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RACP short cards > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Classification Criteria for SLE

A

Needs 4 and at least one from either group

Clinical Criteria

  • acute or subacute cutaneous lupus
  • chronic cutaneous lupus
  • oral or nasal ulcers
  • non scarring alopecia
  • synovitis of two or more joints
  • serositis
  • renal involvement
  • neurological involvement
  • haemolytic anaemia
  • leukopenia <4
  • thrombocytopenia <100

Immunological Criteria

  • ANA
  • anti ds-DNA
  • Anti- Smith
  • low complement
  • direct Coombs positive
  • anti phospholipid antibodies
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2
Q

Mechanism of ustekinumab

A

IL 12/23 inhibitor

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3
Q

Abatacept Mechanism

A

CD80/86 inhibitor preventing T cell activation

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4
Q

Tofacitinib mechanism

A

JAk STAT inhibitor

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5
Q

What HLA is associated with the development of anti-HMG antibodies?

A

HLA DRB1 11:01

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6
Q

What is the main cell found in the synovial fluid of a patient with RA?

A

Neutrophil

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7
Q

What proportion of patients with RA are seronegative?

A

One third

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8
Q

What are the radio graphic features of RA of the hands?

A

Juxtaarticular osteoporosis
Joint space narrowing
Marginal erosions
DIP sparring

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9
Q

Radiographic hand X-ray findings of Gout.

A
  • joint effusion
  • joint space preservation
  • punched out erosions
  • tophi
  • DIP joint involvement
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10
Q

Hand X-ray findings in SLE?

A

Normal
Preserved joint spaces
Can have passively correctable deformity (secondary to tendon damage)

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11
Q

Hand xray changes in psoriatic arthritis?

A 
DIP joints involved 
Pencil in cup deformity 
Dactylitis 
Periostitis 
Arthritis mutilans
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12
Q

Hand X-ray changes in scleroderma.

A 
Acro-osteolysis 
Subcutaneous calcification 
Joint space narrowing 
Juxtaarticular osteoporosis 
Erosions 
First CMC joint subluxation
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13
Q

What is the main contraindication to abatacept?

A

Bowel perforation

Diverticulitis

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14
Q

What are the criteria for inflammatory back pain?

A

4/5 of the following

  • age <40
  • insidious onset
  • improvement with exercise
  • no improvement with rest
  • pain at night with improvement on movement
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15
Q

What is the differential diagnosis of dactylitis.

A 
Reiters Syndrome 
Sarcoidosis 
Psoriatic arthritis 
Flexor tendon sheath infections 
Gout
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16
Q

What are the features of sacroilitis?

A

Early

  • sclerosis
  • joint space narrowing
  • small erosions

Late

  • severe sclerosis
  • joint space widening
  • large erosions
  • fusion (very late)
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17
Q

Clinical criteria for Ankylosing spondylitis?

A
  1. Clinical Criteria (need 1)
    - lower back pain and stiffness for >3 months which improves with exercise
    - limitation of lumbar spine motion
    - limitation of chest expansion
  2. Radiologic Criteria (need 1)
    - sacroiliitis of grade 2 bilaterally
    - or 3 unilaterally
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18
Q

Radiographic findings of ankylosing spondyliitis of the spine?

A 
Shiny corners (Romanus Lesion)
Syndesmophyte formation
Bamboo spine (fusion of bodies by syndesmophytes)
Dagger spine (calcification of interspinous ligaments)
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19
Q

What are the different types of spondyloarthritis?

A

Ankylosing spondylitis
Psoriatic Arthritis
Reactive Arthritis
Enteropathic Arthritis

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20
Q

What are the five clinical patterns of psoriatic arthritis?

A 
Distal Arthritis 
Asymmetric Oligoarthritis 
Symmetric Polyarthritis 
Arthritis mutilans 
Spondyloarthritis
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21
Q

What proportion of patients with psoriatic arthritis have a history of psoriasis?

A

70-85%

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22
Q

Treatment of psoriatic arthritis?

A

NSAIDs
Dmards (methotrexate, sulphasalazine, hydroxychloroquine)
Biological agents
Small molecules (apremilast)

23
Q

Mechanism of sekukinumab?

A

IL 17 inhibitor

24
Q

What is the expected clinical course for reactive arthritis?

A

70% resolve in 6 months
Chronic course in 25%
Destructive arthritis 5%

25
Q

What medication can precipitate scleroderma real crisis?

A

Prednisone

Cyclosporine

26
Q

What is the treatment of secondary raynauds?

A
  1. Cold avoidance
  2. Amlodipine/Nifedipine
  3. Topical GTN Or PDE 5 inhibitors or IV prostanoids
27
Q

Mechanism of belimumab?

A

B lymphocyte stimulator protein inhibitor.

28
Q

What are the histological features of Polymyositis and Inclusion body myositis?

A

Scattered necrotic muscle fibres with CD8 infiltration

29
Q

What are the histological features of dermatomyositis?

A

Perifascicular atrophy and fibrosis with CD4 infiltration

30
Q

What is the median survival of limited sclerosis with pulmonary hypertension?

A

11 months

31
Q

What is the strongest genetic factor for Behçet’s disease?

A

HLA B 51

32
Q

What is the most common ILD pattern in scleroderma?

A

NSIP

33
Q

What is the treatment of scleroderma associated lung disease

A
  1. MMF preferred
  2. Cyclo and azathioprine can also be used
  3. Rituximab And experimental agents (if refractory)
  4. Lung transplantation
34
Q

What are the predictors of mortality for pulmonary hypertension related to scleroderma?

A 
Right heart failure 
Low DLCO
Male 
Age >60
Poor exercise capacity 
Anti U1RNP negative 
Pericardial effusion
35
Q

What is the treatment of WHO class 2-3 SSc PAH?

A
  1. Combination oral therapy (ambrisentan and tadaladil)
  2. Atrial Septostomy (bridge to lung tx)

No role for Calcium channel blocker.

36
Q

What is the management of WHO class 4 SSc PAH?

A
  1. Combination IV prostanoid and oral therapy
  2. Atrial Septostomy (bridge to lung tx)
  3. Lung transplantation

No role for Calcium channel blocker.

37
Q

What is the treatment of SSc associated raynauds ulcers?

A

Iloprost infusion

Cessation of agents which worsen disease (beta blockers)

38
Q

How do you treat scleroderma associated skin disease?

A
  1. MMF

2. Methotrexate second line

39
Q

What is topoisomerase 1?

A

Scl-70

40
Q

How does duration of raynauds inform on the likely subtype of scleroderma?

A

Long standing - likely limited Scleroderma

Short history - likely diffuse scleroderma

41
Q

Diagnostic criteria for sjogrens.

A
  1. Ocular dryness - schooner and Saxon test

2. Blood/histo evidence of autoimmunity - anti Ro or anti La or anti centromere or salivary biopsy

42
Q

What is the most specific US imaging finding of Gout?

A

Double contour sign

43
Q

Mechanism of raburicase?

A

recombinant urate-oxidase enzyme, which converts uric acid to allantoin

44
Q

What is the serum urate aim for 1) non tophaceous gout and 2) tophaceous gout?

A

1) <0.36

2) <0.3

45
Q

What is the treatment of psoriatic arthritis?

A
  1. NSAIDs
  2. DMARDS (methotrexate, leflunomide)
  3. TNF alphas
  4. Anti interleukins
46
Q

What clinical presentation of RA is associated with a good prognosis?

A

Acute onset arthritis in a few large joints

47
Q

What are the negative prognostic factors in RA?

A 
Age <20 or >60
High titre RF 
Anti CCP positive 
Early erosive joint disease 
High inflammatory markers
48
Q

What is the most common extraarticular manifestation of Ank Spon.

A

Uveitis

49
Q

What is the most common first site of disease in knee OA?

A

Patellofemoral joint

50
Q

What are the features of rheumatoid arthritis related arthropathy?

A

MCP joint involvement
Hook like osteophytes
Squared off bone ends
Joint space loss

51
Q

What are the extra-articular features of AS?

A 
Anterior Uveitis
Av Node Block
Aortic Regurg 
Apical Fibrosis 
Amyloidosis 
Achilles tendinitis
52
Q

What is the HLA associated with RA?

A

HLA DR4

53
Q

Ehlers Danlos is most commonly associated with a defect in which type of collagen?

A

Type 3

54
Q

What are anti srp antibodies associated with?

A

Polymyositis

RACP short cards (30 decks)

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