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Med c > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

X ray findings of osteoarthritis

A

Loss of joint space

Osteophytes formation

Subchondral cysts

Subchondral sclerosis

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2
Q

Heberdens and Bouchard nodes, what and where

A

Osteoarthritic signs
Bouchard is PIP inflamation
Heberdens is DIP inflamation

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3
Q

What is the difference in the joints affected by rheumatoid vs osteoarthritis

A

Osteoarthritis affects large weight bearing joints, and in the hand often CMC and DIP. Often asymmetrical

Rheumatoid is symmetrical and can affect smaller joints. SPARES DIP CLASSICALLY

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4
Q

How does pain and stiffness differ after resting (e.g in the morning) in RA vs OA

A

In RA, it can last over 30 mins, and is worse after rest
In OA, it usually lasts less after rest and is worse after use (e.g a long day)

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5
Q

Joints affected more commonly in RA

A

Smaller: wrist, ankle MCP and PIP

DIPs are SPARED in RA!

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6
Q

Associated symptoms of RA

A

Fatigue, weight loss, flu like illness and muscle aches

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7
Q

Serology for RA and what is better

A

Rheumatoid factor: 70% of RA patients have

Anti CCP- more sensitive and more specifc

Check for CRP and ESR also

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8
Q

What scores can be used to monitor RA

A

DAS28 and HAQ

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9
Q

What features are poor prognostic indicators in RA

A

Younger onset,
Male
More joints affected
Seropositive for RF and anti CCP

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10
Q

What is 1,2 and 3rd line mx of RA

A

1- DMARD alone e.g methotrexate,sulfasalazine or hydroxychloroquine (hydroxy is mildest)
2- 2 DMARD combined
3- Methotrexate + biological- TNF inhibitor

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11
Q

Give two examples of anti-TNF drugs

A

Infliximab and adalimumab

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12
Q

Side effect profile of methotrexate

A

Mouth ulcers and mucocitis
Liver toxicity
Myelosuppressipn leading to leukopenia
Teratogenic

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13
Q

Side effect of sulfasalazine

A

Male infertility

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14
Q

Side effects of anti TNF drugs

A

Vulnerable to infection
Reactivation of TB and Hep B

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15
Q

What percentage of people with psoriasis get psoriatic arthritis

A

10-20%

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16
Q

Signs of psoriatic arthritis

A

Nail pitting
Oncholysis - separation of nail from nail bed
Dactylisis - full inflamation of digit
Enthesitis- inflamation of enthuses, where tendon inserts on bone

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17
Q

What are the most common causes of reactive arthritis

A

Chlamydia and gonorrhoea

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18
Q

What are the associations seen in reactive arthritis

A

Can’t see, can’t pee can’t climb a tree

Anterior uveitis
Bilateral conjunctivitis
Circinate balantis

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19
Q

What joints does ankylosimg spondylitis affect

A

Vertebrae and sacroiliac joints

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20
Q

What percentage of people with AS have the HLA-b27 gene

A

90%

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21
Q

Investigations for AS

A

Baseline bloods
ESR and CRP
HLA-B27 genetic test
X ray of spine - shows bamboo spine due to fusion of vertabra

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22
Q

Common associations with AS

A

Chest pain
Enthesitis - leads to Achilles tendinitis and plantar fasciitis
Ant uveitis
Heart block
IBD

23
Q

What test is used for spinal mobility and AS

A

Schobers test:
Find L5 and mark 10cm above and 5 below
Ask patient to touch toes, and if distance between marks is less than 20cm, suggests lumbar restriction

24
Q

Auto antibodies seen in SLE

A

ANA (more detail)
Anti double stranded DNA

Anti smith antibodies (type of extractable nuclear antigen)

25
Q

First line treatment for mild SLE

A

Hydroxychloroquinine and NSAID

26
Q

Clinical picture of giant cell arteritis

A

Sever unilateral headache
Scalp tenderness
Jaw claudication
Blurred or double vision

27
Q

How to diagnose giant cell arteritis

A

Clinical features present (headache, scalp tenderness and jaw claudication)
Raised ESR (>50mm/hr)
Temporal artery biopsy

28
Q

What is found on temporal artery biopsy for GCA

A

Multinuckeated giant cells

29
Q

Initial mx of GCA

A

High dose steroids - pred 30-60mg per day

30
Q

What antibodies are seen in sjogrens

A

Anti-Ro and Anti-la

31
Q

What test can be used to check for sjogrens

A

Shirmer test- folded filter paper under eyelid
Tears should travel at least 15 mm, <10mm is significant

32
Q

What does the FRAX tool tell us

A

Probability of fragility fracture over the next ten years

33
Q

What scores do we use from DEXA scan, and what is significant

A

T scores

More than -1 is normal

-1 to -2 is osteopenia
Less than -2.5 is osteoperosis
Less than -2.5 with a fracture is sever osteoperosis

34
Q

First line treatment for osteoperosis

A

Bisphosphonates- aledondric acid 70mg once a week oral

35
Q

What is denosumab and what is it used for

A

MAB to osteoclasts, prevents bone resorption

36
Q

Side effects of bisphosphonates

A

Reflux and oesophageal erosion- take on empty stomach and sit up for 30 minutes
Atypical fractures
Osteonecrosis of jaw

37
Q

What condition js linked with polymalgia rheumatics

A

Giant cell arteritis

38
Q

Clinical picture of polymalgia rheumatica

A

Bilateral shoulder pain that radiates to elbow
Bilateral pelvic girdle pain

Stiffness that lasts for more than 45 minutes in the morning

Interferes with sleep

39
Q

What is the initial treatment for poly myalgia rheumatica

A

15mg prednisolone per day and review after 1 week and 3/4 weeks

40
Q

ANA and anti-dsDNA- for sle what is more specific and what is more sensitive

What does this mean

A

ANA is the most sensitive and shoukd be used first: if positive then they almost definitely have sle

Anti-dsDNA is the most specific. Anyone who is negative does have it

41
Q

what anti bodies are found in drug induced lupus

A

ana and anti histome antibodies positive

42
Q

Common causes of drug induced lupus

A

Procainmide
Hydralazime
Isonisiaz
Phenytoin

43
Q

Diffused systemic sclerosis

Features

Antibodies

A

Scleroderma of trunk and proximal limbs
ILD and pulmonary hypertension
ED

Had anti scl-70 antibodies

44
Q

Limited systemic sclerosis/ CREST

Features

Antibodies

A

Raynauds
Scleroderma of face and and distal limbs
anti centromere antibodies

45
Q

What is CREST

A

Calcinosis
Raynauds
Oesophageal dysmotility
Sclerodactly
Telangestacis

46
Q

Unilateral or bilateral psoriatic arthritis and ra

A

Ra is symmetrical psoriatic not

47
Q

Risk factors for septic arthritis

A

Age
Immunosuppressive
Prosthetic joint
Joint instrumentation (injections or arthroscopy)
Underlying joint damage already
Transient bacterial is

48
Q

Ix for septic arthritis

A

Bloods; baseline FBC, u and e for AKI, CRP and ESR whic will be raised for inflamation. Clotting screen for haemarthrosis and serum Uris acid to assess for gout. Blood culture

Plain x ray

Joint aspiration is gold standard- should be done before abx given

49
Q

Joint aspiration in septic arthritis findings

A

Cell count - WCC >50000 is worrying
Gram stain
Culture
Polarised light microscopy

50
Q

Gram positive cocci in clusters suggests what on joint aspirate

A

Septic arthritis due to s aureus

51
Q

What criteria is used for a hot joint

A

Kosher criteria

Fever over 38
Non weight bearing
Raised ESR
Raised WCC

52
Q

Managment of septic arthritis

A

Conservative - analgesia and splinting

Medical - IV flucloxacillin for two weeks followed by oral for 2-4 weeks

Joint wash out

53
Q

What to do if a prosthetic joint is thought to be septic

A

Must be aspirated by an ortho surgeon

Med c (3 decks)

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