Rheumatology

Question 1

What are three blood tests for anti-phospholipid syndrome

Answer 1

Anti-cardiolipin antibodies
Anti-beta2 antibodies
Positive lupus anticoagulant assay

Question 2

Symptoms of antiphospholipid syndrome

Answer 2

CLOT

Clots - DVT, PE
Livedo reticularis
Obstetric loss
Thrombocytopenia

Question 3

Blood tests for Sjögren’s syndrome?

Answer 3

Anti-Ro/SSA and Anti-La/SSB) are specific for Sjogren’s

Most patients are ANA positive but this is not specific for Sjogren’s

Question 4

Difference between presentation of polymyalgia rheumatica and polymyositis?

Answer 4

PMR - pain, stiffness

Polymyositis - weakness. (Pain and tenderness may be present in a minority of patients)

Both - bilateral, proximal muscle groups affected.

Question 5

Treatment for polymyositis and dermatomyositos?

Answer 5

1. Corticosteroids

Some may need MXT or azathioprine as a steroid-sparing agent
Hydroxychloroquine may help with skin in dermatomyositis

Question 6

Crystals found in pseudogout

Answer 6

CPPD - calcium pyrophosphate dihydrate

Slightly positively birefringent rhomboid shaped crystals

Question 7

Risk factors for pseudogout

Answer 7

Advanced age
Injury or previous joint surgery
Hyperparathyroidism
Haemochromatosis
Hypomagnesaemia
Hypophosphataemia

Question 8

Treatment for pseudogout

Answer 8

1. NSAIDs
2. Colchicine if NSAIDs contraindicated
3. Short course of oral steroids or infra-articular steroid injection

No prophylactic treatment for pseudogout (unlike gout)

Question 9

Differentials for an inflamed knee monoarthropathy

Answer 9

1. Septic arthritis
2. Crystal arthropathy - gout/pseudogout
3. Inflammatory arthritis - RA and seronegative arthritis

Question 10

Risk factors for gout

Answer 10

Obesity
Hypertension
Chronic kidney disease
Diabetes
Metabolic syndrome
Medications : thiazide diuretics, ACE inhibitors, aspirin
Diet high in purines - meat, seafood - alcohol.

Question 11

What medications are a risk factor for gout

Answer 11

Thiazide diuretics eg bendroflumethoazide, indapamide, hydrochlorothizide (not furosemide - loop diuretic)

ACE inhibitors (-PRIL eg. Perindopril, lisinopril, ramipril, enalapril).

Aspirin

Question 12

Most common organisms that cause septic arthritis

Answer 12

1. Staphylococcus aureus

Other :
Gonococcus (sexually active young adults)
Streptococcus
Gram negative bacilli

Question 13

Key symptoms of septic arthritis

Answer 13

Red, hot swollen joint (acute inflammation)
Fever
Joint pain - severe 
Reduced range of movement 
Unable to weight bear
Systemically unwell

Question 14

Antibody associated with diffuse systemic sclerosis

Answer 14

Anti-Scl70

Question 15

What antibody is present in GPA (granulomatosis with polyangiitis) Wegener’s granulomatosis

Answer 15

c-ANCA

Cytoplasmic

Upper and lower airway features: sinusitis, crusting, nasal discharge, SOB, haemoptysis, chest pain

Question 16

Blood tests for RA

Answer 16

FBC - anaemia of chronic disease common
ESR and CRP - raised
Rheumatoid factor - considered specific for RA. Present in 1% of normal population.
Anti-CCP - anti-cyclic citrullinated peptide. Very specific for RA.

Question 17

Symptoms of Felty’s syndrome?

Answer 17

Highly active Rheumatoid arthritis
Splenomegaly
Neutropenia

Felty’s syndrome is a rare variant of RA.
Linked to strongly positive Rh factor and HLA DR4.

SANTA
Splenomegaly
Anaemia
Neutropenia
Thrombocytopenia
Arthritis (Rheumatoid)

Question 18

What are the seronegative spondyloarthropathies? X 5

Answer 18

Ankylosing spondylitis
Reactive arthritis (formerly Reiter syndrome)
Psoriatic arthritis
Inflammatory bowel disease associated arthritis
Undifferentiated SpA

Negative for Rh factor
Positive for HLA-B27 (not all cases)

Question 19

Symptoms of systemic lupus erythematosus? List 5

Answer 19

1. Malar ‘butterfly’ rash
2. Discoid rash
3. Photosensitivity
4. Oral/nasal ulcers
5. Serositis (serosa is the outer membrane of an organ or tissue) eg pleuritis (lungs), pericarditis (lining of heart), peritonitis (lining of abdomen). Also myocarditis, Libman-Sacks endocarditis → vegetations on mitral valve
6. Arthritis
7. Kidney damage - protein in urine. Lupus nephritis.
8. Neuropsychiatric conditions eg. Headaches, seizures, depression
9. Haematological - anemia / thrombocytopenia / leukopenia. Because of autoantibodies against blood components.
10. ANA antibodies (most people with Lupus have these)
11. Other antibody eg anti-Smith or anti-dsDNA (both specific for lupus)

Systemic symptoms such as
Fever
Fatigue
Myalgia

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