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Rheumatology Flashcards

1
Q

XRay Changes of Osteoarthritis?

A

Loss of Joint Space

Osteophytes

Subarticular Sclerosis (increased density of bone along joint line)

Sunchondral Cysts (fluid filled holes in bone)

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2
Q

Commonly Affected Joints for Rheumatoid vs. Osteoarthritis?

A

Rheumatoid Arthritis

  • PIP joints
  • MCP Joints
  • Wrist/Ankle
  • Cervical SPine
  • Large joints also (Hips, Knees, Shoulders)

Osteoarthritis

  • Hips
  • Knees
  • Sacro-Illiac Joints
  • DIPs
  • MCP at base of thumb
  • Wrist
  • Cervical Spine
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3
Q

Signs of Osteoarthtitis vs. Rhematoid Arthtitis in Hands?

A

Rhematoid Arthritis
* Z shaped deformity to thumb
* Swan neck deformity (Hyper extended PIP w/ flexed DIP)
* Boutonnieres Deformity (Hyperextended DIP with felxed PIP)
* Ulnar deviation

Osteoarthritis:
* Haberdens Nodules (DIP)
* Bouchards Nodes (PIP)
* Squaring at base of thumb

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4
Q

Pathophysiology of Rheamatoid Arthritis?

A

Chronic inflamation of synovial lininf of joints, tendon sheaths and bursa

Symetrical Polyarthritis

3x more common in women than men

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5
Q

Genetic Associations of Rheumatoid Arthritis?

A

HLA DR4

HLA DR1

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6
Q

Antibodies of Rheuamaotid Arthritis?

A

Rheumatoid factor (RF): targets the Fc portion of the IgG antibody

Anti-citrullinated cyclic peptide antibodies (anti-CCP antibodies): more sensistive and specific than rheumatoid factor. Pre-date RA and can indicate presidoposition to develope later

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7
Q

Presentation of Rheumatoid Arthritis?

A

Pain (Worse at rest, improves with activity)

Swelling/Stiffness

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8
Q

Emergency condition associated with RA?

A

Atlantoaxial sublixation
- C2 and C1 shift due to local syncovitis damaging loocal ligaments and bursa
- Can cause spinal cord compression

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9
Q

Signs of Rheumatoid Arthritis?

A

Hands:
* Z shaped deformity to thumb
* Swan neck deformity (Hyper extended PIP w/ flexed DIP)
* Boutonnieres Deformity (Hyperextended DIP with felxed PIP)
* Ulnar deviation
* Boggy feeling on palpation

Extra-articular
- Pulmonary fibrosis
- Felty’s Syndrom (RA/Neutropenia/Splenomegaly)
- Sjorgen’s Syndrome

Eye manifestations:
- Scleritis
- Keratitis
- Cataracts (seconary to steroids)

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10
Q

Investigations for Arthtitis?

A

Check Rehmatoid Factor/ anti-CCP antibodies

CRP/ESR

XRay of hands/Feet
- Join destruction and deformity
- soft tissue swelling
- perioarticular osteopenia
- boney erosions

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11
Q

Management of Rhetumatoid Arthritis

A

Initial/Flare Ups: Steroids/NSAID + PPI

1st Line: Methotrexate, Sulfasalazine

2nd Line: Methotrexate + TNF Inhibitor (Adalibumab, Infliximab, Enterncept)- Risk of TB/Hep B Reactivation

3rd Line: Methotrexate + Rituxumab (Anti-CD20)

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12
Q

Side Effects of Methotrexate?

A

Mouth Ulcers

Liver Toxicity

Pulmonary Fibrosis

Bone marrow supression

Teratonegenic

Folic acid taken on different days from methotrexate, reversible wit leucovorin

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13
Q

Psoriatic Arthritis
- Signs
- XRay Changes

A

Signs
- Psoariasis
- Pitting of Nails
- Oncholysis (separtion of bail from nail bed)
- Dactylitis (Inflamation of finger)

XRay Changes
- Periositis (inflamtion of periosttium => thickended finger)
- Ankylosis (Joint stiffening)
- Osteolysis
- Dactylitis (Soft tissue swelling)
- Pencil in Cup => Telessopic Finger in Arthritis Mutilans (Severe)

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14
Q

Psoriatic Arthritis Therapy?

A

NSAIDS

DMARDs (Methotrexate, sulfasalizine)

Anti-TNF (Entercept, infliximab, adulumbimab)

Ustekinumad (IL12/23)

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15
Q

Reactive Arthritis Accociations?

A

Triggered by gatroenteritis or STI (Chlamydia

Associations:
- Conjunctivits (Bilateral)
- Anterior Uvietis
- Circinate Balntitis (Penis)

Can’t See, Can’t Pee, Can’t climb a Tree

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16
Q

Synovial Fluids Aspiration Investigations?

A

Gram stain/Culture/Sensitivity (Septic Arthritis)

Crystal Examination (Gout/Pseudogout)

17
Q

Ankylosing Spondylitis Investgations??

A

**Schober’s Test
- pt stand stright, find L5 vertabra
- Mark point 10cm above and 5cm below this point
- Ask Pt to bend forward and measure distance betweent he points
- If < 20cm then = restriction lumbar movement

CRP/ESR

HLA B27 Test

XRAY
- Squaring of vertebral bodies
- Bamboo Spine
- Subchondral Sclerosis and erosions
- Ossification of ligaments/disks

MRI (Bone Marrow Edema)

18
Q

Management of Ankylosing Spondylitis?

A

NSAIDs

Steroids

Anti-TNF

Bisphosphonates

Avoid SMoking

PT

19
Q

Lupus
- Presentation
- Investigations

A

Presentation:
- Joint Pain
- Myalgia
- Fever
- Photosensitive Malar Rash
- Lymphadenopathy

Investigations
- ANA Blood test (Anti-dsDNA (Specific to SLE), Anti-Smith (Specific, not sensitive)
- FBC (Anemia of chronic disease)
- C3/C4 Levels
- CRP/ESR
- Immunoglobulins (INCR duye to B cell activation)
- Renal Investigations

20
Q

Autoantibodies and associated conditions?

A

Autoantibodies (ANA Blood test)
- Anti-dsDNA (Specific to SLE)
- Anti-Smith (SLE)
- Anti-centromere (Limited systemic sclerosis)
- Anti-Ro/La (Sjorgen’s Syndrome)
- Anti-Scl-70 (Systemic Sclerosis)
- Anti-Jo-1 (Dermatomyositis)

21
Q

Systemic Sclerosis
- Patterns of Disease
- Antibodies?
- Associations

A

Limited Cutaenous Systemic Sclerosis (CREST Syndrome- Anti-Centromere Antibodies)
- Calcinosis
- Raynaud’s Phenomenon (Fingers White=> Blue when exposed to cold)
- Esophogeal Dyspotility
- Sclerodactility (skin tightening)
- Telangiectasia (small, widened blood vessels on the skin)

Diffuse Cystemic Sclerosis (Anti-Scl-70)
- Cardiovascular Problems (Hypertension/Coronary artery disease)
- Lung Problems (Pulmonary FIbrosis)
- Kidney Problems

21
Q

Lupus Complicaitons?

A

CV Disease leading cause of deatgh

Anemia of Chronic Disease

Pericarditis

Pleuritis

Pulmonary FIbrosis

Lupus Nephritis

22
Q

Measures for pts on long term steroids?

A

Don’t STOP
- Don’t stop taking imedidatley, risk of adrenal crisis
- Sick Day rules. Increase dose when sick
- Treatment card to alert others they’re on steroids if unresponsive
- Osteoporosis prevention (Bisphosphnates, calcium, vitamin D)
- PPI

23
Q

Giant Cell Arteritis
- Associated condition
- Complication
- Symptoms
- Diagnosis
- Management?

A

Associated condition: Polymyalgia Rheumatica

Complication: Blindness, often irreversible

Symptoms: Jaw claudication, Unilateral headach around temple/forehead, scalp tenderness

Diagnosis:
- Clincial presentation
- RAISED ESR 50mm/hour
- Temporal artery biopsy (Multinucleated giant cell)

Management: Steroids

24
**Polymyositis/Dermatomyositis** - Investigations - Associated Cancers? - Presentation - Management?
Investigastions: - Creatine Kinase (Also elevated in MI, AKI, Statins, Excersise) - Autoantibodies (Anti-Jo-1, Anti-Mi-2, Anti-nuclear) Polymyositis/Dermatomyositis are often caused by underlying malaignancy (Pareneoplastic): - Lung - Breast - Ovarian - Gastric Presentation: - Dermatomyositis: Gotron Lesions (Knuckles, elbows , knees) - Photosensitiove erethemetous rash on back/kneck - Rash on face/eyelids - Periorbital Edema Management: **Corticosteroids**
25
**Antiphospholipid Syndrome** - Characteristics - Associations? - Management?
Characteristics: - Hypercoagulable state - Commonly occurs secondary to SLE Associations: - VTE - Aterial Thrommbosis (Stroke/MI/Renal Thrombosis) - Preganacy Complications - Libmann-Sacks Endocarditis (Growths on valves of heart (Mitral) assc w/ SLE/Anti-Phsopholipid syndrome) Management: - Warfarin (Range 2-3) - Pregant women Enoxaparin + Aspiring
26
Small Vessel Vasculitits?
Henochoch-Shonlein Purpora Esosinophillic granulomatosis w/ polyangitis (Churg-Straus) Microscopic Polyangitis Granlumoatosis w/ Polyangitis (Wegner's)
27
Medium Vessel Vasculitits?
Polyartitis Nodosa Esosinophillic granulomatosis w/ polyangitis (Churg-Straus) Kawasaki disease
28
Large Vessel Vasculititis?
Giant cell arteritis Takayasu's Arteritis
29
**Vasculititis** - Presentation - Tests - Management
Presentation: - **Purpura** (Non-blanching spots) - Joint/muscle pain - peripheral neuropathy - Renal impairment Tests - Inflamatory Markers (*CRP/ESR*) - *p-ANCA* (anti-PR3) assc w/ **Microscopic Polyangitis** and **Eosinophillic Granulamtosis w/ polyangitis (Churg-Straus)** - *c-ANCA* (anti-MPRO): **Granlumoatosis w/ Polyangitis (Wegner's)** Management: - Steroids - Immunosupressants (Cyclophosphamide, Methotrexate, Rituximab) - Kawasaki (Asprin/IV Immunoglobulins)
30
pANCAs associated condition(s)?
p-ANCA (anti-PR3) assc w/: - **Microscopic Polyangitis**: Renal Failure/Lungs - **Eosinophillic Granulamtosis w/ polyangitis (Churg-Straus)**: Lung/Skin issues + elevatged esoinophil levels
31
cANCA associated condition(s)?
c-ANCA (anti-MPO): **Granlumoatosis w/ Polyangitis (Wegner's)** - Nose bleeds- Saddle shaped nose (Perforate septum) - Hearing loss - Lungs - Glomeruloneuphritis
32
Kawasaki Disease Associations/Complication/Management?
High fever >5 days Erethematous rash Bilateral conjunctivitis Peeling of palms/soles Strawberry tounge Complication = **Coronary Artery Aneurisms** | Treat with Aspirin/IV Immunoglobulins
33
Takayasu's Arteritis what does it affect? Characteristics?
Aorta and Pulmoary Artereis Pulseless disease Diagnoses w. MRI Angio / Doppler Ultrasound
34
Diagnosis b/n Gout and Pseudogout?
Gout Fluid Aspiration: - **Monosodium urate crystals** - **Needle shaped** - **Negative bifringent** (polarized light) Gout XRay: - **Lytic lesions** - **Punched out erosions** - **Sclerotic boarders** w/ **overhanding edges** Pseudogout Fluid Aspiraiton: - **Calcium pyrophosphate crystals** - **Rhomboid Shaped** - **Positive birefringent** (polarized light) Psedudogout XRAY - **Chondrocalcinosis** (thin white line in middle of joint space, pathognomonic (diagnostic) of pseudogout) - Other changes similar to osteoarthritis (**L**oss of joint space, **O**steophyts, **S**unarticular sclerosis, **S**unchondral cysts)
35
Management of Gout?
Acute Flare: - **NSAIDs** (1st) C/I in Renal impariment/heart disease - **Colchine** (2nd)- GI Disrbances commmon - **Steroids** (3rd) Prophylaxis - **Allopurinol** (Xanthine oxidate inhibitor=> reduces uric acid levels) - Lifestyle changes (Losing weight, huydration, minimizing purine predominant alchohol/meat and seafood)
36
Management of Osteoperosis?
Calcium/Vit D Supplementation Bisphosphonates (Aleodronate) - Side effects include reflux/eosophogeal erosions - Atypical fratures - Osteonecrtosis of Jaw Denosumab (Monoclonal antibody that blocks activity of osteoclasts)
37
OSteomalacia risk factors?
Defective bone mineralization due to insufficient Vit. D caused by: * Dark skin * Low exposure to sunlight * Malabosrbtion conditions (IBD) * Chronic Kidney Disease Also Insufficient Vit D => low levels of calcuium and phosphate => seconary huyperparathyroidism => reabsortion from bones
38
Complications of Paget's Disease?
Osteogenic Sarcoma (Osteosarcoma) Spinal Stenosis => Spinal Cord compression Treated w/ Bisphopphonates

Clinical Medicine (8 decks)

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