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Rheumatology Flashcards

1
Q

Best way to distinguish primary and secondary raynauds

A

Nailfold Capilloroscopy - normal in primary raynauds

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2
Q

Why is febuxistat second line to allopurinol in gout prophylaxis?

A

Inhibits both reduced and oxidised forms of Xanthine Oxidase making it more potent but with higher risk of CVD and all-cause mortality

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3
Q

Treatment GCA

A

High dose steroids
Methotrexate
Tocilizumab (anti-IL6)

Anti-TNF inhibitors NOT recommended

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4
Q

Inclusion Body Myositis distribution

A

Asymmetrical Proximal and Distal weakness
- Quadracips
- Finger flexors - distinguishing factor
- Ankle dorsiflexion
- Cricopharyngeal involvement with dysphagia

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5
Q

Investigation findings inclusion body myositis

A
  • Normal or mildly raised CK
  • Biopsy;
    1. Endomysial inflammation
    2. Rimmed Vacuoles
    3. Proteinaceous inclusions
  • EMG showing mixed myopathic and neuropathic process
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6
Q

Management of OA

A

Weight loss
Exercise
CBT
Proper footwear
NSAIDS
Duloxetine
Intra-articular steroids
Joint replacement

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7
Q

Renal transporters of uric acid

A

ABCG2 - excretion at proximal tubule (and gut)
URAT1 - reabsorption

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8
Q

Serology of drug-induced lupus

A
  • ANA (without anti-dsDNA. Anti-smith, Anti-Ro)
  • Anti-histone
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8
Q

ANCA Vasculitis types

A
  • Granulomatosis with polyangitis (Wegners) - cANCA/PR3 - GN, Lung, Sinus, ENT
  • Microscopic polyangitis - pANCA, MPO - GN and Lung
  • Eosinophilic polyangitis Granulomatosis (Churg-Strauss) - pANCA - Asthma, Nasal polyps, atopy, GN
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9
Q

Anti-synthetase syndrome

A
  • Anti-tRNA Ab - Anti-Jo and Anti-PL12
  • Dermatomyositis
  • Interstitial Lung Disease
  • Raynauds
  • Non-Erosive Arthritis
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10
Q

Diagnostic criteria for PMR

A

Must have;
Age > 50
Bilateral shoulder aching
Abnormal CRP or ESR

Plus > 4 of;
Morning stiffness > 45 minutes (2 points)
Hip pain/limited ROM
Absence of RF or Anti-CCP (2 points)
Absence of other joint involvement
USS findings of shoulder or hip bursitis/synovitis

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11
Q

Antibody associated with limited Scleroderma

A

Anti-Centromere

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12
Q

Antibodies associated with diffuse scleroderma

A

Anti-topoisomerase 1 (Scl-70)
Anti- RNA polymerase - increased risk of renal cell crisis and malignancy

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13
Q

Antibody associated with scleroderma renal crisis

A

Anti-RNA polymerase

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14
Q

Antibody associated with scleroderma interstitial lung disease

A

Anti-topoisomerase (Anti Scl-70)

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15
Q

Definition ‘Extensive’ scleroderma ILD

A

> 20% lung involvement on HRCT
FVC < 70%
DLCO < 55%

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16
Q

Treatment of Scleroderma renal crisis

A

ACE inhibitors

Due to RAAS blockade which leads to resolution of malignant HTN

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16
Q

Treatment of Scleroderma renal crisis

A

ACE inhibitors

Due to RAAS blockade which leads to resolution of malignant HTN

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17
Q

Rheumatoid arthritis diagnostic criteria

A
  • Number of joints
  • Seropositivity (RF +/- Anti-CCP)
  • CRP or ESR
  • Duration of symptoms > 6 weeks
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18
Q

Feltys syndrome

A

Neutropenia
Splenomegaly
Rheumatoid arthritis
Leg Ulcers

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19
Q

Imaging findings in RA

A

Symmetrical
Sparing of DIP
Joint space narrowing with Ankylosis
Erosions
Periarticular ostopenia
Soft-tissue swelling
Subluxation

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20
Q

Major cause of death in RA

A

Cardiovascular disease (associated with higher CRP levels at baseline)

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21
Q

Abatacept

A

CTLA receptor agonist which inactivates CD4 cells.
Can lead to normal CRP in patients despite infection or inflammation

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22
Q

Side effect of hydroxychloroquine

A

Retinopathy
Hyperpigmentation

23
Rheumatoid Factor - False positives
- Chronic infection (most common) - Other Rheumatological pathologies - Hep B and C - Cryoglobulinemia - Endocarditis - Malignancy - Primary Biliary cirrhosis - 4% young population
24
Rheumatoid factor negative conditions
- Ankylosing spondylitis - Psoriatic arthritis - Enteropathic arthritis - PMR
25
Best predictor of RA severity
Early bony erosions on imaging
26
Indicator of disease activity in RA
CRP NOT anti-CCP or RF Note: indictor of disease severity is early erosive bone disease
27
Rescue Rx for MTX toxicity
Folinic acid - utilisation of reduced folates for nucleic acid synthesis
28
Treatment of Latent Tb pre-TNF inhibitor use
9 months Isoniazid 4 months Rifampicin 3 months Isoniazid and Rifampicin
28
Treatment of Latent Tb pre-TNF inhibitor use
9 months Isoniazid 4 months Rifampicin 3 months Isoniazid and Rifampicin
29
First line DMARD for Rheumatoid
Methotrexate
30
Adult Onset Still's disease
Young adults, often during pregnancy Fever Pharyngitis Salmon coloured rash Adenopathy Hepatosplenomegaly Lymphadenopathy High Ferritin Inflammatory arthritis negative Rheumatoid and ANA
31
Reiters syndrome
Reactive Arthritis - asymmetrical oligoarthriritis of lower limbs Urtheritis Conjunctivitis
32
Serological marker indicating disease severity in Lupus
- Low complement levels - dsDNA indicative of severity of renal disease ANA does not indicate severity
33
Serological marker of mixed connective tissue disorder
Anti - RNP
34
Serological markers of Sjogrens
Anti-Ro Anti- La
35
Serological marker drug-induced lupus
Anti- Histone
36
All serological markers of Lupus
ANA (Nuclear) dsDNA (Homogenous) Anti-histone - drug induced (homogenous) Anti-Smith Anti-Ro Anti-lupus Anticoagulant Anti-ribosomal P Anti-beta-glycoprotein 1
37
DISH - diffuse idiopathic skeletal hyperostosis
> 4 Vertebral ossification > 50, Men, Diabetic No involvement of SI joints HLA-B27 negative
38
Treatment of Ankylosing Spondylitis
Exercise NSAIDs Smoking cessation If failed after 12 weeks - Anti-TNF (do not slow radiological progression in AS, but do in psoriatic arthritis) Anti-IL17- Secukinumab Methotrexate has no effect in AS
39
Pencil-in-cup XR appearance
Characteristic for psoriatic arthritis
40
Behcets Syndrome
Systemic Vasculitis Oral Ulcer > 3 times/1 year Genital Ulcers Pathergy (Inflammatory response to skin prick with a sterile needle) Erythema Nodosum Inflammatory arthriris Uveitis Elevated ESR Occurs along "Silk Road" demographic
41
Small vessel vasculitis associations with Hepatitis
Polyarteritis Nodosum - Hepatitis B Cryoglobulinemic vasculitis - Hepatitis C
42
Urate transporters
ABCG2 - excretion at kidneys and gut URAT1 - reabsorption at kidneys
43
Imaging findings of OA
Joint space narrowing Subchondral cysts Osetophytes Sclerosis Gull wing deformity of DIP
44
Rheumatoid Arthritis HLA associations
HLA DRB1-04
45
How does smoking increase RA risk?
Increased conversion arginine -> citrulline -> target for anti-CCP
46
Stimulants for RA
- Smoking - Periodontal infection via Porphyromonas Gingivalis - Gut bacteria Convert Arginine to citrulline which up regulates Anti-CCP
47
Mechanism of action of Leflunomide
- Blocks DHODH which is required in pyrimidine synthesis - Reversed by Cholecystyramine if severe side effects of ILD or hepatitis
48
Best TNF-inhibitor in pregnancy
Certolizumab
49
Risk factors scleroderma renal crisis
- Anti- RNA polymerase and Anti-topoisomerase (Scl-70) - Steroid use - Tendon Friction rub - Cyclosporins
50
Most common ILD pattern in diffuse scleroderma
Non-specific interstitial pneumonia
50
Most common ILD pattern in diffuse scleroderma
Non-specific interstitial pneumonia - diffuse (RA = UIP, basal, AS = apical, Sjogrens = lymphoid)
51
Treatment ILD associated with Scleroderma
Cyclophosphomide or Mycophenolate
52
Nail change in psoriatic arthritis
Nail pitting/Onychodystrophy
53
Jaccoud Arthropathy
Non-erosive arthritis as a result of recurrent joint inflammation from other forms of arthritis. It is distinguished from RA because it is non-erosive and reversible
54
Uric acid level targets in gout
< 0.3 if tophi < 0.36 if no tophi

RACP (17 decks)

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