rheumatology Flashcards
Scoring system for RA
DAS-28
Test for herniated disc
Straight leg raise ie it is + if there is back pain
X-ray finding for osteoarthritis
loss of joint space, osteophytes, sub-articular sclerosis, subchondral cysts
What does CREST stand for
calcinosis
Raynauds
oEsophageal dysmotility
Sclerodactyly
Telangiectasia
Most common causative organism for septic arthritis
Staph aureus
(Strep is the next)
E.coli in drug users
Difference between gout and pseudo-gout
Gout = negatively birefringent crystals, needle shaped
Pseudo = positively birefringent and envelope shape
What seronegative spondylarthropathy is more associated with enthesitis
AS
Especially at the Achilles tendon
*enthesitis = inflammation of tendons, ligaments or joint capsules
Most specific antibody test for SLE
ANA (anti-nuclear antibody)
RF as well but not as specific
Scl-70 associated disease
CREST - systemic sclerosis
Treatment for acute flare up of gout if NSAIDs is not tolerated
colchicine 500mg BD or QDS
What is Behcets
A rare multi-organ disease caused by systemic vasculitis - idiopathic
Affects demographics = Turkey , Mediterranean and Japan
Features of Behcets
ulceration - oral and genital
Uveitis
Erythema nodosum
HLA B51 associated
Mode of action : sulfasalazine
It is a prodrug of 5-ASA which works through decreasing neutrophil chemotaxis alongside suppressing proliferation of lymphocytes and pro-inflammatory cytokines
Mode of action : methotrexate
An anti-metabolite that inhibits dihydrofolate reductase
- an enzyme essential for the synthesis of purines and pyrimidines
Adverse effects of methotrexate
Mucositis
Myelosuppression
Pneumonitis
Pulmonary fibrosis
Liver fibrosis
= always give methotrexate with folinic acid
What needs to be monitored for a patient on methotrexate
FBC and LFTs
Treatment for SLE nephritis
Prednisolone + Cyclophosphamide
Which part of the spine can rheumatoid arthritis affect
Cervical spine (lumbar and thoracic are usually spared) ie subluxation of the Atlanto-axial joint
Most common causative organism for urethritis
Chlamydia trachomatis
How to differentiate between eGPA and GPA
GPA = c-ANCA
eGPA = p-ANCA
Management of mono or oligo-articular disease (pseudo-gout)
(*accessible to injection)
Intra-articular injection of steroids
Antibodies and associated conditions
Interpretation of OA x-ray
Is RA seropositive or seronegative
Seropositive
Cut off values for DAS-28
What are the seronegative inflammatory arthropathies
-AS
-psoriatic arthritis
-enteropathic
-reactive
Seronegative arthropathy associated with IBDs
Enteropathic arthritis
What is Reiters
Triad = urethritis, uveitis, conjunctivitis
What complement levels are low in SLE
C3 + C4
Management of skin disease and arthralgia SLE
Hydroxychloroquine
Topical steroids
NSAIDs
Are commonly used
Severe organ disease SLE treatment (eg lupus nephritis, CNS lupus)
IV steroids and cyclophosphamide
What do you need to monitor in someone with SLE
Anti-dsDNA and complement levels
Urinalysis - glomerulonephritis
CV risk - BP and cholesterol
*parotid gland swelling
Sjogrens
What is Sjogrens
Autoimmune condition characterised by lymphocytic infiltrates in exocrine organs —> causing dryness of eyes and mouth (sicca)
What’s going on here
Schirmers - Sjogrens
What criteria is used to diagnose Sjogrens
American-European consensus group classification
Need 4/6 for a diagnosis
Diffuse systemic sclerosis associated Antibody
Anti-scl70
Limited systemic sclerosis antibody
Anti-centromere
Management of raynauds
CCBs
Iloprost
Bosentan
*anti-RNP antibodies
= mixed connective tissue disease
What is uric acid
The final compound in the breakdown of purines in DNA metabolism
Definitive investigation for gout
Sampling synovial fluid with polarised microscopy
Chondrocalcinosis refers to what
When calcium pyrophosphate deposition occurs in cartilage
= pseudogout
What is seen
Chondrocalcinosis at the knee
If serum creatinine kinase are crazily high what two conditions are you considering ?
Rhabdomyolysis
Polymyositis
What immune cells are significant in polymyositis
CD8+
Heberdens nodes associated with what disease
Osteoarthritis
A 32 year old man is diagnosed with a pulmonary embolus with no clinical risk factors, anti-cardiolipin antibodies are raised
What is the most appropriate management
= life long warfarin
A thrombotic event in a patient with antiphospholipid syndrome is an indication for life-long anti coagulation
Classic radiological findings on RA
Periarticular erosions
Loss of joint space
T/F large vessel vasculitides are generally ANCA negatives
T - small vessel are more typically ANCA positive (GPA , eGPA)
How is fibromyalgia diagnosed ?
Clinical picture only
