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FCRAP > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What disease is pseudogout associated with?

A
  • hyperparathyroidism
  • hypothyroidism
  • haemochromatosis
  • acromegaly
  • low magnesium, low phosphate
  • Wilson’s disease
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2
Q

what is keratoderma blenorrhagica associated with and what is it?

A

pustular lesions on palms, soles - seen in reactive arthritis; indistinguishable from palmarplantar pustulosis (bad psoriasis)

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3
Q

risk of developing psoriatic arthritis if have psoriasis

A

15%; more often skin disease occurs first; 30% have a family hx of psoriasis
HLAc26 a/w psoriasis alone
HLA Dr7 a/w psoriatic arthritis
HLA B27 a/w psoriatic arthritis with spondylitis
MICA-A allele strongly a/w with Psoriatic arthritis

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4
Q

clinical patterns in PsA (joint disease - 6)

A 
predominantly DIP (a/w nail disease)
asymmetrical oligoarticular
polyarticular small c/w rheumatoid
arthritis with spondylitis
arthritis mutilans
SAPHO syndrome
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5
Q

PsA arthritis treatment

A

NSAIDs
DMARDs (sulphasalazine MTX - skin only (more irreversible liver fibrosis), ciclosporin, leflunomide) peripheral joints only
anti TNF - skin and all joint (again more liver tox)
ustekinumab IL12/23

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6
Q

SAPHO syndrome

A 
synovitis - sternoclavicular, manubrium
acne
palmarplantar pustulosis
hyperostosis
osteitis

HLA B27 in 13%

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7
Q

gonococcal arthritis

A

dermatitis - pustules esp on hands
tenosynovitis
migratory polyarthritis
NOT a/w HLA B27; due to disseminated gonoccal infx

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8
Q

behcets disease (silk road)

A 
recurrent oral ulceration 
PLUS 2 of:
recurrent genital ulceration
eye lesions - panuveitis -> blindness
skin lesions - EN, PG, Sweets
positive pathergy test (inflammatory response to scratch etc)

ALSO a/w arthritis, thrombosis, vasculitis, CNS (dural sinus thrombosis)

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9
Q

acute rheumatic fever diagnostic criteria

A

2 major or 1 major; 2 minor

major: carditis, polyarthritis, chorea, erythema marginatum, subcut nodules
minor: fever, arthralgia, PHx rheum fever, raised ESR, CRP, prolonged PR, evidence of GAS infix (ASOT, strep Abs)

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10
Q

antiphospholipid syndrome

A 
aPL X 2 > 12/52 apart
AND
> 1 thrombosis
OR
3 consecutive mc < 10/40
1 mc > 10/40
pre eclampsia < 34/40

aPL = anticardiolipin, lupus anticoagulant, beta2microglobulin

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11
Q

typical EMG findings in myositis

A

EMG – increased insertional activity, spontaneous fibrillations, abnormal myopathic low amplitude and polyphasic motor potentials, complex repetitive discharges

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12
Q

typical muscle biopsy findings in myositis

A

muscle degeneration a/w macrophages, internalised nuclei, pale, hyalinised, split fibres, marked variation in fibre size

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13
Q

Anti synthetase syndrome features

A
  • Jo1 antibodies

- Myositis, ILD, arthritis, fever, raynauds, mechanics hands

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14
Q

APS treatment

A

aPL alone - RFx rx; heparin for travel
> 1 thrombosis + aPL - warfarin
recurrent thrombosis on warfarin - add DMARD
pregnant: no events - aspirin (cease at 34/40)
events - add clexane

avoid warfarin in pregnancy

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15
Q

methotrexate

A

antimetabolite
SEs: GI, ulcers, hair loss, liver fibrosis (more in PsA), bone marrow suppression, renal toxicity at high dose
AEs: accelerated rheumatoid nodule formation
acute pneumonitis - reversible
B cell lymphomas - regress off MTX

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16
Q

hydroxychloroquine (plaquenil)

A

retinal toxicity - need 3-5 yearly ophthal review
otherwise well tolerated
OK in pregnancy

17
Q

sulfasalazine

A

SEs: rash, headache, BM suppression, hepatotoxicity, haemolysis in G6PD def, reversible oligospermia

18
Q

Leflunomide

A
  • inhibits pyrimidine synthesis (which are required for T cell proliferation)
  • need to wash out with cholestyramine for 11 days pre conception
  • SEs: diarrhoea, peripheral neuropathy, LFTs
  • CI in pregnancy
19
Q

cyclosporin

A

renal toxicity

20
Q

Azathioprine

A
  • purine analogue
  • use in SLE for maintenance
  • screen for homozygous deficiency of TMPT enzyme which metabolises 6MP product of azathioprine as these people are at higher risk of bone marrow suppression
  • pregnancy cat D
21
Q

Cyclophosphamide

A
  • alkylating agent
  • induction in lupus nephritis
  • risk haemorrhagic cystitis, bladder CA
  • increases risk of CIN X 3
  • age dependent decrease in fertility
  • pregnancy cat D
22
Q

gout

A

2-60,000 leuks in aspirate
negatively birefringent crystals (in cells at time; can be aspirated between attacks)
aim urate < 0.36mmol/L
xray: -cystic changes, well-defined erosions with sclerotic margins with overhanging bony edges; soft tissue masses

23
Q

medications affecting urate levels

A
  • allopurinol
  • uricosuric agents
  • thiazide or loop diuretics
  • low-dose aspirin

beer > spirits (wine not a factor)

24
Q

long term hypouricaemic therapy indicated for gout if:

A

> 2 attacks; uric acid stones; uric acid > 535umol/L, tophi, chronic gouty arthritis

25
Q

allopurinol

A

xanthine oxidase inhibitor - for urate overproducers
side effects: toxic epidermal necrolysis, systemic vascluitis, bone marrow suppression, granulomatous hepatitis, renal failure
- rash, leukopenia or thrombocytopenia, diarrhea, and drug fever
- avoid in Han Chinese and Thai pts if HLAB5801 positive due to high rates of intolerance

26
Q

Calcium oxalate deposition disease

A
  • primary – rare – death, renal failure, by age 20
  • secondary – to ESRF → arthritis
  • worse if ascorbic acid supplements as this is metabolised to oxalate which is inadequately cleared in uremia and by dialysis
  • bipyramidal crystals
  • NSAIDs, colchicine, glucocorticoids, increased dialysis
27
Q

CPPD pseudogout

A

precipitants:

  • Trauma
  • Rapid reduction in calcium levels – surgery (esp parathyroidectomy)
28
Q

RA diagnosis

A 
Joint involvement
- 1 med-large (0)
- 2-10 med-large (1)
- 1-3 small (2)
- 4-10 (3)
Duration
- 6 weeks (1)
RA or CCP
- Negative (0)
- Low titre (1)
- High titre (2)
ESR or CRP
- Normal (0)
- Abnormal (1)
29
Q

hyperuricaemia

A

due to decreased renal uric acid excretion

30
Q

nail fold capillaroscopy

A

abnormal predicts scleroderma

31
Q

monitoring in RA

A

ESR, CRP, stiff joint count

NOT rheumatoid factor!

32
Q

ANA staining

A

centromere, nucleolar - scleroderma
homogenous, rim - SLE
speckled - non specific

33
Q

anti histone Ab

A

drug induced lupus

34
Q

anti ribosomal p

A

highly specific to SLE

35
Q

FRAX tool

A

age, weight, height, PHx fracture, FHx NOF, steroids, rheumatoid arthritis, etOH, secondary osteoporosis, smoker

36
Q

rheumatoid arthritis Rx

A

rituximab, adalimumab, golimumab, infliximab all better with methotrexate
except tocilizumab

37
Q

Ab seen from ANA without further testing

A

anti centromere

FCRAP (19 decks)

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