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MSK > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is the ideal first line treatment of inflammatory arthritis?

A

DMARD therapy within 3 months of symptom onset

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2
Q

What are the indications for methotrexate?

A

Rheumatoid arthritis
Psoriatic arthritis
Connective tissue diseases
Vasculitis

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3
Q

What are the adverse effects of methotrexate?

A

Leucopaenia/thrombocytopaenia
Hepatitis/cirrhosis
Pneumonitis
Rash
Mouth ulcers
Nausea/diarrhoea
Teratogenic

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4
Q

What precautions should be taken when someone is on methotrexate?

A

Limit alcohol intake
Monitor FBC and LFTs

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5
Q

What are the side effects of sulfasalazine?

A

Nausea
Rash
Mouth ulcers
Neutropaenia
Hepatitis
Reduced sperm count

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6
Q

What precautions should be taken whem someone is on sulfasalazine?

A

Monitor FBCs and LFTs

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7
Q

When is hydroxychloroquine used?

A

Connective tissue disorders
Rheumatoid arthritis

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8
Q

What is the key side effect of hydroxychloroquine?

A

Rarely causes retinopathy

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9
Q

What are the criteria for starting an RA patient on biologic?

A

High disease activity score
Not treated with 2 DMARDs

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10
Q

What are the adverse effects of biologics?

A

Increased risk of infection (especially TB)

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11
Q

What is the treatment for an acute episode of gout?

A

Colchicine
NSAIDs
Steroids

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12
Q

Which urate lowering drugs are used in the prophylaxis of gout?

A

Allopurinol
Febuxostat
Uricosurics

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13
Q

What are the adverse effects of allopurinol?

A

Rash (vasculitis)
Azothioprine interaction
Rarely marrow aplasia

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13
Q

What are the adverse effects of allopurinol?

A

Rash (vasculitis)
Azothioprine interaction
Rarely marrow aplasia

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14
Q

What are the risk factors for rheumatoid arthritis?

A

Female
Family history (HLA-DR4 mediated)
Triggers
- Infection
- Stress
- Cigarette smoking

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15
Q

What is the clinical presentation of rheumatoid arthritis?

A

Symmetrical pain and swelling in peripheral synovial joints
Early morning stiffness lasting longer than 60 mins
Positive pressure test
Trigger finger
Carpal tunnel syndrome
Palindromic rheumatism
Poor grip strength

16
Q

What is the management of rheumatoid arthritis?

A

START DMARD THERAPY WITHIN 3 MONTHS OF SYMPTOM ONSET
Care by rheumatologist
NSAIDs and steroids as adjuncts
Stop smoking
Osteoporosis screening
Immunisations

17
Q

What are the risk factors for osteoarthritis?

A

Genetic
Age
Female
Obesity
Biomechanical

18
Q

What qualifies as generalised osteoarthritis?

A

Either spinal or hand plus 2 other regions

19
Q

What are the symptoms of osteoarthritis?

A

Pain made worse with activity
Morning stiffness lasting less than 60 mins
Inactivity gelling
Joint instability
Poor grip if thumb affected
Pain in hip OA may radiate to the knee or groin or from the lower back

20
Q

What are the signs in osteoarthritis?

A

Joint line tenderness
Crepitus
Joint effusion
Bony swelling
Deformity
Limited motion
Heberden’s and Bouchard’s nodes
Knee OA:
- Varus and valgus deformities
- Baker’s cysts (outpouching in popliteal fossa)

21
Q

What is the difference between Heberden’s and Bouchard’s nodes?

A

Heberden’s nodes affect the DIPs and Bouchard’s nodes affect the PIPs

22
Q

What are the signs of osteoarthritis on an x-ray?

A

Marginal osteophytes
Joint space narrowing
Subchondral sclerosis
Subchondral cysts

23
Q

What is the management of osteoarthritis?

A

Lifestyle changes
Physiotherapy
Occupational therapy
Analgaesia
Steroid injections
Joint replacement

24
Q

Who is typically affected by gout?

A

Males more than females
Post-menopausal in females
Age 20-80

25
Q

What are the clinical features of acute gout?

A

Usually monoarthropathy
Settles in 10 days without treatment
Abrupt onset (overnight)
May have normal uric acid

26
Q

What are the clinical features of chronic tophaceous gout?

A

Chronic joint inflammation
Often associated with diuretic use
High serum uric acid
Tophi
May get acute attacks

27
Q

What investigations would you run if you suspected gout?

A

Serum uric acid (elevated)
Inflammatory markers (elevated)
Polarised microscopy of synovial fluid
Renal investigations
X-rays

28
Q

What is the treatment for acute gout?

A

NSAIDs
Colchicine
Steroids

29
Q

What are the methods of preventing future episodes of acute gout?

A

Xanthine oxidase inhibitors
- Allopurinol
- Febuxostat
Urosuric drugs
- Sulfinpyrazone
- Probenecid
- Benzbomarone
Start 1 week after an acute attack
Lifestyle modifications

30
Q

What is the treatment for pseudogout?

A

NSAIDs
Colchicine
Steroids
Rehydration

31
Q

What are the risk factors for SLE?

A

Female
Chinese and black ethnicity
Childbearing age
Can be triggered by an infection

32
Q

Which auto antibodies would you test for if you suspected SLE?

A

ANA (positive MAY suggest SLE)
Anti-dsDNA (elevated)
APLS
Complement (low)
Anti-Ro
Anti-Sm

33
Q

What is the treatment for SLE?

A

Vaccines
Sun protection
Hydroxychloroquine in all patients
Short steroid courses in flare ups
Imunosuppression

34
Q

What are the key features of an inflammatory spondyloarthropathy?

A

Worse with rest/better with activity
Early morning stiffness for more than 30 mins

35
Q

What are the key features of a mechanical spondyloarthropathy?

A

Worse with activity/better with rest
Worse in the evening

36
Q

What is the typical presentation of ankylosing spondylitis?

A

Affects men more than women
Age 20-30
Morning joint or back stiffness
Back or buttock pain that improves with activity
Back or joint pain at night that wakes patient up
Positive Schober’s test
Thoracic kyphosis and hyperextension of neck

MSK (10 decks)

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