Rheumatology

Question 1

Poor prognostic factors for rheumatoid arthritis

Answer 1

R - Rheumatoid factor positive
H - HLA DR4
E - Early erosions on XR
U - Unstable (poor functional status)
M - Manifestations (extra-articular)
A - AntiCCP
T - Timing (insidious onset)

Question 2

Limited cutaneous systemic sclerosis

Answer 2

Raynaud’s may be the first sign
Scleroderma affects face and distal limbs predominantly
Subtype is CREST syndrome:
- Calcinosis
- Raynaud’s
- oEsophageal dysmotility
- Sclerodactyly
- Telangectasia

Question 3

Drugs that cause drug induced lupus

Answer 3

Procainamide
Hydralazine

Less common - isoniazid, minocycline, phenytoin

Question 4

Drug induced lupus features

Answer 4

Arthralgia, myalgia, malar rash, pulmonary involvement
Less common - renal/nervous system involvement
Stops on cessation of drug

Question 5

Investigation results for drug induced lupus

Answer 5

ANA positive
dsDNA negative
Anti-histone antibodies positive in 80-90%
Anti-Ro and anti-Smith only positive in around 5%

Question 6

Side effects of methotrexate

Answer 6

Myelosuppression
Liver cirrhosis
Pneumonitis

Question 7

Side effects of sulfasalazine

Answer 7

Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease

Question 8

Side effects of leflunomide

Answer 8

Liver impairment
Interstitial lung disease
Hypertension

Question 9

Side effects of hydroxychloroquine

Answer 9

Retinopathy
Corneal deposits

Question 10

Side effects of prednisolone

Answer 10

Cushingoid features
Osteoporosis
Impaired glucose tolerance
Hypertension
Cataracts

Question 11

Side effects of penicillamine

Answer 11

Proteinuria
Exacerbation of myasthenia gravis

Question 12

Side effects of etanercept

Answer 12

Demyelination
Reactivation of tuberculosis

Question 13

Side effects of infliximab and adalimumab

Answer 13

Reactivation of tuberculosis

Question 14

Side effects of rituximab

Answer 14

Infusion reactions are common

Question 15

Behcet’s syndrome

Answer 15

Vasculitis
Painful mouth sores, genital sores, eye inflammation
Increase risk of VTE

Question 16

Anti-tissue transglutaminase antibody

Answer 16

Coeliac disease

Question 17

Anti-mitochondrial antibody

Answer 17

Primary biliary cholangitis

Question 18

Anti-nuclear antibody

Answer 18

SLE
Sjogren’s

Question 19

Anti-neutrophil cytoplasmic antibody (ANCA)

Answer 19

Vasculitis e.g. granulomatosis with polyangiitis, microscopic polyangiitis etc.

Question 20

Anti-Jo-1 antibody

Answer 20

Idiopathic inflammatory myopathies e.g. polymyositis and dermatomyositis

Question 21

Pseudogout findings

Answer 21

Calcium pyrophosphate deposits
Arthrocentesis shows positively birefringent crystals
Radiologically chondrocalcinosis

Question 22

Henoch-Schonlein purpura

Answer 22

IgA mediated small vessel vasculitis
Overlap with IgA nephropathy (Berger’s disease)
Usually in children following infection
Usually self-limiting

Question 23

Henoch-Schonlein purpura presentation

Answer 23

Palpable purpuric rash - buttocks and extensor surfaces of arms and legs
Abdo pain
Polyarthritis
IgA nephropathy - haematuria, renal failure