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Rheumatology Flashcards

1
Q

HSP

A

IgA vasculitis
small vessel
triggered by an upper airway infection (e.g. tonsillitis) or a gastroenteritis.

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2
Q

HSP epidemiology

A

It is most common in children under the age of 10 years.

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3
Q

Granulomatosis with polyangiitis (GPS) (Wegener’s granulomatosis) clinical presentation

A 
nosebleeds
crusty nasal secretions
hearing loss
sinusitis.
saddle shaped nose 
lungs:cough, wheeze and haemoptysis.
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4
Q

Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss syndrome) clinical presentation

A

elevated eosinophil , shortness of breath

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5
Q

Which types of vasculitis are medium vessel

A

Polyarteritis nodosa
Kawasaki Disease
Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss syndrome)

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6
Q

Which types of vasculitis are small vessel

A

Henoch-Schonlein purpura
Granulomatosis with polyangiitis (GPS/GPA) (Wegener’s granulomatosis)
Eosinophilic granulomatosis with polyangitis ( EGPA) (Churg-Strauss syndrome)
Microscopic polyangiitis
Anti-GBM
AntiC1q ( urticarial vasculitis)
Cryoglobinaemia

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7
Q

Which types of vasculitis are large vessel vasculitis

A

Polymyalgia rheumatica
Giant cell arteritis
Takayasu’s arteritis

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8
Q

Polyarteritis Nodosa epidemiology

A

men aged 40-60.

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9
Q

Polyarteritis Nodosa associations

A

most associated with hepatitis but can also occur without a clear cause or with hepatitis C and HIV.

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10
Q

Polyarteritis Nodosa clinical presentation

A

~~~
renal impairment, strokes and myocardial infarction.
rash called livedo reticularis
inflamed gallbladder
testicular pain
abdominal angian
neuro
chest
Aneurysms is a late finding

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11
Q

Polymyalgia Rheumatica epidemiology

A

above 50 years, women, caucasians

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12
Q

Polymyalgia Rheumatica key features

A

Bilateral shoulder pain that may radiate to the elbow
Bilateral pelvic girdle pain
Worse with movement
Interferes with sleep
Stiffness for at least 45 minutes in the morning
Systemic symptoms such as weight loss, fatigue, low grade fever and low mood
Upper arm tenderness
Carpel tunnel syndrome
Pitting oedema

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13
Q

Treatment of

Polymyalgia Rheumatica

A

prednisolone

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14
Q

Giant cell arteritis GCA (also known as temporal arteritis)

A

presents with symptoms affecting the temporal arteries .There is a strong link with polymyalgia rheumatica.

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15
Q

Giant cell arteritis GCA (also known as temporal arteritis) features

key features

A 
headache - unilateral, forehead/temple
Jaw claudication
tongue pain 
eye symptoms
Fever
Muscle aches
Fatigue
Weight loss
Loss of appetite
Peripheral oedema
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16
Q

Diagnosis of Giant cell arteritis

A

Multinucleated giant cells are found on the temporal artery biopsy.

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17
Q

Management of Giant cell arteritis

A

Start steroids immediately before confirming the diagnosis to reduce the risk of permanent sight loss
Aspirin 75mg daily decreases visual loss and strokes
Proton pump inhibitor (e.g. omeprazole) for gastric prevention while on steroids

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18
Q

Takayasu’s arteritis

A

Mainly affects aorta, usually presents before the age of 40 years with non-specific systemic symptoms, such as fever, malaise and muscle aches, or with more specific symptoms of arm claudication or syncope

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19
Q

Scleroderma /( Systemic sclerosis)

A

Systemic sclerosis is an autoimmune inflammatory and fibrotic connective tissue disease.most notably affects the skin in all areas but it also affects the internal organs.Scleroderma translates directly to hardening of the skin.

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20
Q

Scleroderma - Limited cutaneous systemic sclerosis clinical presentation

A

CREST

  • Calcinosis
  • Raynauds
  • Oesophageal dysmotility
  • Sclerodactyly
  • Telangectasia
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21
Q

Diffuse cutaneous systemic sclerosis features

A

Sclerodactyly
Telangiectasia
Calcinosis
Raynaud’s phenomenon
​​Oesophageal dysmotility
Systemic and pulmonary hypertension
Pulmonary fibrosis
Scleroderma renal crisis

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22
Q

Scleroderma - diffuse cutaneous systemic sclerosis autoantibodies

A

Anti-Scl-70

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23
Q

limited cutaneous systemic sclerosis autoantibodies

A

Anti-centromere antibodies

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24
Q

systemic sclerosis autoantibodies

A

Antinuclear antibodies ANA

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25
what does nail fold capillaroscopy show in systemic sclerosis
Abnormal capillaries, avascular areas and micro-haemorrhages
26
Myositis epidemiology
40-60 year olds, more common in females
27
Polymyositis
chronic inflammation of muscles
28
Clinical presentation of polymyositis
``` Weakness predominant: proximal Trunk weakness a poor prognostic sign Muscle pain, fatigue and weakness Occurs bilaterally Mostly affects the shoulder and pelvic girdle Develops over weeks ```
29
Dermatomyositis
connective tissue disorder where there is chronic inflammation of the skin and muscles. can be associated with malignancy
30
Dermatomyositis Skin Features:
muscular features of polymyositis with additional skin rashes Gottron lesions (scaly erythematous patches) on the knuckles, elbows and knees Photosensitive erythematous rash on the back, shoulders and neck Purple rash on the face and eyelids Periorbital oedema Subcutaneous calcinosis
31
Myositis investigations
CK>1000 Autoantibodies Electromyography (EMG) Muscle biopsy Blood tests that are elevated include lactate dehydrogenase, aldolase, ALT and AST.
32
polymyositis autoantibodies
•Anti-Jo-1 antibodies: polymyositis (but often present in dermatomyositis)
33
dermatomyositis autoantibodies
Anti-Mi-2 antibodies | Anti-nuclear antibodies
34
Mx myositis
Corticosteroids Immunosuppressants (such as azathioprine) IV immunoglobulins Biological therapy (such as infliximab or etanercept) Hydroxychloroquine occasionally helps with skin disease in dermatomyositis. As well as pharmacological therapy, physiotherapy is essential to rehabilitate patients.
35
Ehlers danlos
group of genetic conditions that cause defects in collagen, resulting in hypermobility of the patient’s joints and abnormalities in connective tissue such as the skin, bones, blood vessels and organs Inheritance is autosomal dominant.
36
Ehlers danlos features
soft and stretchy skin severe joint hypermobility, joint pain and abnormal wound healing prone to hernias, prolapses, mitral regurgitation and aortic root dilatation.
37
Sjogren's syndrome
autoimmune disorder characterised by decreased lacrimal and salivary gland secretion, which manifests as dry eyes and dry mouth.
38
Extraglandular features of Sjogrens syndrome
Systemic upset such as fever, myalgia, malaise or fatigue. Arthritis Raynaud's Cutaneous vasculitis which manifests as purpura and skin ulcers. interstitial lung disease, renal disease and neurological disease including seizures
39
Sjogren autoantibodies
Most patients are ANA positive but this is not specific for Sjogren's syndrome. Anti-Ro and Anti-La Autoantibodies are both specific for Sjogren's syndrome.
40
Schirmer's test
this demonstrates reduced tear production using a strip of filter paper on the lower eyelid: wetting of <5mm is positive for shorten
41
Rose bengal staining
his demonstrates keratitis due to conjunctivitis sicca when using a slit-lamp used for sjorgrens
42
Sjogrens syndrome Mx
artificial tears such as hypromellose. artificial saliva Vaginal dryness can be treated with topical lubrication. Arthritis can be treated with hydroxychloroquine ± NSAIDs. corticosteroids for complications such as vasculitis and pulmonary, renal or neurological disease
43
SLE epidemiology
more common in females (F:M = 9:1) more common in Afro-Caribbeans and Asian communities onset is usually 20-40 years incidence has risen
44
SLE skin signs
malar (butterfly) rash: across the nose and cheek bones that gets worse with sunlight. discoid rash: scaly, erythematous, well demarcated rash in sun-exposed areas. Lesions may progress to become pigmented and hyperkeratotic before becoming atrophic photosensitivity Raynaud's phenomenon livedo reticularis non-scarring alopecia
45
Anti-Smith
(highly specific to SLE but not very sensitive)
46
Mx SLE
NSAIDs for joint stiffness, MSK pain Steroids (prednisolone) to suppress immune response Hydroxychloroquine (first line for mild SLE,reduce constitutional & MSK Sx & mucocutaneous manifestations) Suncream and sun avoidance for the photosensitive the malar rash Biological therapies are considered for patients with severe disease eg rituximab
47
OA xray changes
L – Loss of joint space O –Osteophytes S – Subarticular sclerosis S – Subchondral cysts
48
Gout aspirated fluid shows
No bacterial growth Needle shaped crystals Negatively birefringent of polarised light Monosodium urate crystals
49
pseudo gout Aspirated fluid will show
No bacterial growth Calcium pyrophosphate crystals Rhomboid shaped crystals Positive birefringent of polarised light
50
Gout xray shows
Typically the space between the joint is maintained Lytic lesions in the bone Punched out erosions Erosions can have sclerotic borders with overhanging edges
51
classic xray change in pseudogout
Chondrocalcinosis- thin white line in the middle of the joint space caused by the calcium deposition.
52
Clinical presentation of Sjogren's syndrome
``` dry eyes and dry mouth. Systemic upset Arthritis Raynaud's Cutaneous vasculitis ```
53
OA risk factors can be remembered by the mnemonic SHATTERED FAMILY:
``` S – Steroid use H – Hyperthyroidism, hyperparathyroidism A – Alcohol and smoking T – Thin (BMI<22) T – Testosterone deficiency E – Early menopause R – Renal/liver failure E – Erosive/inflammatory bone disease D – Diabetes FAMILY HISTORY ``` Age (>50 for women and >65 for men) Female sex
54
Clinical presentation pagets disease
Elderly, bone pain, deformity, pathological fractures, hearing loss
55
Pagets disease features on Xray
well defined osteolytic lesion on X-ray = osteoporosis circumscripta skull xray appearance= cotton wool appearance
56
Ankylosing spondylitis epidemiology
20-30 years old.. M>F, strong family history
57
Clinical presentation Ankylosing spondylitis
Symptoms develop over more than 3 months. lower back pain and stiffness and sacroiliac pain in the buttock region. pain in the buttocks can alternate from left to right. The pain and stiffness is worse with rest and improves with movement. The pain is worse at night and in the morning and may wake them from sleep. can affect other organ systems
58
Management of ankylosing spondylitis
NSAIDs Steroids can be use during flares Anti-TNF medications Secukinumab is a monoclonal antibody against interleukin-17. It is recommended by NICE if the response to NSAIDS and TNF inhibitors is inadequate.
59
Clinical presentation Reactive arthritis
Classic triad: cant see , pee or climb a tree (triad of urethritis, conjunctivitis and arthritis)
60
Clinical presentation Antiphospholipid syndrome
Clots - Usually venous thromboembolism (eg. deep venous thrombosis or pulmonary embolism), but arterial embolism (eg. myocardial infarction or stroke) can also occur. Livedo reticularis - A mottled, lace-like appearance of the skin on the lower limbs. Obstetric loss - Recurrent miscarriages, pre-eclampsia and premature births can occur. Thrombocytopenia. In addition cardiac valve disease can occur, usually aortic and mitral regurgitation ± stenosis.
61
Antiphospholipid blood tests
One or more of the following positive blood tests are needed on 2 occasions, 12-weeks apart to diagnose APS: Anti-cardiolipin antibodies. Anti-beta2-GPI antibodies. Positive lupus anticoagulant assay.
62
Anti-dsDNA
highly specific test for lupus (SLE)
63
Felty’s syndrome
RA, splenomegaly and low white cell count Felty syndrome is a long-term complication of rheumatoid arthritis. It presents with a combination of splenomegaly and low WCC. In this case, mild thrombocytopenia is caused by splenomegaly.
64
location of herberden and bouchards nodes
Heberden’s nodes (in the DIP joints) | Bouchard’s nodes (in the PIP joints)
65
Seronegative arthropathies
associated with HLA-B27
66
Rheumatoid xray features
``` Loss of joint space Erosions Soft tissue swelling Soft bones osteopenia Subluxation ```
67
Behcet's syndrome
complex multisystem disorder associated with presumed autoimmune-mediated inflammation of the arteries and veins.
68
Behcet's syndrome epidemiology
eastern Mediterranean (e.g. Turkey) Men 20-40y old fhx
69
Behcet's syndrome features
1) oral ulcers 2) genital ulcers 3) anterior uveitis thrombophlebitis and deep vein thrombosis arthritis neurological involvement (e.g. aseptic meningitis) GI: abdo pain, diarrhoea, colitis erythema nodosum Pericarditis
70
Rheumatoid arthritis
autoimmune condition that causes chronic inflammation of of the joints symmetrical polyarthritis.
71
Rheumatoid arthritis epidemiology
3x more common in women peak onset is in 40-60 year olds More common in smokers
72
Antibodies in rheumatoid arthritis
Rheumatoid Factor (RF) Cyclic citrullinated peptide antibodies (anti-CCP antibodies) are autoantibodies that are more sensitive and specific to rheumatoid arthritis
73
Clinical Presentation RA
Pain - worse after rest but improves with activity Swelling Stiffness systemic symptoms: Fatigue, Weight loss, Flu like illness, Muscles aches and weakness
74
RA signs in hands
Z shaped deformity to the thumb Swan neck deformity- flexed DIP Boutonnieres deformity -hyperextended DIP
75
RA Mx
short course of steroids at first presentation and during flare ups NSAIDS with ppl DMARD biological therapy

Medicine (72 decks)

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