rheumatology Flashcards
what is characteristic of many rheumatological conditions
auto antibody production
what does a seropositive condition mean
auto antibodies in the serum
what is ann auto antibody
it is produced by the immune system and acts against one or more of the individuals proteins
anti CCP associated iwth
rheumatoid arthritis
ANA non specific associated with
SLE, Sjogrens syndrome, systemic sclerosis, MCTD, antoimmune liver disease
dsDNA antibody associated iwth
SLE
anti Sm associated with
SLE
Anti-Ro associated iwth
SLE, Sjogrens syndrome
Anti-La
sjogrens syndrome
anti - centromere antobody
systemic sclerosis (limited)
anti-scl-70 antibody
systemic sclerosis (diffuse)
ti -RNP antibody
SLE, MCTD
ANTI-jO-1 ANTIBODY
myositis
anti cardiolipin antibody and lupus anticoagulant
anti phospholipid syndrome
ANCA
small vessel vasculitis
what is the most common form of arthritis
osteoarthrtitis
what is osteoarthtrtits
progressive degenerative condition affecting joints due to gradual thinning of cartilage, loss of joint space and formation of bony spurs
what are bony spurs
osteophytes
what is pathogenesis of osteoarthrtitis
loss of matrix cartiage, release of cytokines including IL-1, TNF, and mixed metalloproteinases as well as prostaglandins by the chondrocytes
signs and symptoms of osteoarthritis
gradual onset, mechanical pain, crepitus, stiffness, body swelligs and deformity of the joint, can get effusions and soft tissue swelling which can lead to loss of function and mobility
most effected joint of osteoathritis
hands, knees, hip and spine
what are the risk factors for osteoarthritis
age, female, genetic, occupation, previous injury, obesity, underlying conditions
what is an example of genetic predisposition to osteoarthritis
nodal OA
investigations of osteoarthritis
bloods, X ray
blood findings in osteoarthtritis
inflammatory markers are usually normal
typical radiological findings in osteoarthtritis
joint space narrowing, subchondral sclerosis, bony cysts, osteophytes
non pharmalogical managment of OA
education, physio, wgt loss, floot wear, aids sich as walking sticks and jar openers
pharmalogical management of OA
analgesia, NSAIDs, pain modulators, intraarticular steroids
surgical intervention of OA
arthroscopic washout, loose body, soft tissue trimming, joint replacement
what is rheumatoid arthritis
aymmetrical inflammation affecting mainly peripheral joints (mostly synovial) which can lead to joint damage and irreversible deformities leading to loss of function and increased morbidity and mortality
who is RA most common in
women
what is the prevelance of RA
1% in the uk
what is RA mediated by
HLA DR4
what are the triggers of RA
infections, stress, cigerrettes
what is early RA
less than 2 years of symptoms
what is the therapuetic window of opportunity for RA
first 3 months
extra articular manifestations in RA
rheumatoid nodules on extensor surfaces, lung involvement - pleaural effusions, interstitial fibrosis and pulmonary nodules, CVS morbidity and mortality increased, occular
diagnosis of RA
history and clincial exam, prolonged morning stiffness in small joints, positive compression test, blood testing for anaemia and raised platelets, inflammatory markers raised, auto antibodies RF and ACPA, X ray for periarticular osteopenia and soft tissue swelling, per articular erosions can occur later, US for synovial inflammation and MRI for tendons
what score should you use to assess weather the patient is improving or worsening in RA
DAS28^2
first line treatment for RA
methotrexate, analgesia and steoirds for symptosm releif
second line for RA
biologic therapy - anti TNFAalpha drigs
what mist patients have to qualify for biologic therapy
a score larger than 5.1
complications of RA
joint damage and deformaties, atlanto axial sublucation causing cervical cord compression
what does spondyloaryhropathy affect
spine and joints - sacroiliac
what causes spondylarthrtopathy
HLA B27 +ve
what is enthesitis
inflammation at insertation of tendons into bones
what is dactylitis
sausage digits
what is anklyosing spondylitis
inflammation of the spine
who is AS more common in
men
clinical features of AS
back pain enthestitis, peripheral arthritis
extra articular features of AS
anterior uveitis, CVS involvement, pulmonary, asymptomatic enteric mucosal inflammation, nuero involvement
what does syndesmophytes mean
fusion of vertebrae
diagnosis of AS
examine - occiput to wall test, chest expansion, schober test, bloods, Xrays
what % of people have PsA without psoriasis
10-15%
clinical features of PsA
inflammatory arthritis, sacrolitis, nail involvement, dactylitis, enthesitis, extra articular
diagnosis of psoriatic arthritis
bloods and Xrays
treatment of PsA
NSAIDs, corticosteroids, DMARDs, antiTNF if severe, secukinumab, physio, OT, orthotics
