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Clinical Medicine > Rheumatology > Flashcards

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
Q

Polymyositis/Dermatomyositis
- Investigations
- Associated Cancers?
- Presentation
- Management?

A

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
Q

Antiphospholipid Syndrome
- Characteristics
- Associations?
- Management?

A

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
Q

Small Vessel Vasculitits?

A

Henochoch-Shonlein Purpora

Esosinophillic granulomatosis w/ polyangitis (Churg-Straus)

Microscopic Polyangitis

Granlumoatosis w/ Polyangitis (Wegner’s)

27
Q

Medium Vessel Vasculitits?

A

Polyartitis Nodosa

Esosinophillic granulomatosis w/ polyangitis (Churg-Straus)

Kawasaki disease

28
Q

Large Vessel Vasculititis?

A

Giant cell arteritis

Takayasu’s Arteritis

29
Q

Vasculititis
- Presentation
- Tests
- Management

A

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
Q

pANCAs associated condition(s)?

A

p-ANCA (anti-PR3) assc w/:
- Microscopic Polyangitis: Renal Failure/Lungs
- Eosinophillic Granulamtosis w/ polyangitis (Churg-Straus): Lung/Skin issues + elevatged esoinophil levels

31
Q

cANCA associated condition(s)?

A

c-ANCA (anti-MPO): Granlumoatosis w/ Polyangitis (Wegner’s)
- Nose bleeds- Saddle shaped nose (Perforate septum)
- Hearing loss
- Lungs
- Glomeruloneuphritis

32
Q

Kawasaki Disease Associations/Complication/Management?

A

High fever >5 days

Erethematous rash

Bilateral conjunctivitis

Peeling of palms/soles

Strawberry tounge

Complication = Coronary Artery Aneurisms

Treat with Aspirin/IV Immunoglobulins

33
Q

Takayasu’s Arteritis what does it affect?

Characteristics?

A

Aorta and Pulmoary Artereis

Pulseless disease

Diagnoses w. MRI Angio / Doppler Ultrasound

34
Q

Diagnosis b/n Gout and Pseudogout?

A

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 (Loss of joint space, Osteophyts, Sunarticular sclerosis, Sunchondral cysts)

35
Q

Management of Gout?

A

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
Q

Management of Osteoperosis?

A

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
Q

OSteomalacia risk factors?

A

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
Q

Complications of Paget’s Disease?

A

Osteogenic Sarcoma (Osteosarcoma)

Spinal Stenosis => Spinal Cord compression

Treated w/ Bisphopphonates

Clinical Medicine (8 decks)

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