Rheumatology

Question 1

Gout?

Answer 1

Monosodium urate (uric acid) crystals
Hyperuricaemia
Big toe 1st MTPJ affected, mono arthritis
Needle shaped

Question 2

Pseudo gout?

Answer 2

Calcium pyrophosphate dihydrate crystals
Birefringence positive
Brick shaped

Question 3

Rheumatoid arthritis joints?

Answer 3

MCP
MTP
PIP
Wrists, knees, ankles

polyarthritis

Question 4

Osteoarthritis?

Answer 4

Cartilage worn out, bony remodelling
Gradual onset, slow progressive

Question 5

Osteoarthritis joints?

Answer 5

DIP
PIP
CMC
Spine, knees, hips
MTP

Question 6

Osteophytes at PIP joints?

Answer 6

Bouchard’s nodes

Question 7

Osteophytes at DIP joints?

Answer 7

Heberden’s nodes

Question 8

Bone spurs?

Answer 8

Osteophytes

Question 9

Fibrous joints?

Answer 9

No space between bones, e.g. sutures in skull
Synarthroses (no movement)

Question 10

Cartilaginous joints?

Answer 10

Bones connected by cartilage (e.g. spinal vertabrae)
Amohiarthroses - very limited movement

Question 11

Synovial joints?

Answer 11

Space between adjoining bones (synovial cavity)
Diarthroses - free movement

Question 12

Components of synovial joint

Answer 12

Synovium (type I collagen)
Synovial fluid (hyaluronic acid-rich viscous fluid)
Articular cartilage (type II collagen, aggrecan)

Question 13

Cartilage components?

Answer 13

Chondrocytes
ECM (water, collagen, Proteoglycans mainly aggrecan)

Aggrecan - Proteoglycans with many chondroitin sulfate and keratin sulfate chains, interacts with hyaluronan.

Question 14

Common rheumatoid arthritis extra articular features?

Answer 14

Fever, weight loss
Subcutaneous nodules

Question 15

Subcutaneous nodules?

Answer 15

Central area of fibrinoid necrosis surrounded by histiocytes and peripheral layer of connective tissue.

Question 16

Pathogenesis of RA?

Answer 16

Abnormal synovial membrane.
Neovascularisation
Lymphangiogenesis
Inflammatory cells

Question 17

Dominant cytokine in RA?

Answer 17

Tumour necrosis factor - alpha

Question 18

Blood tests for RA?

Answer 18

Low Hb, high platelet, high ESR, high CRP.

Question 19

Antibodies in RA?

Answer 19

Rheumatoid factor - recognise Fc portion of IgGs.
- typically IgM.
Antibodies to citrullinated protein antigens (ACPA)

Question 20

RA investigations?

Answer 20

X-rays
Ultrasound
MRI

Question 21

Pharmacological treatments for RA?

Answer 21

Glucocorticoid therapy
NSAIDs
DMARDs

Question 22

Methotrexate?

Answer 22

Inhibits dihydrofolate reductase

Question 23

RA biological therapies?

Answer 23

1. Anti-TNF
2. B cell depletion
3. Modulation of T cell co-stimulation
4. Inhibition of IL-6 signalling

Question 24

Psoriatic arthritis?

Answer 24

Scaly red plaques on extensor surfaces
Asymmetrical, erosions if IPJs
MCPJs NOT affected, and no rheumatoid factor.

Question 25

Reactive arthritis?

Answer 25

Sterile inflammation, urogenital or gastrointestinal infections
Eye, skin and tendon infmallation.
First manifestation of HIV and Hep C

Question 26

Inflammatory Spondyloarthritis (SpA)

Answer 26

Ankylosing spondylitis (enthesitis, HLA-B27, TNF-a, IL-17 + 23).
Spine and sacro-iliac joints inflammed.

Question 27

SLE?

Answer 27

Autoantibodies, can affect almost any organ (often kidneys)
ANA + anti-dsDNA Abs clinical tests.

Question 28

Histopathological examination of RA nodules?

Answer 28

Histiocytes
Fibrinoid necrosis

Question 29

First line anti rheumatic drug?

Answer 29

Methotrexate