Rheumatology Flashcards
What are three blood tests for anti-phospholipid syndrome
Anti-cardiolipin antibodies
Anti-beta2 antibodies
Positive lupus anticoagulant assay
Symptoms of antiphospholipid syndrome
CLOT
Clots - DVT, PE
Livedo reticularis
Obstetric loss
Thrombocytopenia
Blood tests for Sjögren’s syndrome?
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
Difference between presentation of polymyalgia rheumatica and polymyositis?
PMR - pain, stiffness
Polymyositis - weakness. (Pain and tenderness may be present in a minority of patients)
Both - bilateral, proximal muscle groups affected.
Treatment for polymyositis and dermatomyositos?
- Corticosteroids
Some may need MXT or azathioprine as a steroid-sparing agent
Hydroxychloroquine may help with skin in dermatomyositis
Crystals found in pseudogout
CPPD - calcium pyrophosphate dihydrate
Slightly positively birefringent rhomboid shaped crystals
Risk factors for pseudogout
Advanced age Injury or previous joint surgery Hyperparathyroidism Haemochromatosis Hypomagnesaemia Hypophosphataemia
Treatment for pseudogout
- NSAIDs
- Colchicine if NSAIDs contraindicated
- Short course of oral steroids or infra-articular steroid injection
No prophylactic treatment for pseudogout (unlike gout)
Differentials for an inflamed knee monoarthropathy
- Septic arthritis
- Crystal arthropathy - gout/pseudogout
- Inflammatory arthritis - RA and seronegative arthritis
Risk factors for gout
Obesity
Hypertension
Chronic kidney disease
Diabetes
Metabolic syndrome
Medications : thiazide diuretics, ACE inhibitors, aspirin
Diet high in purines - meat, seafood - alcohol.
What medications are a risk factor for gout
Thiazide diuretics eg bendroflumethoazide, indapamide, hydrochlorothizide (not furosemide - loop diuretic)
ACE inhibitors (-PRIL eg. Perindopril, lisinopril, ramipril, enalapril).
Aspirin
Most common organisms that cause septic arthritis
- Staphylococcus aureus
Other :
Gonococcus (sexually active young adults)
Streptococcus
Gram negative bacilli
Key symptoms of septic arthritis
Red, hot swollen joint (acute inflammation) Fever Joint pain - severe Reduced range of movement Unable to weight bear Systemically unwell
Antibody associated with diffuse systemic sclerosis
Anti-Scl70
What antibody is present in GPA (granulomatosis with polyangiitis) Wegener’s granulomatosis
c-ANCA
Cytoplasmic
Upper and lower airway features: sinusitis, crusting, nasal discharge, SOB, haemoptysis, chest pain
Blood tests for RA
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.
Symptoms of Felty’s syndrome?
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)
What are the seronegative spondyloarthropathies? X 5
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)
Symptoms of systemic lupus erythematosus? List 5
- Malar ‘butterfly’ rash
- Discoid rash
- Photosensitivity
- Oral/nasal ulcers
- 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
- Arthritis
- Kidney damage - protein in urine. Lupus nephritis.
- Neuropsychiatric conditions eg. Headaches, seizures, depression
- Haematological - anemia / thrombocytopenia / leukopenia. Because of autoantibodies against blood components.
- ANA antibodies (most people with Lupus have these)
- Other antibody eg anti-Smith or anti-dsDNA (both specific for lupus)
Systemic symptoms such as
Fever
Fatigue
Myalgia
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