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Specialities > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is the first-line treatment for osteoporosis?

A

A bisphosphonate, alendronic acid with calcium and vitamin D supplements

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2
Q

What is calcitriol?

A

The man-made, active form of vitamin D

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3
Q

What is Behcet’s disease?

A

Auto-immune mediated inflammation of the arteries and veins i.e. systemic vasculitis

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4
Q

What is the classic triad of Behcet’s disease?

A

Oral ulcers, genital ulcers and anterior uveitus

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5
Q

What is the treatment for Behcet’s disease?

A

Symptom management

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6
Q

What is the classic epidemiology of Behcet’s disease?

A
  • Common in eastern Mediterranean
  • More common and severe in men
  • Affects younger adults 20-40
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7
Q

What are the classic preceding events before reactive arthritis?

A
  • History of gastrointestinal or genitourinary infection

- Infection in the last 1-4 weeks

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8
Q

What are the presenting features of reactive arthritis?

A
  • Fever
  • Arthritis
  • Enthesitis (inflammation where tendons insert into bones)
  • Conjunctivitis and iritis
  • Skin lesions
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9
Q

What joins are usually affected in reactive arthritis?

A

Large joints of the lower limb, tend to be asymmetrical

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10
Q

What is the treatment for reactive arthritis?

A

NSAIDs and corticosteroids

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11
Q

What is rheumatic fever?

A

An autoimmune condition that affects the heart, joints, muscles, skin and brain

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12
Q

What is the cause of rheumatic fever?

A

Group A streptococcal throat infection e.g. Streptococcus pyogenes in the last 2-6 weeks

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13
Q

What are the major diagnostic criteria for rheumatic fever?

A
  • Erythema marginatum
  • Chorea
  • Polyarthritis
  • Carditis
  • Subcutaneous nodules
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14
Q

What is the cause of chronic rheumatic heart disease?

A

Chronic changes to heart valves as a result of carditis seen in rheumatic fever

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15
Q

What is the treatment for rheumatic fever?

A

IM antibiotics (benzathine benzylpenicillin, erythromycin in pen allergic) and symptom management

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16
Q

What are the key diagnostic factors for rheumatoid arthritis?

A
  • Active symmetrical arthritis lasting >6 weeks
  • Age 50-55
  • Female
  • Joint pain and swelling
  • Morning stiffness
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17
Q

What joints are commonly affected in rheumatoid arthritis?

A

MCP, PIP and MTP joints

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18
Q

What are the investigations for suspected RA?

A
  • Rheumatoid factor (+ve in 60-70%)

- Anti-CCP (anti-cyclic citrullinated peptide antibody) (+ve in 70%)

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19
Q

What is the treatment for mild RA in patients not planning pregnancy?

A

DMARD e.g. hydroxychloroquine

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20
Q

What is a DMARD?

A

Disease-modifying anti-rheumatic drug

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21
Q

What is the primary treatment option for patients with RA that are pregnant or planning a pregnancy?

A

Prednisolone

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22
Q

What is the treatment for poorly controlled RA?

A

Methotrexate plus biological agent or DMARD

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23
Q

How are flares of rheumatoid arthritis managed?

A

With oral or IM corticosteroids

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24
Q

What can be used to monitor SLE flares?

A

Complement - they are usually low during active disease

25
Q

What are the classic signs and symptoms of SLE?

A
  • Malar (butterfly) rash
  • Photosensitive rash
  • Discoid rash
  • Mouth ulcers
  • Fatigue
  • Arthralgia
  • Unexplained fever
26
Q

99% of patients with SLE are ___ ________.

A

ANA positive

27
Q

What blood results would you see in patients suspected of having SLE?

A
  • Anaemia
  • Leukopenia
  • Thrombocytopenia
  • Elevated urea, creatinine ESR and CRP
  • Positive ANA
28
Q

What is the treatment of choice for SLE?

A

Hydroxychloroquine

29
Q

What is the first line treatment for SLE patients with lupus nephritis?

A

Induction therapy, hydroxychloroquine and corticosteroids e.g. cyclophosphamide and prednisolone

30
Q

What is gout characterised by?

A

Acute onset of severe joint pain, with swelling, effusion, warmth, erythema, and or tenderness of the involved joint(s).

31
Q

What is the difference between gout and pseudogout when analysing the synovial fluid?

A

Gout = strongly negative birefringent needle-shaped crystals under polarised light

Pseudogout = positively birefringent rhomboid-shaped crystals under polarised light

32
Q

The joint most affected (70% of cases) in gout is the _____ ___ joint. However, the _____, _______, ______, _____, _____ and _____ are also commonly affected.

A

First MTP

Foot, ankle, knee, fingers, wrist and elbow

33
Q

What are strong risk factors for gout?

A
  • Male sex
  • Older age
  • Post-menopausal
  • High consumption of meat, seafood and alcohol
  • Use of diuretics, ciclosporin and pyrazinamide
34
Q

What is the cause of gout?

A

Chronic hyperuricaemia (uric acid > 0.45 mmol/l)

35
Q

What is the first-line treatment for acute gout?

A

NSAID plus corticosteroid plus colchicine

36
Q

What is the first-line treatment for recurrent gout 2-3 weeks post acute episode?

A

Allopurinol and suppressive therapy (NSAID or low dose colchicine)

37
Q

What is allopurinol?

A

Urate-lowering therapy used to treat gout

38
Q

What is pseudogout also known as?

A

Calcium pyrophosphate arthritis (CPP)

39
Q

The prevalence of CPP _______ with each decade after the age of __ years.

A

Doubles

60

40
Q

What are the strong risk factors for pseudogout?

A
  • Old age
  • Injury new or previous to joints
  • Hyperparathyroidism
  • Hemochromatosis
  • Hypomagnesemia
  • Hypophosphatasia
41
Q

What is the first-line treatment for pseudogout?

A

Intra-articular corticosteroids (preferably triamcinolone hexacetonide) with paracetamol

42
Q

What is the first-line treatment for pseudogout when injections are not possible/tolerated?

A

NSAIDs

43
Q

What type of arthritis is psoriatic arthritis?

A

Seronegative inflammatory spondyloarthropathy

44
Q

What are the key differences seen in psoriatic arthritis that differentiates it from rheumatoid arthritis?

A
  • Mono- or oligoarticular
  • DIP joint involvement
  • Dactylitis
  • Sacroiliitis
  • History of psoriasis
  • Nail changes (pitting)
45
Q

What is the treatment for psoriatic arthritis?

A

A combination of DMARDs, NAIDS, physiotherapy and intra-articular corticosteroid injections

46
Q

What are patients with psoriatic arthritis at increased risk of?

A

Myocardial infarction, angina, and hypertension

47
Q

Regard a hot, swollen, acutely painful joint with restriction of movement as ______ ________ until proven otherwise, even in the absence of fever and irrespective of microbiology and blood test results.

A

Septic arthritis

48
Q

What are the most common organisms seen in septic arthritis?

A

Staphylococci or streptococci

49
Q

What tests should you do on the synovial fluid of a patient with suspected septic arthritis?

A
  • Fluid microscopy
  • Gram stain
  • Polarising microscopy
  • Culture and sensitivities
  • White cell count
50
Q

Should you aspirate a joint suspected of being infected before or after starting antibiotic therapy?

A

Before unless more urgent treatment is indicated

51
Q

What is your management for a suspected infection in prosthetic joint(s) and why?

A

Refer to orthopaedics because aspiration needs to be done in a sterile operating theatre environment

52
Q

What is the treatment for septic arthritis in an accessible joint with no systemic involvement?

A
  • Empirical IV antibiotics e.g. flucloxacillin/clindamycin
  • Aspirate the joint to dryness
  • Analgesia
53
Q

What is the most common cause of septic arthritis in young adults who are sexually active?

A

Neisseria gonorrhoeae

54
Q

What is Sjögren’s syndrome?

A

An autoimmune disease characterised by dry eyes and dry mouth (xerostomia) as a consequence of lymphocytic infiltration into lacrimal and salivary glands

55
Q

What antibodies are associated with Sjögren’s syndrome?

A
  • ANA
  • Anti-60 kD (SS-A) Ro
  • Anti-La auto-antibodies
56
Q

What is polymyalgia rheumatica characterised by?

A

Pain and morning stiffness in the neck, shoulder girdle and/or pelvic girdle. There is also a rapid response (24-72 hours) to corticosteroids.

57
Q

What condition is polymyalgia rheumatica associated with?

A

Giant cell arteritis

58
Q

What are the pathological changes seen in bursitis?

A
  • Synovial thickening
  • Bursal adhesions
  • Villus formation
  • Tags
  • Deposition of chalky deposits

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