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Pocket MSRA - Book 1 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What are the key presenting features of OA?

A

Oligo-pauci-arthritis (<5 joints)
-can be asymmetrical
Joint stiffness worsens t/o day
Neuropathic pain

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2
Q

What are the key examination findings of OA?

A

Oligo-pauci-arthritis (<5 joints)
-can be asymmetrical
Crepitus
Muscle wasting
HerbeDen (DIPJ) and Bouchard (PIPJ) nodes

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3
Q

What are the key risk factors for OA?

A

Age
Obesity
Trauma

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4
Q

How should OA be treated?

A

Lifestyle/conservative w/ paracetamol –>
NSAIDs –>
Co-codamol –>
Intra-articular steroids –>
Joint replacement

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5
Q

What are the key risk factors for RA?

A

Smoking
FHx

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6
Q

What are the key presenting features of RA?

A

Poly-articular (>5 joints)
-symmetrical
DEFORMING
Early morning stiffness/pain improves w/ use
Constitutional sx

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7
Q

What are the key examination findings of RA?

A

Poly-articular (>5 joints)
-symmetrical
Boggy joints
Rheumatoid nodules
Joint deformity

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8
Q

What are the different patterns of RA?

A

Insidious (70%)
Acute (15%)
Constitutional (10%)
Palindromic (5%)

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9
Q

What are the systemic associations of RA?

A

ILD
Pleural effusion
Atherosclerosis
Anaemia
Mononeuritis multiplex + compression neuropathy
Scleritis & episcleritis
Felty syndrome
Lymphoma

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10
Q

What is Felty syndrome?

A

Triad of:
-RA
-Splenomegaly
-Neutropenia
Causes recurrent infections

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11
Q

What is a Swan-Neck deformity?

A

PIPJ hyperextended
DIPJ flexed

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12
Q

What is a Boutonniere deformity?

A

PIPJ flexed
DIPJ hyperextended

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13
Q

What is a Z-thumb?

A

MCPJ fixed flexion
PIPJ and DIPJ hyperextended

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14
Q

What is Jaccoud’s arthropathy?

A

Ulnar subluxation
-non-erosive

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15
Q

What is Vaughan-Jackson syndrome?

A

Inability to extend 5th finger 2o extensor tendon disruption on ulnar side
-seen in RA

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16
Q

What is arthritis mutilans?

A

Severe destructive joint disease
-seen in RA/PA

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17
Q

What % of patients w/ RA have a positive RF?

A

70%

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18
Q

What are the XR signs of arthritis?

A

Osteopenia
Cartilage loss
Space loss
Erosions
Subluxation

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19
Q

What is the management of RA?

A

Steroids AND DMARDs
-Methotrexate
-Hydroxychloroquine

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20
Q

How does PA present?

A

ANY joint pattern
Psoriatic rash
Tendon disease
Nail disease

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21
Q

What tendon problems are common in PA?

A

Achilles tendinitis
Golfer/tennis elbows
Plantar fasciitis
DACTYLITIS

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22
Q

What nail problems are common in PA?

A

Pitting
Onycholysis
Subungual hyperkeratosis
Dystrophy

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23
Q

What ix are indicated in PA?

A

ESR
XR (pencil-in-cup deformity)
SERONEGATIVE

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24
Q

What is the rx for PA?

A

NSAIDs
Methotrexate
AVOID STEROIDS - psoriatic flare
Sulfasalazine - if spinal
Ciclosporin +/- retinoids +/- anti-TNF +/- secukinumab +/- ustenkinumab - if severe

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25
What are the key features of reactive arthritis?
Can't see (uveitis) Can't pee (urethritis/cervicitis) Can't climb a tree (joint pain - usually monoarthropathy) Rashes Post infection
26
What mucocutaneous rashes are seen in reactive arthritis?
Keratoderma blenorrhagia Circinate balanitis
27
What infections is reactive arthritis commonly associated with?
Salmonella Chlamydia Campylobacter NOT GONORRHEA
28
What is the treatment for reactive arthritis?
Self-limiting NSAIDs +/- steroid inj
29
What is ankylosing spondylitis?
Inflammation of sacro-iliac joints/spine Typically affects young adult males who SMOKE
30
What are the HLA B-27 related arthritides?
Psoriatic Reactive Ankylosing Spondylitis
31
What are the key features of ank spond?
A's -achilles tendinitis -ant uveitis -aortitis (AR) -apical pulmonary fibrosis -acute pleural effusion -ant. chest wall fusion -associated colitis
32
How is ank spond investigated?
XR spine -sacroillitis -romano lesion -syndesmophytes -bamboo spine (end-stage)
33
What is the treatment for ank spond?
1 - Stop smoking, NSAIDs, PT 2 - Anti-TNFa 3 - Secukinumab
34
What are the crystal arthropathies?
Gout Pseudogout
35
What are the risk factors for Gout?
CKD Lifestyle - red meat, EtOH Thiazides/thiazide-like (indapamide) precipitate attacks
36
How is gout diagnosed?
Joint aspiration -negatively birefringent needles-shaped MSU crystals
37
How is gout treated?
Flare - NSAIDs, colchicine --> steroids PPx - Allopurinol (not started during a flare but NOT stopped)
38
What are the common s/e of Allopurinol?
Rashes (rarely SJS) Somonlence Vertigo Ataxia
39
What are the risk factors for Pseudogout?
M>W
40
How is pseudogout investigated?
Joint aspirate -rhomboid +ve birefringement XR -chondrocalcinosis
41
How can pseudogout be distinguished from gout clinically?
Larger joints affected (shoulder, wrist, knee) Attacks more prolonged but less painful
42
How should pseudogout be treated?
NSAIDs, colchicine Local injection
43
How does septic arthritis present?
Red hot MONOArthropathy and unwell patient
44
How should septic arthritis be ix and rx?
Joint aspirate IV a/b May need washout
45
What are the s/e of Methotrextate?
Teratogenic Requires folate replacement Pneumonitis/ILD GI upset Bone marrow suppression Hepatotoxicity
46
What are the s/e of Sulphasalazine?
Bone marrow suppression (FBC) Hepatotxic (LFTs) Rash MALE INFERTILITY
47
What are the s/e of Hydroxychloroquine?
Bulls eye maculopathy -yearly screening if >40 OR eye problems
48
What are the s/e of Azathioprine?
Fever Bruising Hepatotoxicity (LFTs) Bone marrow suppression (FBC)
49
What are the s/e of Penicillamine?
Drug-induced SLE Rash Ulcers Loss of taste Proteinuria (Pr:Cr) Bone marrow suppression (FBC)
50
What are the s/e of Cyclophosphamide?
Skin pigmentation MALE INFERTILITY Haemorrhagic cystitis
51
What are the s/e of Ciclosporin?
Bone marrow suppression (FBC) Renal failure (hyperK, Cr, HTN, oedema) Gingival hyperplasia
52
What are the s/e of anti-TNFa?
Disseminated TB (screen before starting) CHF Sepsis Demyelination
53
What are the clinical criteria for SLE?
1 - Acute cutaneous (malar) 2 - Chronic cutaneous (discoid) 3 - Non-scarring alopecia 4 - Oronasal ulcers 5 - Arthritis (>2 joints) 6 - Serositis 7 - Renal (Type IV Nephritis) 8 - Neuropsychiatric 9 - Haemolytic anaemia 10 - Leukopenia 11 - Thrombocytopenia
54
What are the immunological criteria for SLE?
1 - DCT +ve 2 - ANA 3 - Anti-DNA 4 - Anti-Smith 5 - Antiphospholipid 6 - Low C3/C4/CH50
55
What medications can induce SLE?
Penicillamine Isoniazide Minocycline Hydralazine Phenytoin Procainamide Quinidine Anti-TNFa
56
What is the association between APS and SLE?
~1/3 of SLE have APS
57
How does APS present?
Hypercoagulable state -recurrent pregnancy loss -DVTs/PEs -Budd Chiari -CVA
58
How is APS treated?
Hydroxychloroquine Azathioprine Low-dose steroids Anticoagulation
59
How is SLE treated?
Avoid sunlight Mild - NSAIDs, + HCQ Mod - HCQ + low dose steroids +/- AZA/MTX Severe - pulse steroids, mycophenolate, cyclophosphamide, biologics
60
What are the risk factors for Sjogrens?
Female Middle-age Other autoimmune conditions
61
How dose Sjogren's present?
Sicca Xerostomia Dry vagina = thrush + dyspaerunia
62
How is Sjogren's investigated?
Anti-RNP Anti-Ro/Anti-La (60%) RhF (100%) Biopsy of small salivary glands
63
What are the complications of Sjogren's?
B-cell marginal zone lymphoma Neonatal lupus
64
How is Sjogren's treated?
NSAIDs HCG
65
What is the difference between Polymyositis and Dermatomyositis?
POLYmyositis - skin only DERMATOmyositis - skin + skm involvement
66
What are the presenting features of polymyositis/dermatomyositis?
Muscle -b/l proximal weakness (esp. anti-grav muscles) -tender -waddling gait Skin -shawl sign -heliotrope rash -gottron's papule -linear erythema -angioedema -mechanic's hand -hyperaemic nail fold
67
How are polymyositis/dermatomyositis treated?
Steroids IVIG Rituximab Cyclophosphamide SCREEN FOR CA
68
What are the features of CREST syndrome?
CREST syndrome -calcinosis -raynauds -eosophageal dysmotility -sclerodactyly -telangiectasia of face Associated w/ pulm HTN
69
What are the two main subtypes of systemic sclerosis?
Limited (CREST) Diffuse
70
What are the features of diffuse systemic sclerosis?
Skin tightening affecting neck/truck w/ early organ involvement -ILD --> pulm HTN -cardiac fibrosis -GI dysmotility -renal crisis
71
How is systemic sclerosis treated?
Cyclophosphamide
72
What are the two-types of anti-nuclear cytoplasmic antibody?
c-ANCA (GPA) p-ANCA (MPA)
73
What is the ddx for pulmonary-renal syndromes?
Wegener's (GPA) Microscopic polyangiitis (MPA) Lupus Goodpastures
74
What are the presenting features of Wegener's (GPA)?
Cavitating lung lesions ENT/nasopharyngeal sx Crescenteric rapid progressive glomerulonephritis Arthralgia Deafness
75
What are the presenting features of MPA?
Pulm haemorrhage Proteinuria Purpura + vasculitic rash Peripheral neuropathy Polyarthralgia Painful gut (mesenteric angina)
76
What is Goodpastures disease?
Type IV Collagen a/b against glomerular basement membrane and lung collagen --> rapid-onset crescenteric nephritis --> pulm haemorrhage
77
What is Churg-Strauss?
Eosinophilic granulomatosis w/ polyangiitis -small-medium vessel vasculitis
78
How does Churg-Strauss present?
Adult-onset asthma w/ nasal polypods Eosinophilia --> pneumonia/cardiac involvement
79
What is Cryoglobulinaemia?
Vasculitis caused by protein precipitation at low temps -Type 1 (monoclonal IgG/M) = seen in MGUS -Type 2 = hep C associated -Type 3 = mixed polyclonal Ig disease
80
What is polyarteritis nodosa?
Necrotising vasculitis affecting all organs EXCEPT lungs
81
How does polyarteritis nodosa present?
Coronary - angina Renal - AKI, HTN SMA - mesenteric angina (post prandial colicky pain) Skin ulcers, livedo reticularis Neuro - mononeuritis multiplex Myalgia Sterile orchitis
82
How is polyarteritis nodosa diagnosed?
Biopsy Angiogram -saccular microaneurysms w/ alternating fibrosis
83
How is polyarteritis nodosa treated?
Mild --> AZA, MTX, MMF Severe --> Cyclophosphamide Stenting when inflammation settled
84
What is Takayasu arteritis?
Large vessel vasculitis Causes claudication sx in patients w/ no risk factors
85
How is Takayasu arteritis diagnosed?
Radiological (MRA/CT-PET)
86
How is Takayasu arteritis treated?
Pulse steroids Cyclophosphamide Stent when inflammation settled
87
What is Giant cell/temporal arteritis?
Large vessel vasculitis -predilection for extracranial branches of carotid artery
88
How does GCA present?
Constitutional sx Pulse-synchronous unilateral headache Stiff, tender temp artery Scalp tenderness w/ facial pain Jaw/arm claudication Vertigo/hearing loss Amaurosis fugax/transient visual loss PMR
89
How is GCA diagnosed?
Clinical High ESR Temporal artery biopsy
90
How is GCA treated?
Pulse steroids Wean steroids until sx free at lowest dose

Pocket MSRA - Book 1 (7 decks)

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