Rheumatology Flashcards
Side effects of trimethoprim and methotrexate
Bone marrow suppression and fatal pancytopenia
What gene is Dermatitis herpetiformis
HLA-DR3
What problems can bisphosphonates cause?
Oesophageal problems
Alendronic Acid
Side effect of hydroxychloroquine
Severe and permanent retinopathy
Risk factor for pseudogout
Hyperparathyroidism
Investigation for osteoporosis in a man
Check testosterone
What bones does Paget’s Disease affect?
Skull, spine, pelvis and long bones of the lower extremities
Investigation for Pagets disease
Isolated rise in alkaline phosphatase
How long should patients with antiphospholipid syndrome be on anticoagulation for after the first VTE
and what anticoagulation
Lifelong warfarin
Renal impairment, respiratory symptoms, joint pain, systemic features
ANCA associated vasculitis
Interferon alpha
Flu-like Sx
Cardiac complications of Ehlers Dhanlos
Aortic regurgitation
Before starting biologics for RA what do you investigate?
CXR to look for TB
Arterial/venous thromboembolism, miscarriage, livedo reticularis
Antiphospholipid syndrome
Key investigation for polymyalgia rheumatica
Raised inflammatory markers
Elderly and gout - management
NSAIDs avoided due to GI haemorrhage
Give Colchicine instead
What type of hypersensitivity reaction is SLE
3
Joint aspirate in RA
High WBC count, predominantly PMNs
Appearance is cloudy with an absence of crystals
Antibody in Dermatomyositis
Anti-Jo
Osteoporosis blood test values
Normal
Sjogren’s syndrome increased risk of…
Lymphoid malignancies e.g. lymphoma
Investigation before starting on azathioprine
Check TPMT
2 features of Marfan’s syndrome
Pectus excavatum and pes planus
ABx for septic arthritis
IV flucloxacillin
triad in behcet’s
Oral ulcers
Genital ulcers
Anterior uveitis
Patients who are allergic to aspirin may also react to…
sulfasalazine
Diagnosis of ankylosing spondylitis
Sacro-ilitis on a pelvic xray
What type of hypersensitivity reaction is ITP
2
Bone pain, tenderness and proximal myopathy (–> waddling gait)
Osteomalacia
Treatment of suspected visual loss secondary to temporal arteritis
IV methylprednisolone (otherwise oral if no vision change)
Prolonged APTT
Antiphospholipid syndrome
Investigation for ankylosing spondylitis
Plain radiography of the pelvis
What does haemochromatosis increase the risk of?
Gout
What forms the basis of the T score from the DEXA scan?
The T score is based on the bone ass of a young reference population
Features of reactive arthritis
Develop 4 weeks after precipitating infection and run a relapsing remitting course
3 features of temporal arteritis
Constant throbbing headache
Pain on chewing (jaw claudication)
Tender scalp (when brushing hair)
5 features of ankylosing spondylitis on xray
Syndesmophytes Bamboo spine (late sign rarely seen in practise)
Subchondral erosions
Sclerosis
Squaring of the lumbar vertebrae
Side effect of bisphosphonates
Osteonecrosis of the jaw
Swollen first finger and wrist pain with fatigue, 1st degree relative with psoriasis
Psoriatic arthritis
dactylitis
Sjogrens disease
Feature
Test
Antibodies
Reduced saliva, joint arthralgia, fatigue
Positive Schirmer’s test
Anti-Ro/Anti-La
Interaction between allopurinol and azathioprine
Bone marrow suppression
Malignancy and raised creatinine kinase
Polymyositis
Lytic lesion in the diaphysis of pelvis and long bones with an ‘onion appearance’
Ewing’s Sarcoma
Which test would be useful to rule out SLE?
ANA
Pharmacological treatment of Raynaud’s
Nifedipine
1st line treatment for SLE
Hydrochloroquine
2 side effects of methotrexate
Mucositis (apthous-like ulcers)
Pulmonary fibrosis
cANCA
granulomatosis with polyangiitis
pANCA
Churg-Strauss syndrome
Ulcerative Colitis
eosinophilic granulomatosis with polyangiitis
Dermatological finding in Behcet’s syndrome
Erythema nodosum
Epicondylitis: which gives pain on flexion/extension?
Pain on extension: lateral
Pain on flexion: medial
Positively bifringent rhomboid shaped crystals
Pseudogout
Negatively bifringement needle shaped crystals
Gout
Frank haematuria, persistent dry cough, dysponea, sinusitis, nosebleeds, saddle shaped nose and bibasal crepitations
Granulomatosis with polyangiitis
Crystals in pseudogout
Calcium pyrophosphate crystals
Joint pain, pink bumpy rash, fever
Bilateral cervical lymphadenopathy, palpable spleen
Negative RF and ANA
Adult onset still’s disease
Starting allopurinol
Give colchicine ‘cover’ when starting
Three features of Felty’s syndrome
Rheumatoid Arthritis
Splenomegaly
Low white cell count
Results of adjusted calcium, PTH, ALP and PO4 in osteogenesis imperfecta
Normal
Antibodies in antiphospholipid syndrome
Anti-Cardiolipin Antibody
Management of renal complications with systemic sclerosis
ACEi
Treatment of acute reactive arthritis
NSAIDs
intraarticular steriods if resistant to NSAIDs and small number of joints affected
Score to assess hypermobility
Beighton score
What is schirmer’s test
Determines whether the eye produces enough tears to make it moist
Bone pain tenderness and proximal myopathy with a waddling gait
Osteomalacia
treatment of pagets disease
Bisphosphonates
Joint aspirate in reactive arthritis (reiter syndrome)
Sterile synovial fluid with a high white blood cell count
Side effect of isoniazid
Drug-induced lupus
FIRST thing you do with suspected temporal arteritis
High dose oral prednisolone
Score for disease activity in RA
DAS28
The 6 A’s in Ankylosing Spondylitis
Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis
What autoimmune disease is pericarditis associated with?
SLE
What type of hypersensitivity is allergic contact dermatitis
Type 4
Low levels of which type of complement are associated with the development of SLE?
C4
What is the Z score adjusted for in DEXA scans?
Age, gender and ethnic factors
Juxa-articular osteoporosis/osteopenia is an early xray feature of which arthritis?
RA
What auto-antibody is reactive arthritis associated with?
HLA-B27
Myositis with anti-Jo antibodies can predispose what?
lung fibrosis
What condition is associated with dermatomyositis
Internal malignancy
Swelling in RIGHT INDEX FINGER
Psoriatic arthritis
Methotrexate and pregnancy
Stop 6 months before trying
What should you check before starting azathioprine due to increased risk of toxicity?
Thiopurine methyltransferase deficiency
creatinine kinase in polymyalgia rheumaticA
Normal
creatinine kinase in polymyositis
raised
Primary raynauds
young women with bilateral symptoms
Initial treatment of ankylosing spondylititis
NSAIDs and physio
Thromboprophylaxis for antiphospholipid syndrome with no previous thrombosis
Aspirin
What hand sign can reactive arthritis cause
Dactylitis
Duration of ABx for septic arthritis
4-6 weeks
Distinguish gout from pseudogout
Chondrocalcinosis
What antibodies are associated with drug induced lupus?
Antihistone antibodies
Renal impairment, respiratory symptoms, joint pain
ANCA associated vasculitis
Is obesity and rheumatoid arthritis a risk factor for osteoporosis
Obesity - no
RA - yes
Is azathioprine safe to use in pregnancy?
Yes
Bisphosphonate holiday
Repeat DEXA and FRAX and stop if low risk then review in 2 years
What condition are chemotherapy patients at higher risk for?
Gout
What investigation is used to monitor SLE and what will the result be?
Complement levels - levels are usually low during active disease
What rash is found with reactive arthritis
Keratoderma blenorrhagica
Septic arthritis investigation
Synovial fluid analysis
What movement of the spine is reduced in ankylosing spondylitis?
Reduced lateral flexion
Most common organism in septic arthritis - young adults and adults
Young adults: Neisseria gonorrhoeae
Adults: Staphlococcus aureus
Pathophysiology of marfans
Mutation in a protein called Fibrillin-1
What inheritance is marfans?
Autosomal dominant
Suspected rheumatoid first line imaging
xray
is hydroxychloroquine safe in pregnancy
yes
How many NSAIDs must have failed for a patient with ankylosing spondylitis to have anti-TNFa drugs
2
You can start an oral bisphosphonate without a DEXA scan
Side effect of colchicine
Diarrhoea
Patients who are allergic to aspirin might also react to…
… sulfasalazine
Side effects to alendronate
Give risedronate
Is there limb weakness in polymyalgia rheumatica?
No - power is normal
Periarticular erosions are seen in which arthrititis?
RA
Examination test in ank spond
Schobers test
Giant cell arteritis Sx but normal biopsy - what do you do?
Continue the prednisolone regardless of the biopsy result
Initial management of RA
Methotrexate plus a short course of oral prednisolone
What condition increases the risk of temporal arteritis
Polymyalgia rheumatica
First line pain relief for osteoarthritis
Paracetamol
Most specific test for SLE
Anti-dsDNA
What does a raised CRP in a patient with SLE indicate
Underlying infection
