Rheumatology Flashcards
Which antibody is associated with diffuse systemic sclerosis?
Anti-Scl-70
Which antibody is associated with limited systemic sclerosis?
Anti-centromere
Which antibody is associated with Polymyositis?
Anti-Jo-1
Which antibody is associated with Dermatomyositis?
Anti-Mi-2
What x-ray signs are seen in rheumatoid arthritis?
LESS
Loss of joint space
Periarticular erosions
Sublaxation
Soft tissue swelliing
Also: Juxta-articular osteoporosis
What are extra-articular features of ankylosing spondylitis?
Chest pain due to costrochondritis Anterior uveitis Plantar fasciitis Inflammatory bowel disease Pulmonary fibrosis Achilles tendonitis Amyloidosis Aortic regurgitation
What are complications of SLE?
Pericarditis/Myocarditis Pulmonary fibrosis CVD Antiphospholpid syndrome Anaemia Lupus nephritis
How does Dermatomyositis present?
Weakness of shoulders and pelvic girdle
Gottron lesions, Photosensitive rash on back/shoulders/neck, periorbital oedema, purple rash around eyes
What is seen on XR in pseudo gout?
Chondrocalcinosis
How can you interpret a T score?
-1 to -2.5 = Osteopenia
Less than -2.5 = Osteoporosis
What are dermatological features of SLE?
Livedo reticularis
Photosensitive malar rash
Lichen planus
What is seen on CXR in ankylosing spondylitis?
Apical fibrosis
What kind of retinopathy does Hydroxychloroquine cause?
Bulls eye retinopathy - loss of central vision
Which bones are most commonly effected in Paget’s disease?
Skull
Spine + Pelvis
Femur + tibia
Which clotting marker is raised in antiphospholipid syndrome?
APTT
How does reactive arthritis present?
Acute monoarthritis
Cant see = Anterior uveitis, Conjuntivitis
Cant pee = balanitis
Cant climb a tree = dactylitis, Keratoderma blenorrhagica
What are features of SLE?
Arthrits/arthralgia
Myalgia
Butterfly malar rash (photosensitive)
Fatigue
What is discoid lupus erythematosus?
More in women with darker skin
Photosensitive lesions
Associated with scarring alopecia
Management= topical steroids
What drugs cause drug induced lupus?
Hydralazine Isoniazid Phenytoin Minocycline Procainamide
What is seen on nailfold capillaroscopy in systemic sclerosis?
Avascular necrosis
Micro-haemorrhages
Abnormal capillaries
What antibodies are raised in antiphospholipid syndrome?
Lupus anticoagulant
Anticardiolipin antibodies
Anti-beta-2 glycoprotein 1 antibodies
How does Behcet’s disease present?
MAIN TRIAD OF
1) Recurrent oral ulcers
2) Recurrent genital ulcers
3) Recurrent anterior uveitis
Also: Erythema nodosum Morning stiffness + arthralgia DVT, thrombophlebitis Abdo pain, diarrhoea
What is polyarteritis nodosa?
Medium vessel vasculitis
Fever, malaise, arthralgia Mononeuritis multiplex Livedo reticularis Haematuria Renal failure Necrotic ulcers
What abnormal blood results are present in temporal atertis?
Raised ESR+CRP
Raised ALP
Normocytic anaemia
Raised platelets
Which autoantibodies are present in Sjorgen’s syndrome?
Anti-Ro and Anti-La
What are features of Marfan’s syndrome?
Tall stature High arched palate Pectus excavatum Pes planus Scoliosis Dilation of aortic sinuses —> Mitral regurg, aortic regurg, aortic dissection Upwards lens dislocation Repeated pneumothoraces Dural ectasia (ballooning of the dural sac)
What are features of Ehler-Danlos syndrome?
Hypermobility Stretchy elastic fragile skin Easy bruising Aortic regurg Mitral valve prolapse Aortic dissection SAH
What is Adult Still’s disease? How is it managed?
Arthralgia Raised serum ferritin Salmon pink rash Pyrexia Lymphadenopathy
Management = NSAIDs
What are examples of large vessel vasculitis?
Temporal arteritis
Takayasu’s arteritis
What are examples of medium vessel vasculitis?
Polyarteritis nodosa
Kawasaki disease
What are examples of a small vessel vasculitis?
ANCA associated - GPA, eGPA
Immune mediated - HSP, Anti-GBM
How can you differentiate between polymyositis and polymyalgia rheumatica clinically?
Polymyalgia rheumatica = NO WEAKNESS
Polymyositis = WEAKNESS
What to do if someone with polymyalgia rheumatic does not respond to steroids?
Consider alternative diagnosis - Polymyalgia rheumatica should respond really well to steroids
When are bisphosphonates CI?
CKD 4 or 5
What is an alternative to bisphosphonates if they are CI?
Denosumab - needs to be started in secondary care
What is second line in someone who cannot tolerate the side effects of oral alendronate?
IV Risedronate
What is seen on skull x-ray in Paget’s disease?
Thickened vault Osteoporosis circumscripta (Cotton-wool appearance)
Which things are associated with HLA-b27?
Reactive arthritis
Ankylosing spondylitis
Anterior uveitis
What EARLY x-ray findings are seen in RA?
- loss of joint space
- juxta-articular osteoporosis
- soft-tissue swelling
What LATE x-ray findings are seen in RA?
- periarticular erosions
* subluxation
What are poor prognostic features of 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
What does the joint aspirate in RA show?
Yellow cloudy fluid
high WCC
What is Z score adjusted for?
Age, gender, ethnicity
How to start allopurinol?
Always start allopurinol with either colchicine or NSAID for up to 6 months
How is an acute flare of RA managed?
IM Methylprednisolone
What shape are the crystals in gout and pseudo gout?
Gout = rhomboid shaped Pseudogout = needle shaped
How do you manage a first episode of RA?
Methotrexate + short bridging course of oral prednisolone
What are complications of Paget’s disease?
Deafness Bone sarcoma Fractures Skull thickening High-output cardiac failure
