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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
Q

What is the pathogenesis of fibromyalgia ?

A

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.

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26
Q

What are the signs and symptoms of fibromyalgia ?

A

Joint and muscle stiffness
Profound fatigue
Unrefreshed sleep
Numbness
Headaches
IBS or bladder syndrome
Depression or anxiety
Poor concentration

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27
Q

What can be seen on examination in fibromyalgia ?

A

There are no physical abnormalities to the MSK or neurological systems.
Patients may have tender points on palpation of their muscles.

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28
Q

What are the risk factors for fibromyalgia ?

A

Female
Age 40-50
May have an obvious trigger

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29
Q

What treatment options are there for fibromyalgia ?

A

Drug treatment is mainly with low dose amitriptyline.
Advice on improving sleep and physical activity levels.
CBT is also effective.

30
Q

What investigations are there for fibromyalgia ?

A

FBC
U&E’s
LFT
ESR
This are done to exclude other pathology.

31
Q

What is osteoporosis ?

A

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
Q

What are non-modifiable risk factors for osteoporosis ?

A

Advanced age
Female gender
Caucasian or south Asian
Family history of osteoporosis
History of trauma

33
Q

What are the modifiable factors for osteoporosis ?

A

Low BMI
Premature menopause
Calcium / vitamin D deficiency
Inadequate physical activity
Cigarette smoking
Excessive alcohol intake
Medications - corticosteriods

34
Q

What is the treatment for osteoporosis ?

A

Treatment should focus on risk modification : weight-bearing exercise, vitamin D supplementation, limiting alcohol and smoking cessation.
Oral bisphosphonates

35
Q

What are the secondary causes of osteoporosis ?

A

Coeliac disease
Eating disorder
Hyperparathyroidism
Hyperthyroidism

36
Q

What is gout ?

A

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
Q

What are non-modifiable risk factors for gout ?

A

Age - over 40
Male

38
Q

What are modifiable risk factors for gout ?

A

Increased purine uptake
Alcohol intake
High fructose intake
Obesity
Congestive heart failure
Renal failure
Hypertension
Smoking
Diabetes mellitus

39
Q

How is gout prevented ?

A

Maintain optimal weight
Regular exercise
Diet modification
Reduced alcohol consumption
Smoking cessation

40
Q

How is gout treated ?

A

NSAID’s
Oral / IM steriods
Give allopurinol for chronic cases

41
Q

What is ankylosing spondylitis ?

A

A long term condition in which the spine and other areas of the body become inflamed.

42
Q

How does ankylosing spondylitis present ?

A

Bilateral buttock pain
Chest wall and thoracic pain
Loss of lumbar lordosis
Exaggerated thoracic kyphosis
Reduced chest expansion

43
Q

What investigations are done for ankylosing spondylitis ?

A

CRP
MRI spine and sacroiliac joints ( more sensitive than x-ray )

44
Q

What treatment is given for ankylosing spondylitis ?

A

NSAIDs
Physiotherapy
TNF inhibitors
IL-17 inhibitors

45
Q

What are some extra-articular manifestations of ankylosing spondylitis ?

A

Anterior uveitis
Aortic incompetence
AV block
Apical lung fibrosis
Amyloidosis

46
Q

What is polymyalgia rheumatica ?

A

A clinical syndrome characterised by pain and stiffness of the shoulder, hip girdles and neck

47
Q

Who is most affected by polymyalgia rheumatica ?

A

Older age ( 70 years )
Associated with GCA

48
Q

What are the symptoms of polymyalgia rheumatica ?

A

Proximal limb pain and stiffness
Difficulty getting up from chairs
Fatigue
Weight loss
Low grade fever

49
Q

What is seen on examination in polymyalgia rheumatica ?

A

Decreased ROM of shoulders, neck and hips
Muscle strength - limited by pain and stiffness
Muscle tenderness

50
Q

How is a diagnosis of polymyalgia rheumatica made ?

A

Raised inflammatory markers
Check levels of ESR, Plasma viscosity and CRP
Consider temporal artery biopsy is symptoms of GCA

51
Q

What is the treatment of polymyalgia rheumatica ?

A

Prednisolone
Methotrexate can be steriod sparing in relapsing patients

52
Q

What is giant cell arteritis ?

A

Chronic vasculitis of large and medium sized vessels that occurs among individuals over 50 years old. ( often called temporal arteritis ).

53
Q

What are the risk factors for giant cell arteries ?

A

Over 50 years old
More common in women
Genetic predisposition HLA-DR4

54
Q

What are the symptoms of GCA ?

A

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
Q

How is a diagnosis made for GCA ?

A

Raised ESR, CRP or Plasma viscosity
New onset of localised headache
Tenderness of decreased pulsation of the temporal artery
New visual symptoms

56
Q

How is GCA treated ?

A

Prednisolone 60-100mg PO per day
For acute onset visual symptoms consider methylprednisolone IV
Low dose aspirin therapy to reduce thrombotic risks

57
Q

What is osteomalacia ?

A

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
Q

What are the symptoms of osteomalacia ?

A

Pain felt in joints and bones
Muscle pain and weakness
Bones that break more easily
Difficulty walking
Potential pins and needles

59
Q

What is the treatment for osteomalacia ?

A

Vitamin D and calcium supplements

60
Q

Which condition would proximal joint pain indicate ?

A

Polymyalgia rheumatica

61
Q

What condition is indicated if there is distal joint pain ?

A

OA
Gout

62
Q

What condition is indicated if the joints affected are small ones ?

A

Early stage RA

63
Q

What condition is indicated if the joints affected are large ones ?

A

OA

64
Q

What are some causes of acute mono arthritis ?

A

Infections
Gout

65
Q

What are some causes of chronic mono arthritis ?

A

Psoriatic arthritis
Reactive arthritis
OA
Infections ( TB )

66
Q

What are some causes of polyarthritis ?

A

RA
Psoriatic arthritis
Reactive arthritis
SLE
Gout - uncontrolled

67
Q

What is an antalgic gait ?

A

Pain causes the patient to reduce the time spent on the affected side.

68
Q

What is trendelenburg gait ?

A

Due to poor hip abduction the pelvis drops down on the opposite side when standing on the affected leg.

69
Q

What is a hemiplegic gait ?

A

It is a narrow based stance. The leg is swung forwards and the toes scrape the floor.

70
Q

What is an ataxic gait ?

A

Wide based stance. There is staggering or stamping. Arms may be flung out to improve balance.

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