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Medicine Block > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is a typical history for someone with RA ?

A

Usually female
30-50 years old
Progressive, peripheral and symmetrical polyarthritis
Usually affects finger joints

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2
Q

How long must a patient be having symptoms for to be considered for a RA diagnosis ?

A

At least 6 weeks

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3
Q

How long is the morning stiffness for an RA patient ?

A

More than 30 minutes

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4
Q

What is seen on examination in someone with RA ?

A

Soft tissue swelling and tenderness first
Ulnar deviation/ palmar subluxation of MCPs
Swan neck and boutonniere deformity in digits
Rheumatoid nodules

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5
Q

What investigations are performed if someone is suspected of having RA ?

A

FBC -normocytic anaemia
Inflammatory markers - raised
Rheumatoid factor and anti-CCP are present
X ray of hands - deformity

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6
Q

what is seen on X ray in someone with RA ?

A

Loss of joint space
Erosions
Soft tissue swelling
Subluxation

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7
Q

What treatment is offered for RA ?

A

Initially DMARD mono therapy - methotrexate
Steriods
Symptoms control with NSAIDs ( PPI cover )
If disease is severe consider biologics ( anti-TNF )

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8
Q

What are some extra-articular manifestations of RA ?

A

Carpal tunnel syndrome
Elevated cardiac risk
Anaemia
Amyloidosis
Pericarditis
Pleural disease
Pulmonary disease
Sjogren’s disease

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9
Q

What is present in Felty’s syndrome ?

A

RA
Splenic enlargement
Neutropenia

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10
Q

What is lupus ?

A

An autoimmune multisystem disease with inadequate T cell suppressor activity and increased B cell activity

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11
Q

What criteria are needed for a lupus diagnosis ?

A

4 of the following :
- ANA positive
- renal abnormalities
- Arthralgia / arthritis
- serositis
- haematological abnormalities
- photosensitivity
- oral ulcers
- immunological abnormalities
- neurologic abnormalities
- Malar rash / discoid rash

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12
Q

What is seen on examination in SLE ?

A

Raynaud’s
Joint pain and swelling
Hand rash
Hair loss
Mouth ulcers
Proximal myalgia
Pleuritic chest pain
Pericardial pain
Truncal rash

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13
Q

What investigations are done when suspecting lupus ?

A

FBC - anaemia and leukopenia
U & E’s
LFT
CRP - may be normal
Plasma viscosity and ESR - raised
Urine dipstick

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14
Q

What antibodies may be raised in SLE ?

A

Antinuclear antibodies
Anti-DsDNA antibodies

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15
Q

What treatment options are there for SLE ?

A

Sun protection
Hydrochloroquine is given for rash and Arthralgia
Mycophenolate mofetil, Azathioprine and Rituximab are commonly used
Short courses of prednisolone can be given for flare ups

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16
Q

What triggers SLE ?

A

UV light

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17
Q

What is osteoarthritis ?

A

A degenerative joint disorder where there is progressive loss of articular cartilage

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18
Q

What are the key features of cartilage in OA ?

A

Loss of elasticity with reduced tensile strength
Cellularity and proteoglycan content are reduced

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19
Q

What are some risk factors for osteoarthritis ?

A

Age
Obesity
Trauma
Genetics

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20
Q

Signs and symptoms of OA ?

A

Hip, knee and spine most commonly affected.
Pain is provoked by movement and weight-bearing
Joint giving way is common

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21
Q

What is seen on radiographs in OA?

A

Joint space narrowing
Sub articular sclerosis
Bone cysts
Osteophytes

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22
Q

What treatment options are there for OA ?

A

Non-drug therapy - strengthening and movement exercises
Regular paracetamol for pain relief
Intra-articular corticosteriods
Surgery

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23
Q

What is fibromyalgia ?

A

A common disorder of central pain processing characterised by chronic widespread pain in all 4 quadrants of the body.

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24
Q

What is allodynia ?

A

It is a heightened and painful response to innocuous stimuli.

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25
What is the pathogenesis of fibromyalgia ?
It can be induced by deliberate sleep deprivation. Sleep disturbance is probably the trigger in most patients. This causes hyper-activation in response to noxious stimulation and neural activation in brain regions associated with pain perception in response to non-painful.
26
What are the signs and symptoms of fibromyalgia ?
Joint and muscle stiffness Profound fatigue Unrefreshed sleep Numbness Headaches IBS or bladder syndrome Depression or anxiety Poor concentration
27
What can be seen on examination in fibromyalgia ?
There are no physical abnormalities to the MSK or neurological systems. Patients may have tender points on palpation of their muscles.
28
What are the risk factors for fibromyalgia ?
Female Age 40-50 May have an obvious trigger
29
What treatment options are there for fibromyalgia ?
Drug treatment is mainly with low dose amitriptyline. Advice on improving sleep and physical activity levels. CBT is also effective.
30
What investigations are there for fibromyalgia ?
FBC U&E’s LFT ESR This are done to exclude other pathology.
31
What is osteoporosis ?
A skeletal condition characterised by low bone mass, deterioration of bone tissue and disruption of bone architecture that leads to compromised bone strength and an increased risk of fracture.
32
What are non-modifiable risk factors for osteoporosis ?
Advanced age Female gender Caucasian or south Asian Family history of osteoporosis History of trauma
33
What are the modifiable factors for osteoporosis ?
Low BMI Premature menopause Calcium / vitamin D deficiency Inadequate physical activity Cigarette smoking Excessive alcohol intake Medications - corticosteriods
34
What is the treatment for osteoporosis ?
Treatment should focus on risk modification : weight-bearing exercise, vitamin D supplementation, limiting alcohol and smoking cessation. Oral bisphosphonates
35
What are the secondary causes of osteoporosis ?
Coeliac disease Eating disorder Hyperparathyroidism Hyperthyroidism
36
What is gout ?
An inflammatory arthritis related to a hyperuricemia The metatarsophalangeal joint is most commonly affected. Deposition of mono sodium urate crystals accumulate in the joints and soft tissues.
37
What are non-modifiable risk factors for gout ?
Age - over 40 Male
38
What are modifiable risk factors for gout ?
Increased purine uptake Alcohol intake High fructose intake Obesity Congestive heart failure Renal failure Hypertension Smoking Diabetes mellitus
39
How is gout prevented ?
Maintain optimal weight Regular exercise Diet modification Reduced alcohol consumption Smoking cessation
40
How is gout treated ?
NSAID’s Oral / IM steriods Give allopurinol for chronic cases
41
What is ankylosing spondylitis ?
A long term condition in which the spine and other areas of the body become inflamed.
42
How does ankylosing spondylitis present ?
Bilateral buttock pain Chest wall and thoracic pain Loss of lumbar lordosis Exaggerated thoracic kyphosis Reduced chest expansion
43
What investigations are done for ankylosing spondylitis ?
CRP MRI spine and sacroiliac joints ( more sensitive than x-ray )
44
What treatment is given for ankylosing spondylitis ?
NSAIDs Physiotherapy TNF inhibitors IL-17 inhibitors
45
What are some extra-articular manifestations of ankylosing spondylitis ?
Anterior uveitis Aortic incompetence AV block Apical lung fibrosis Amyloidosis
46
What is polymyalgia rheumatica ?
A clinical syndrome characterised by pain and stiffness of the shoulder, hip girdles and neck
47
Who is most affected by polymyalgia rheumatica ?
Older age ( 70 years ) Associated with GCA
48
What are the symptoms of polymyalgia rheumatica ?
Proximal limb pain and stiffness Difficulty getting up from chairs Fatigue Weight loss Low grade fever
49
What is seen on examination in polymyalgia rheumatica ?
Decreased ROM of shoulders, neck and hips Muscle strength - limited by pain and stiffness Muscle tenderness
50
How is a diagnosis of polymyalgia rheumatica made ?
Raised inflammatory markers Check levels of ESR, Plasma viscosity and CRP Consider temporal artery biopsy is symptoms of GCA
51
What is the treatment of polymyalgia rheumatica ?
Prednisolone Methotrexate can be steriod sparing in relapsing patients
52
What is giant cell arteritis ?
Chronic vasculitis of large and medium sized vessels that occurs among individuals over 50 years old. ( often called temporal arteritis ).
53
What are the risk factors for giant cell arteries ?
Over 50 years old More common in women Genetic predisposition HLA-DR4
54
What are the symptoms of GCA ?
Headache - generally unilateral and over the temple Tongue and jaw claudication upon mastication Visual findings may develop over weeks ( Amaurosis fugax, blindness, diplopia and blurring ) Scalp tenderness
55
How is a diagnosis made for GCA ?
Raised ESR, CRP or Plasma viscosity New onset of localised headache Tenderness of decreased pulsation of the temporal artery New visual symptoms
56
How is GCA treated ?
Prednisolone 60-100mg PO per day For acute onset visual symptoms consider methylprednisolone IV Low dose aspirin therapy to reduce thrombotic risks
57
What is osteomalacia ?
It is a vitamin D deficiency causing low mineralisation and increased calcium resorption. It causes weak and soft bones. This is ‘rickets’ in adults.
58
What are the symptoms of osteomalacia ?
Pain felt in joints and bones Muscle pain and weakness Bones that break more easily Difficulty walking Potential pins and needles
59
What is the treatment for osteomalacia ?
Vitamin D and calcium supplements
60
Which condition would proximal joint pain indicate ?
Polymyalgia rheumatica
61
What condition is indicated if there is distal joint pain ?
OA Gout
62
What condition is indicated if the joints affected are small ones ?
Early stage RA
63
What condition is indicated if the joints affected are large ones ?
OA
64
What are some causes of acute mono arthritis ?
Infections Gout
65
What are some causes of chronic mono arthritis ?
Psoriatic arthritis Reactive arthritis OA Infections ( TB )
66
What are some causes of polyarthritis ?
RA Psoriatic arthritis Reactive arthritis SLE Gout - uncontrolled
67
What is an antalgic gait ?
Pain causes the patient to reduce the time spent on the affected side.
68
What is trendelenburg gait ?
Due to poor hip abduction the pelvis drops down on the opposite side when standing on the affected leg.
69
What is a hemiplegic gait ?
It is a narrow based stance. The leg is swung forwards and the toes scrape the floor.
70
What is an ataxic gait ?
Wide based stance. There is staggering or stamping. Arms may be flung out to improve balance.

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