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rheumatology Flashcards

1
Q

in OA, where would you find Heberdens nodes?

A

DIP joint

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2
Q

in OA, where would you find Bouchards nodes?

A

PIP joint

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3
Q

what are the x-ray findings in OA?

A

loss of joint space
osteophytes
subchondral sclerosis
subchondral cysts

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4
Q

what would be the treatment for OA in the knee and hip?

A

arthroplasty

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5
Q

what would be the treatment for OA in the MTP, wrist and ankles?

A

arthrodesis (fusion of bones together)

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6
Q

what mediates RA?

A

HLA-DR4

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7
Q

what are some triggers of RA?

A

smoking
infection
stress

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8
Q

what joints does RA mainly affect?

A

small joints of hands and feet - MCP and PIP
typically spares DIP joints
wrist and ankle

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9
Q

what are some later deformities seen with RA?

A

joint subluxation of the cervical spine
swan neck - PIP joint hyperextension, DIP joint flexion
boutonieres - PIP joint flexion, DIP joint hyperextension
z thumb

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10
Q

when are extra articular features present in RA?

A 
when serology is positive and include:
lung fibrosis (lower lungs) 
keratoconjunctivitis sicca 
vasculitis
osteoporosis
scleritis
neutropenia 
Raynauds 
Carpal tunnel 
pericarditis
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11
Q

what is felty’s syndrome?

A

RA + splenomegaly + neutropenia

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12
Q

what x ray findings are seen in RA?

A

loss of joint space
peri-articular erosions
subluxations
junta-articular osteoporosis

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13
Q

what is seen on serology in RA?

A

raised RF
raised anti-CCP
raised ESR and CRP

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14
Q

how is a diagnosis made in RA?

A

clinical diagnosis

serology not completely sensitive

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15
Q

what is the 1st line treatment for RA?

A

DMARD (methotrexate) +/- short course of prednisolone

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16
Q

how is disease monitored in RA?

A

using CRP and DAS28

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17
Q

how is a flare up of RA treated?

A

using corticosteroids (oral or IM)

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18
Q

what needs to be done and why before starting methotrexate?

A

FBC - agranulocytosis

LFTs - hepatotoxicity (cirrhosis)

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19
Q

what are names of DMARDs apart from methotrexate?

A

leflunomide
sulfasalazine
hydroxychloroquine

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20
Q

when are steroids used in RA?

A

for remission induction in flares

as filler while other drugs start to work

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21
Q

when can anti-TNF therapy be used in RA?

A

after inadequate response to 2 DMARDs (one being methotrexate)

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22
Q

name anti-TNF therapy

A

etanercept

infliximab

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23
Q

what are biologics co-prescribed with?

A

methotrexate

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24
Q

what is the DAS28 score?

A

<2.6 remission
2.6-3.2 low disease activity
3.2-5.1 moderate disease activity
>5.1 active disease

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25
what features do spondyloarthritides share?
seronegative - negative for RF positive for HLA-B27 mutation arthritis of spine and SI joints involves less then 5 lower limb joints dactylitis (sausage fingers) enthesitis (inflammation of tendon and ligament insertion) extra articular features - anterior uveitis, rash, IBD and aortic valve incompetence
26
what pathophysiology is seen with AS?
widening and subchondral sclerosis of SIJ (eventual fusion of SIJ joint) formation of syndesmophytes that fuse together causing stiffness and immobility calcification of vertebral ligaments
27
what are calcified vertebral ligaments described as on x-ray in AS?
bamboo spine
28
what additional symptoms are associated with AS?
``` fatigue anterior uveitis painful heel and feet (Achilles tendonitis, plantar fasciitis) SOB - atypical upper zone fibrosis aortic regurgitation amyloidosis IgA nephropathy ```
29
what spinal posture is seen in advanced AS?
questions mark posture - thoracic kyphosis - cervical spine hyperextension
30
what is seen on examination for AS?
tender SIJ Schobers test positive (reduced lunar flexion) reduced chest expansion
31
what is schobers test?
when patient flexes lumbar spine, should increase from 15cm to greater than 20cm but in AS reduced lumbar flexion
32
how is a diagnosis made in AS?
clinically due to late radiographic changes
33
what imaging can be used in AS?
MRI of spine and SIJ
34
what is the first line management of AS?
NSAIDs, physio, encourage exercise
35
what treatment can be used to help enthesitis?
intra-articular steroids
36
what treatment can be used to help peripheral joint disease?
sulfasalazine | mainly of the hip joint
37
if there is non responsive pain and stiffness in AS what treatment can be used?
anti-TNF
38
what develops first in PA, the arthritis or the psoriasis?
psoriasis
39
what joints does PA affect most commonly?
DIP of hands and feet
40
what other joint patterns can PA affect?
symmetrical polyarthritis | unilateral sacroilitis
41
what other presentations are seen with PA?
psoriatic rash | nail changes - pitting, onycholysis, subungual hyperkeratosis
42
what is seen on x-ray with PA?
pencil in dup deformity (due to osteolysis)
43
how is PA treated?
1st line - NSAIDs and physio | progressive disease - methotrexate or anti-TNF
44
what is reactive arthritis?
sterile synovitis occuring 1-4 weeks after infection
45
what infections are commonly associated with reactive arthritis?
GI - salmonella | STI - chlamydia
46
what is another name for reactive arthritis?
Reiter's syndrome
47
what is Reiter's syndrome? and what phrase can help remember it?
uveitis, urethritis, arthritis | --> can't see, can't pee, can't bend the knee
48
what symptoms are associated with reactive arthritis?
``` asymmetrical lower limb pain (knee common) red eye, blurred vision pain on urination mouth ulcers rash on soles of feet and palms of hands ```
49
what is the rash on hands and feet seen with reactive arthritis?
keratoderma blennorhagica (painful, brown, raised lesion)
50
what investigations are done for reactive arthritis?
joint aspiration to rule out septic arthritis | urine sample for chlamydia
51
what is the treatment for reactive arthritis?
rest and NSAIDs | if recurring, potentially DMARD treatment started
52
what is enteropathic arthritis?
arthritis associated with IBD or post gastric bypass surgery
53
what are associated symptoms of enteropathic arthritis?
GI symptoms | erythema nodosum
54
what investigations are done for enteropathic arthritis?
stool sample FBC, LFTs colonoscopy or upper GI endoscopy
55
what is the treatment for enteropathic arthritis?
treat underlying IBD NSAIDs intra articular steroids
56
what can cause gout?
increased urate production: - alcohol - red meat and fish - haemolytic diseases decreased excretion: - CKD - hypothyroidism - drugs (diuretics, chemotherapies)
57
what is acute gout?
mono arthritis that typically presents in 1st MCP, ankle or knee joint lasts 3-10 days
58
what is chronic gout?
multiple acute attacks that cause tophi to develop in joints (large, painless white deposits of sodium urate)
59
what are the investigations for gout?
blood - urate levels | joint aspiration - needle shaped, negatively birefringent crystals
60
what is the treatment for acute gout?
1st line: NSAIDs and PPI 2nd line: cochicine 3rd line: steroids (around 2 weeks for acute attack)
61
why would a patient be put on colchicine instead of NSAIDs in gout? what should you warn patients off with colchicine?
peptic ulcer disease | D & V
62
when is chronic treatment started for gout?
after 1st attack of gout
63
what is the treatment for chronic gout?
1st: allopurinol 2nd: febuxosat
64
when should chronic gout treatment be started?
2 to 4 weeks after attack | not to be started during attack
65
what extra treatment should patients be given when starting chronic gout treatment and why?
cover with acute drug (colchicine) | can potentially precipitate an attack
66
what is deposited in the joints in pseudogout?
calcium pyrophosphate crystals
67
what is deposited in the joints in gout?
sodium urate crystals
68
what is the difference between the crystals in gout and pseudogout?
gout - needle shaped negatively birefringent pseudogout - rhomboid shaped weakly positive birefringent
69
what conditions are associated with psuedogout?
metabolic ones - diabetes, haemochromatosis, hyperparathyroidism ageing injury
70
what joints are affected in pseudo gout?
knee, wrist and shoulder
71
what is the treatment for pseudogout?
1st line: NSAIDs +/- intra articular steroids 2nd line: colchicine (no prophylactic treatment)

FINALS (25 decks)

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