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NP: Adult > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Xray changes in OA

A

Loss of joint space
Osteophytes (bone spurs)
Subarticular sclerosis (Inc density of bone along joint line)
Subchondral cysts (fluid-filles holes in the bone)

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2
Q

Hands signs in advanced RA

A

Z shaped deformity to the thumb
Swan neck deformity (hyperextended PIP and flexed DIP)
Boutonniere deformity (hyperextended DIP and flexed PIP)
Ulnar deviation of the fingers at the MCP joints

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3
Q

Investigations for RA

A

RF (present in 70% pts)
Anti-CCP antibodies (more sensitive and specific than RF)
CRP, ESR
X-rays - hands and feet for bone changes
US or MRI - to detect synovitis

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4
Q

Treatment for RA in pregnancy

A

Hydroxychloroquine
Sulfasalazine (extra folic acid is required)
(Methotrexate is teratogenic)

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5
Q

What is the first-line treatment for OA?

A

Topical NSAIDs for knee osteoarthritis
Oral NSAIDs where required and suitable (co-prescribed with a proton pump inhibitor for gastroprotection)

Intra-articular steroids
Joint replacement

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6
Q

What is the most common gene associated with RA?

A

HLA-DR4

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7
Q

List the unique side effects of DMARDs.

A

Methotrexate: Bone marrow suppression and leukopenia, and highly teratogenic
Sulfasalazine: Orange urine and male infertility (reduces sperm count)
Hydroxychloroquine: Retinal toxicity, blue-grey skin pigmentation and hair bleaching
Anti-TNF medications: Reactivation of tuberculosis
Rituximab: Night sweats and thrombocytopenia

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8
Q

How to distinguish between RA and psoriatic arthritis?

A

Psoriatic arthritis tends to affect the distal interphalangeal (DIP) joints and axial skeleton, whereas rheumatoid arthritis tends not to affect these joints

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9
Q

How do you manage an acute, warm, swollen, painful joint?

A

Treat as septic arthritis: abx, aspirate (gram stain, C&S, crystals)

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10
Q

What is ankylosing spondylitis?

A

Inflammatory condition affecting the axial skeleton (vertebral column, sacroiliac joints)
Part of the seronegative spondyloarthropathy group of conditions, also including psoriatic arthritis and reactive arthritis

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11
Q

What are associated conditions with ankylosing spondylitis?

A

A – Anterior uveitis
A – Aortic regurgitation
A – Atrioventricular block (heart block)
A – Apical lung fibrosis (fibrosis of the upper lobes of the lungs)
A – Anaemia of chronic disease

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12
Q

What tests are done to confirm ankylosing spondylitis?

A

Inflammatory markers
HLA-B27 gene testing
X-ray spine and sacrum
Schober’s test

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13
Q

What are the tests for SLE?

A

ANA
Inflammatory markers
anti-dsDNA (highly specific to SLE)

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14
Q

What are the 2 main patterns of disease in systemic sclerosis?

A

Limited cutaneous systemic sclerosis
Diffuse cutaneous systemic sclerosis

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15
Q

List the features of limited cutaneous systemic sclerosis.

A

C – Calcinosis
R – Raynaud’s phenomenon
E – Esophageal dysmotility
S – Sclerodactyly
T – Telangiectasia

  • Calcinosis = calcium deposits under the skin most commonly found in the fingertips
  • Raynaud’s phenomenon = First white, due to vasoconstriction
    Then blue, due to cyanosis
    Then red, due to reperfusion and hyperaemia (Raynaud’s disease is where Raynaud’s phenomenon occurs without an associated systemic disease. It is idiopathic and makes up 80-90% of patients with Raynaud’s phenomenon)
  • Sclerodactyly = skin changes in the hands. Skin tightening around the joints restricts the range of motion and reduces function. The fat pads on the fingers are lost. The skin can break and ulcerate.
  • Scleroderma = hardening of skin
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16
Q

List the features of diffuse cutaneous systemic sclerosis.

A

Diffuse cutaneous systemic sclerosis includes the CREST features and also affects internal organs, causing:

Cardiovascular problems (e.g., hypertension and coronary artery disease)
Lung problems (e.g., pulmonary hypertension and pulmonary fibrosis)
Kidney problems (e.g., glomerulonephritis and scleroderma renal crisis)

17
Q

What is the treatment for Raynaud’s?

A

Keeping the hands warm (e.g., gloves and hand warmers)
Calcium channel blockers (e.g., nifedipine)
Other specialist drugs include losartan, ACE inhibitors, sildenafil and fluoxetine

  • Beta blockers can worsen the symptoms of Raynaud’s.
18
Q

What is the non-medical management of systemic sclerosis?

A

Avoiding smoking
Gentle skin stretching to maintain the range of motion
Regular emollients
Avoiding cold triggers for Raynaud’s
Physiotherapy to help maintain healthy joints
Occupational therapy for adaptations to daily living to cope with limitations

19
Q

Name the antibodies that are positive in systemic sclerosis.

A

ANA
anti-centromere antibodies (limited cutaneous systemic sclerosis)
anti-Scl-70 (diffuse cutaneous systemic sclerosis)

20
Q

What is the most common joint affected in reactive arthritis?

A

Knee

21
Q

What are the most common triggers for reactive arthritis?

A

Gastroenteritis
Chlamydia

  • Gonorrhea typically causes septic arthritis
22
Q

What is the classic triad with reactive arthritis?

A

Can’t see (conjunctivitis/ anterior uveitis)
Can’t pee (urethritis)
Can’t climb a tree (arthritis)

23
Q

Which group of conditions are part of seronegative spondyloarthropathy?

A

Psoriatic arthritis
Reactive arthritis
Ankylosing spondylitis

24
Q

Which antibody is highly specific to SLE but not very sensitive?

A

Anti-Sm

Anti-dsDNA (also highly specific)

Also check ANA

25
Q

What is the key complication of giant cell arteritis?

A

Vision loss

26
Q

Which antibodies are associated with polymyositis?

A

Anti-Jo-1 antibodies

27
Q

Antiphospholipid syndrome is associated with which autoimmune condition?

A

SLE

28
Q

What is Sjögren’s syndrome?

A

An autoimmune condition affecting the exocrine glands (lacrimal, salivary glands)

29
Q

Which antibodies are associated with Sjögren’s syndrome?

A

Anti-Ro
Anti-La

30
Q

Test for Sjögren’s syndrome?

A

Schirmer test

31
Q

Explain the mechanism of action of pilocarpine.

A

Pilocarpine stimulates muscarinic receptors, stimulating the parasympathetic nerves and promoting salivary and lacrimal gland secretion

32
Q

When is gout prophylaxis initiated?

A

Prophylaxis is not started until weeks after the acute attack has resolved. NSAIDs or colchicine may be given to prevent a gout attack during the initial period. Once allopurinol or febuxostat is initiated, it is continued during an acute attack.

33
Q

Who should be assessed for osteoporosis?

A

Individuals over age 50 who have experienced a fragility
fracture

34
Q

How is osteoporosis defined?

A

Bone mineral density of 2.5 or more standard deviations below the peak bone mass for young adults (i.e., T-score ≤ –2.5)

35
Q

What does the FRAX measure?

A

The 10-year risk of a major osteoporotic fracture and a hip fracture

36
Q

What is Paget’s disease?

A

Excessive bone turnover (reabsorption and formation) due to increased osteoclast and osteoblast activity. The excessive turnover is not coordinated, leading to patchy areas of high density (sclerosis) and low density (lysis)

37
Q

What blood test are associated with Paget’s disease?

A

Raised ALP
Normal calcium
Normal phosphate

38
Q

Treatment for Paget’s disease

A

Bisphosphonates

39
Q

What is the testing interval for patients with a T score of -2.5 or below?

A

q1-3 yrs (otherwise 5-10 yrs)

NP: Adult (11 decks)

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