rheumatology Flashcards
what may distinguish psoriatic arthritis from rheumatoid arthritis?
Psoriatic arthritis usually rheumatoid factor negative and instead associated with HLA-B27.
65 y/o female
pc: increasing pain + swelling of left knee. associated decrease in mobility.
oe: swollen, painful left knee + swelling of DIPS
likely diagnosis?
Osteoarthritis
why?
age, distribution of arthritis.
most common in hands and weight bearing joints (knee, hips , spin)
PIP - bouchards nodes
DIP - heberdens nodes
21 y/o male
pc: ulceration affecting mouth + scrotum.
oe: painful, swollen ankles, knees and right elbow
some associated d + v
likely diagnosis?
exacerbation of behcets
- idiopathic
- caused by inflammation of venules
what gene is behcets associated with?
HLA-B51
behcets disease characterised by:
- reccurrent ulceration (mouth + genatalia)
- uveitis
- skin lesions (erythema nodosum)
often affects young people from the mediterranean, middle east and far east.
17 y/o female
pc: rash over both cheeks, pain swelling in hands and feel.
ix: anti-double stranded DNA antibodies (anti-dsDNA)
likely diagnosis?
SLE
- characterised by butterfly facial rash, pathognomic anti-dsDNA autoantibodies
xerostomia is
dry mouth
why does sjogren syndrome occur?
T cell infiltration of the lacrimal and salivary glands
what is the patellar tap test and when is it performed?
indicates if there is swelling in the knee joint.
if you can feel patella floating when you’re tapping it means fluid has accumulated under it
what is shown in the aspirate of a patient with gout?
negatively birefringenet needle shaped crystals.
patient unlikely to be systematically unwell.
what might be present in the aspirate of patients with pseudogout?
positively birefringement crystals.
psuedogout
- classically affects knee
- deposition of calcium pyrophosphate crystals in joint
characteristic deformities in rheumatoid arthritis?
- ulnar deviation
- boutonniere
- swan neck
- z deformity of thumb
what is granulomatosis with polyangiitis
necrotizing small vessel vasculitis.
GPA associated with palpable purpura on extremities.
classic triad of involvement
1. upper resp tract and sinuses
2. lungs (–> haemoptysis pulmonary cavitary lesions)
3. kidneys
c-ANCA
recap CREST syndrome
- calcinosis
- raynaud syndrome
- oesophageal dysmotility
- sclerodactyly
- telangiectasia
diagnosis requires presence of at least two of the symptoms.
what type of condition is crest syndrome?
autoimmune
- associated with dysfunction of fibroblasts
- leads to organ fibrosis
- leads to scarring
what antibodies is CREST syndrome associated with?
positive anti-centromere
anti-nuclear antigen antibodies
name a disease characterised by
- pain
- muscle weakness
- heliotrope rash around eyelids
- gottron pappules
dermatomyositis
- autoimmune, inflammatory
- causing symmetrical weakness of proximal muscles
ANA antidbody
discrete erythematous scaly papules found in dermatomyositis are known as :
dermatomyositis
which antibodies are positive in sjogrens syndrome?
anti-la antibodies
the antibody Scl70 is raised in:
diffuse systemic sclerosis
24 y/o male presents with lower back pain + early morning stiffness which slowly improves throughout the day
positive schobers test:
diagnosis
ankylosing spondylitis
name a condition which classically causes the following symptoms:
pain + stiffness
- neck
- shoulders
- pelvic girdle
polymyalgia rheumatica
- associated with giant cell arteritis
demographics
> 50
women >
caucasians >
ESR key investigation as PMR characterised by raised levels of inflammatory markers
examples of appropriate pharmacological treatments for severe pain disturbance in fibromyalgia?
- duloxetine
- pregabalin
- tramadol
what condition is characterised by the following triad:
- splenomegaly
- neutropenia
- rheumatoid arthritis
Felty’s syndrome
seropositive arthritis is characterised by the presence of what:
rheumatoid factor
example of seronegative spondyloarthropathies?
PEAR
Psoriatic arthritis
Enteropathic arthritis (associated with IBD)
Ankylosing spondylitis
Reactive arthritis
describe pagets disease?
- excessive bone resorption & haphazard bone growth
- usually asymptomatic
- results in weak, misshapen bones
mneumonic : PANICS
P - pain in bone
A - arthralgia
N - neural deafness, nerve compression
I - increased bone density
C - cardiac failure
S - skull or sclerotic vertebra
Anti-saccharomyces cerevisiae antibodies are immune proteins that are frequently present in patients who have what condition?
inflammatory bowel disease
may also be present in behcets disease.
what is the first line intervention for a patient presenting with a history of SLE limited to joints and skin
first tried on hydroxychloroquine
- antimalarial
severe SLE
- DMARDS (disease modifying ant rheumatic drugs)
- methotrexate (if acute joint synovitis)
anti-mitochondrial antibody is associated with:
primary biliary cholangitis
what is takayasu arteritis?
aka pulseless disease
- affects aorta and its large branches
- causes thickening and fibrosis of vessel wall. narrows lumen - ISHCAEMIA
- weak / absent pulse
- chest pain / claudication
- renal artery stenosis - non specific symptoms
- weakness, fatigue, fever, weight loss, arthralgia
Epidemiology
- women < 40
- esp asian
most common bacteria to cause septic arthritis?
staph aureus
notes
- strep pyogenes also common, often associated with autoimmune disease, trauma.
- pseudomonas aeruginosa may be cause of septic arthritis in children, elderly or IVDU or immunocompromised
