discoid rash
SLE Ix
FBC U&E LFT Clotting - lupus anticoagulant Immunological - ANA, dsDNA, complement Urine dip
Monitoring disease severity in SLE
Severe disease causes low C3 and C4: C4 drops before C3
Mx of SLE
Medical
- Hydroxychloroquine
- Steroids
- DMARDs (MTX, azathioprine)
Sjogren’s syndrome Ix
- Schirmer’s test (quantify dry eyes)
- Salivary gland biopsy (lymphocytic infiltrate)
- ANA and dsDNA
Sjogren’s Mx
- Artificial tears
- Hydroxychloroquine
Dermatomyositis presentation
- Heliotrope rash
- Gottron’s papules
- Mechanic’s hands
Dermatomyositis Ix
- ANA, Anti-Jo1
- FBC, U&E
- CK
CREST syndrome presentation
Calcinosis Raynauds (most common PC, and normally first feature) Oesophageal dysmotility Scerodactyly Telangiectasia
Mx of systemic sclerosis
Prevent lung fibrosis and treat Raynaud’s
- Steroids
- Azathioprine
- CCB (for raynaud’s)
Antiphospholipid syndrome diagnosis
Positive lab + 1 clinical criteria
- +ve lupus coagulant or anti-phospholipid antibodies at 2 measurements 3 months apart
- Arterial/venous thrombosis
- Pregnancy loss 3x <10 weeks
- Pregnancy loss 1x >10 weeks
Management of APLS
- Primary thromboprophylaxis
○ Aspirin - Secondary thromboprophylaxis
○ Lifelong Warfarin
○ Add aspirin if recurrent VTE occurs while on warfarin
Chapel Hill Classification of vasculitides
Small vessel
- Microscopic Polyangiitis - pANCA
- GPA (epistaxis + renal impairment) - cANCA
- eGPA (Churg-Strauss, asthma + eosinophilia) - pANCA
Medium vessel
- Polyarteritis nodosa
Large vessel
- Takayasu Arteritis
- GCA
Marker of prognosis in
