Rheumatology Flashcards by Belle Storey

Immunological investigation requested in rheumatoid arthritis

Rheumatoid factor
anti-CCP antibodies

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3 hand findings in rheum arthritis

Swan neck (PIP hyperextension, DIP flexion) - swan havin a drink with neck down
Z thumb
Ulnar deviation
Boutonniere deformity (PIP flexion, DIP hyperextension)

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3 X-ray abnormalities in rheum arthritis

Loss of joint space
Soft tissue swelling
Juxta-articular osteopenia
Bony erosions

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4 extra-articular features of rheum arthritis

scleritis
lymphadenopathy
splenomegaly
pleural effusion
pulmonary fibrosis
vasculitis
anaemia
Raynaud’s

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Felty’s syndrome triad

Splenomegaly
Neutropenia
RA

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Other than rheumatoid, give 3 possible causes of polyarthritis

psoriatic arthritis
osteoarthritis
reactive arthritis

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mechanism of action of NSAIDs in RA

COX-1 inhibitor which reduces prostaglandins and therefore reduces inflammation

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How is methotrexate administered and how frequently is it given

IM or oral, and once weekly

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What drug should be taken along side regular methotrexate

folic acid

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Other than GP and rheumatologist, give 2 healthcare professionals involved in the care of RA pt

physiotherapist
specialist RA nurse
occupational therapist
orthopaedic surgeon

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Give 4 common risk factors for gout

male
alcohol
obese
high purine diet (red meat, fish)

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Give 1 drug used for gout in

a) acute treatment

b) long term prevention

a) NSAID or colchicine
b) allopurinol

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key X-ray finding in gout

punched out erosions

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what would polarised light microscopy of the synovial fluid show in gout

negatively birifringement needle shaped

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Joint calcification X-ray finding in psuedogout

chondrocalcinosis

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Joints commonly affected in pseudogout

knee
hips
wrist

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2 risk factors for psuedogout

hypothyroidism
wilsons
OA
increasing age

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investigation to confirm diagnosis of pseudogout and what would it show

synovial fluid - positively birefringement rhomboids

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other than pseudogout, give 2 other causes of monoarthritis

gout
reactive arthritis
septic arthritis
trauma

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4 examination signs present in osteoarthritis

crepitations
stiffness
muscle wasting
pain on movement

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4 X-ray signs present in osteoarthritis

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

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4 possible treatment options for osteoarthritis

conservative (weight loss, exercise, physio)
simple analgesia (topical NSAID, oral NSAID, paracetamol)
intrarticular steroids
surgical

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2 immunological blood tests positive in SLE

Anti-dsDNA
Anti-Smith

ANA (most sensitive but not as specific/many false positives)

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2 dermatological effects of SLE

Photosensitive malar rash
Discoid lupus

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Cause of recurrent miscarriage in SLE pt

antiphospholipid syndrome

excluding malar rash, 3 features of SLE

hair loss lymphadenopathy joint pain SOB splenomegaly myalgia

2 drugs used in SLE treatment

hydroxychloroquine NSAIDs steroids DMARDs e.g. methotrexate Biologic therapies e.g. rituximab

Purple discolouration of eyelids in dermatomyositis

heliotrope

Rough, red papules over knuckles in dermatomyositis

gottron's papules

2 autoantibodies associated with dermatomyositis

anti-jo anti-mi

What is Raynaud's phenomenon?

fingers turn white then blue

Give 3 causes of Raynaud's, other than scleroderma

SLE atherosclerosis RA

Give 4 classical features of scleroderma, other than Raynaud's

calcium deposits in the skin oesophageal dysfunction thickening of skin (sclerodactyly) weight gain

Name 3 seronegative spondyloarthropathies

Psoriatic arthritis Ankylosing spondylitis Reactive arthritis

Antigen present in the majority of seronegative spondyloarthropathies

HLA-B27

Classic X-ray changes in ankylosing spondylitis

sacroiliitis: subchondral erosions, sclerosis squaring of lumbar vertebrae 'bamboo spine' (late & uncommon) syndesmophytes: due to ossification of outer fibers of annulus fibrosus

2 medical options for management of ankylosing spondylitis

1st line: NSAIDs Refractory: Anti-TNF e.g. entanercept monoclonals e.g. infliximab

Reactive arthritis triad (Reiter's syndrome)

cant see (uveitis) cant pee (cystitis) cant climb a tree (arthritis)

Other than chronic plaque psoriasis, name 2 other forms of psoriasis

guttate pustular erythrodermic

Give 2 sites that the skin lesions of chronic plaque psoriasis commonly affect

extensor surfaces of elbows and knees Scalp

periarticular osteolysis and shortening of the bones in psoriatic arthritis

arthritis mutilans

3 organisms that may trigger reactive arthritis

chlamydia camyplobacter salmonella shigella

Other than granulomatosis with polyangiitis, name 1 other ANCA positive small vessel vasculitis

microscopic polyangiitis churg-strauss

Name 1 ANCA negative small vessel vasculitis

HSP Goodpastures

Name 1 large-vessel vasculitis

temporal arteritis Takayasu arteritis

Name 1 medium vessel vasculitis

kawasaki

Name 2 systemic conditions of which vasculitis is a feature of the disease

infective endocarditis RA SLE IBD Hep B and C polymyositis

Other than granulomatosis with polyangiitis, name 4 other causes of mononeuritis multiplex

HIV RA DM sarcoidosis

3 targets for biological therapies in RA

TNF (infliximab) CD20 B-cells (rituximab) IL-6 JAK

Name of procedure for surgical treatment of hip osteoarthritis

Total hip arthroplasty or hemiarthroplasty

When would psoriatic arthritis be worse

Morning

Difference between oligoarthritis and polyarthritis

Oligo = <4 Poly = 5 or more

Nail signs of psoriatic arthritis

Nail pitting / leukonychia / nail ridging / nail crumbling / oil-drop sign or oil-drop discolouration / salmon patch / onycholysis / subungal hyperkeratosis / splinter haemorrhages

crystal composition in a) gout b) pseudogout

a) monosodium urate b) calcium pyrophosphate

Allopurinol drug class

Xanthine oxidase inhibitor

2nd line drug treatment to allopurinol

Febuxostat

Definition of sensitivity

proportion of people who test positive among all those who actually have the disease

Definition of specificity

proportion of people who test negative among all those who actually do not have that disease

2 common complications a/w SLE

Coronary artery disease Hypertension Anaemia Pericarditis

Presenting features of temporal arteritis

Severe temporal unilateral headache Scalp tenderness (e.g., noticed when brushing the hair) Jaw claudication Blurred or double vision Loss of vision if untreated

2 investigations to diagnose GCA

ESR Temporal artery ultrasound (halo sign) Temporal artery biopsy

1 piece of advise to reduce risk of progression in osteoarthritis

Persist with activity to keep joints moving