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1 - MSRA > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Common features of ANCA associated vasculitis

A
  • Renal impairment
  • Resp symptoms - dyspnoea, haemoptysis
  • Systemic symptoms - fatigue, weight loss, fever
  • Vasculitic rash
  • Sinusitis
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2
Q

cANCA associated with

A

Granulomatosis with polyangiitis

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3
Q

pANCA associated with

A

Churg-Strauss
UC
Primary sclerosing cholangitis
Anti-GBM disease
Crohn’s

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4
Q

Role of ANCA monitoring

A

Some correlation between cANCA levels and disease activity, not for pANCA

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5
Q

Gene associated with ankylosing spondylitis

A

HLA B27

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6
Q

Symptoms ankylosing spondylitis

A

Insidious onset low back pain and stiffness
Stiffness worse in morning, improves with exercise

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7
Q

Examination features ankylosing spondylitis

A

Reduced lateral flexion
Reduced forward flexion
Reduced chest expansion

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8
Q

What is Schober’s test

A

Line drawn 10cm above and 5cm below back dimples. Distance between the two lines should increase by more than 5cm when patient bends as far forward as possible

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9
Q

Conditions associated with ankylosing spondylitis

A
  • Apical fibrosis
  • Anterior uveitis
  • Aortic regurgitation
  • Achilles tendonitis
  • AV node block
  • Amyloidosis
  • Cauda equina syndrome
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10
Q

XR findings ankylosing spondylitis

A
  • Sacroilitis - subchondral erosions, sclerosis
  • Squaring of lumbar vertebrae
  • Bamboo spine
  • Syndesmophytes

Apical fibrosis on CXR

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11
Q

Spirometry ankylosing spondylitis

A

Restrictive defect (pulmonary fibrosis, kyphosis, ankylosis of costovertebral joints)

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12
Q

Management ankylosing spondylitis

A

NSAIDs first line
DMARD

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13
Q

Causes of antiphospholipid syndrome

A

Primary disorder
SLE
Lymphoproliferative disorders
Phenothiazines

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14
Q

Features antiphospholipid syndrome

A
  • Venous/arterial thrombosis
  • Recurrent miscarriage
  • Livedo reticularis
  • Pre-eclampsia
  • Pulmonary hypertension
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15
Q

Investigation findings antiphospholipid syndrome

A

Positive antibodies
Thrombocytopenia
Prolonged APTT

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16
Q

What antibodies in antiphospholipid syndrome

A

Anticardiolipin antibodies
Anti-beta2GPI antidbodies
Lupus anticoagulant

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17
Q

Why prolonged APTT in antiphospholipid syndrome

A

Due to ex-vivo reaction of lupus anticoagulant autoantibodies with phospholipids in the coagulation cascade

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18
Q

Management antiphospholipid syndrome

A

Primary thromboprophylaxis - low dose aspirin
Secondary thromboprophylaxis - for first A/VTE, warfarin with target 2-3. If recurrent, consider + low dose aspirin, target 3-4

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19
Q

Adverse effects azathioprine

A

Bone marrow depression
Nausea/vomiting
Pancreatitis
Increased risk non-melanoma skin cncer

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20
Q

Gene association Behcet’s

A

HLA B51

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21
Q

Classic features Behcet’s syndrome

A

Oral ulcers
Genital ulcers
Anterior uveitis

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22
Q

Other features Behcet’s syndrome

A

Thrombophlebitis
DVT
Arthritis
Neurological involvement e.g. aseptic meningitis
Abdominal pain, diarrhoea, colitis
Erythema nodosum

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23
Q

What is positive pathergy test Behcets

A

Puncture site following needle prick becomes inflamed with small pustule

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24
Q

Uses of bisphosphonates

A

Prevention and treatment of osteporosis
Hypercalcaemia
Paget’s disease
Pain from bone mets

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25
Q

Adverse effects bisphosphonates

A

Oesophageal reactions - oesophagitis, oesophageal ulcers
Osteonecrosis of the jaw
Increased risk of atypical stress fractures of the proximal femoral shaft
Acute phase response (fever, myalgia, arthralgia) following administration
Hypocalcaemia

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26
Q

How to take bisphosphonates

A

Swallow whole with water while sitting or standing, empty stomach 30 mins before breakfast (or other oral meds), sit or stand upright for at least 30 mins after taking

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27
Q

Lab findings osteoporosis

A

Normal calcium, phosphate, ALP and PTH

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28
Q

Lab findings osteomalacia

A

Low calcium and phosphate
High ALP and PTH

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29
Q

Lab findings primary hyperparathyroidism

A

High calcium
Low phosphate
High ALP
High PTH

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30
Q

Lab findings chronic kidney disease (→ chronic hyperparathyroidism)

A

Low calcium
Increased phosphate
Increased ALP
Increased PTH

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31
Q

Lab findings Paget’s disease

A

Normal calcium and phosphate
Increased ALP
Normal PTH

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32
Q

Lab findings osteopetrosis

A

Normal

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33
Q

X-ray findings osteosarcoma

A

Codman triangle from periosteal elevation
Sunburst pattern

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34
Q

Risk factors osteosarcoma

A

Mutation of Rb gene
Paget’s disease of bone
Radiotherapy

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35
Q

X-ray findings Ewing’s sarcoma

A

‘Onion skin’ appearance

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36
Q

Most common site osteoma

A

Skull

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37
Q

Most common site giant cell tumour

A

Epiphyses long bones

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38
Q

Most common site osteosarcoma

A

Metaphyseal region long bones (prior to epiphyseal closure) - femur, tibia, humerus

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39
Q

Most common site Ewing’s sarcoma

A

Pelvis and long bones

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40
Q

Most common side chondrosarcoma

A

Axial skeleton

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41
Q

Causes dactylitis

A

Spondyloarthritis, e.g. psoriatic and reactive arthritis
Sickle cell disease
TB
Sarcoidosis
Syphilis

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42
Q

What is dermatomyositis

A

Inflammatory disorder causing symmetrical, proximal muscle weakness and skin lesions

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43
Q

Cause dermatomyositis

A

Idiopathic
Connective tissue disorders
Malignancy - ovarian, breast, lung - 20-25% of cases

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44
Q

What is polymyositis

A

Variant of dermatomyositis where skin manifestations are not prominent

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45
Q

Skin features dermatomyositis

A

Photosensitivity
Macular rash over back and shoulder
Heliotrope rash in periorbital region
Gottron’s papules
Mechanics hands
Nail fold capillary dilatation

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46
Q

What are Gottron’s papules

A

Roughened red papules over extensor surfaces of fingers

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47
Q

What is mechanics hands

A

Extremely dry and scaly hands with linear cracks on palmar and lateral aspects of fingers

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48
Q

Non-skin features of dermatomyositis

A

Proximal muscle weakness +/- tenderness
Raynaud’s
Respiratory muscle weakness
Interstitial lung disease, e.g. fibrosing alveolitis or organising pneumonia
Dysphagia, dysphonia

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49
Q

Investigation findings dermatomyositis

A

80% ANA positive
30% anti-synthetase antibodies, inc anti-Jo1, anti-STP, anti-Mi-2

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50
Q

Drug induced lupus vs SLE

A

In drug induced, renal and nervous system involvement unusual
Usually resolves on stopping drug

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51
Q

Features drug induced lupus

A

Arthralgia
Myalgia
Malar rash
Pleurisy

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52
Q

Antibodies drug induced lupus

A

ANA positive in 100%, dsDNA negative
Anti-histone in 80-90%
Anti-Ro/anti-Smith in 5%

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53
Q

Most common causes drug induced lupus

A

Procainamide
Hydralazine

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54
Q

Less common cause drug induced lupus

A

Isoniazid
Minocycline
Phenytoin

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55
Q

Inheritence Ehler-Danlos syndrome

A

AD

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56
Q

Features Ehler-Danlos syndrome

A

Elastic, fragile skin
Joint hypermobility, recurrent joint dislocation
Easy bruising
Cardiac lesions
Subarachnoid haemorrhage
Angioid retinal streaks

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57
Q

Cardiac lesions Ehler-Danlos syndrome

A

Aortic regurgitation
Mitral valve prolapse
Aortic dissection

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58
Q

Drugs causing gout

A

Diuretics - thiazides, furosemide
Ciclosporin
Alcohol
Cytotoxic agents
Pyrazinamide
Aspirin

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59
Q

Most common site gout

A

1st metatarsophalangeal joint

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60
Q

Uric acid suggestive of gout

A

≥360umol/L

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61
Q

Synovial fluid analysis in gout

A

Needle shaped negatively bifringent monosodium urate crystals under polarised light

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62
Q

Radiological features gout

A

Joint effusion
Well defined punched out erosions with sclerotic margins in juxta-articular distribution, often with overhanging edges
Relative preservation of joint space until late disease
Eccentric erosions
Soft tissue tophi

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63
Q

Acute management gout

A

NSAIDs and colchicine first line
Oral steroids if contraindicated

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64
Q

Limitations colchicine

A
  • Slower onset of action
  • Causes diarrhoea
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65
Q

Colchicine in renal impairment

A

Can be used with caution
Reduce dose if 10-50, avoid if <10

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66
Q

Urate lowering therapy in gout

A

Allopurinol first line
Febuxostat second line

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67
Q

Dose of allopurinol

A

Initial dose 100mg OD, titrated to aim for serum uric acid <360

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68
Q

When to aim for uric acid <300 in gout

A

Patients with tophi, chronic gouty arthritis, ongoing frequent flares despite uric acid <360umol/L

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69
Q

Best antihypertensive in gout

A

Losartan (uricosuric action)

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70
Q

Referred lumbar spine pain cause and location

A

Femoral nerve compression cause referred pain in hip

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71
Q

Referred lumbar spine pain features

A

Femoral nerve stretch test positive (lie patient prone, extend hip joint with straight leg then bend knee)

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72
Q

Cause of greater trochanteric pain syndrome

A

Due to repeated movement of fibroelastic iliotibila band

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73
Q

Features of greater trochaneteric pain syndrome

A

Pain and tenderness over lateral side of thigh

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74
Q

Cause meralgia paresthetica

A

Compression of lateral cutaneous nerve of thigh

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75
Q

Features meralgia paresthetica

A

Burning sensation over antero-lateral aspect of thigh

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76
Q

Risk factors avascular necrosis

A

High dose steroid therapy
Previous hip fracture or dislocation

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77
Q

Cause pubic symphysis dysfunction

A

Ligament laxity increases in response to hormonal changes of pregnancy

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78
Q

Features pubic symphysis dysfunction

A

Pain over the pubic symphysis with radiation to groin and medial aspect of thigh
Waddling gait

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79
Q

Transient idiopathic osteoporosis features

A

Uncommon condition seen in third trimester of pregnancy

  • Groin pain associated with limited range of movement in the hip
  • May be unable to weight bear
  • ESR may be elevated
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80
Q

Conditions associated with HLA-A3

A

Haemochromatosis

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81
Q

Conditions associated with HLA-B51

A

Behcet’s disease

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82
Q

Conditions associated with HLA-B27

A

Ankylosing spondylitis
Reactive arthritis
Acute anterior uveitis
Psoriatic arthritis

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83
Q

Conditions associated with HLA-DQ2/8

A

Coeliac

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84
Q

Conditions associated with HLA-DR2

A

Narcolepsy
Goodpastures

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85
Q

Conditions associated with HLA-DE3

A

Dermatitis herpetiformis
Sjorgens syndrome
Primary biliary cirrhosis

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86
Q

Conditions associated with HLA-DR4

A

T1DM
RA

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87
Q

Adverse effects hydroxychloroquine

A

Bull’s eye retinopathy - severe and permanent visual loss

88
Q

Hydroxychloroquine pregnancy

A

Can be used

89
Q

Mechanism type I hypersensitivity reaction

A

Antigen reacts with IgE bound to mast cells

90
Q

What reactions are type I allergic reactions

A
  • Anaphylaxis
  • Atopy (asthma, eczema, hayfever)
91
Q

Mechanism type II hypersensitivity reaction

A

IgG or IgM binds to antigen on cell surface

92
Q

What conditions involve type II hypersensitivity reactions

A
  • Autoimmune haemolytic anaemia
  • ITP
  • Goodpasture’s syndrome
  • Pernicious anaemia
  • Acute haemolytic transfusion reactions
  • Rheumatic fever
  • Pemphigus vularis/bullous pemphigoid
93
Q

Mechanism type III hypersensitivity reactions

A

Free antigen and antibody (IgG, IgA) combine

94
Q

What conditions involve type III hypersensitivity reactions

A
  • Serum sicknes
  • SLE
  • Post streptococcal glomerulonephritis
  • Extrinsic allergic alveolitis
95
Q

Mechanism type IV hypersensitivity reactions

A

T-cell mediated

96
Q

What conditions involve type IV hypersensitivity reactions

A
  • Tuberculosis (and tuberculin skin reaction)
  • Graft versus host disease
  • Allergic contact dermatitis
  • Scabies
  • Extrinsic allergic alveolitis
  • MS
  • GBS
97
Q

Mechanism type V hypersensitivity reactions

A

Antibodies that recognise and bind to cell surface receptor, either stimulating them or blocking ligand binding

98
Q

What conditions involve type V hypersensitivity reaction

A

Graves disease
Myasthenia gravis

99
Q

Features lateral epicondylitis

A
  • Pain and tenderness localised to lateral epicondyle
  • Pain worse on wrist extension against resistance with elbow extended, or supination of forearm with elbow extended
100
Q

Inheritance pattern Marfans

A

AD

101
Q

Features Marfans syndrome

A
  • Tall stature
  • High arched palate
  • Arachnodactyly
  • Pectus excavatum
  • Pes planus
  • Scoliosis of >20 degrees
  • Heart lesions
  • Repeated pneumothoraces
  • Eye lesions
  • Dural ectasia
102
Q

Marfans syndrome heart lesions

A
  • Dilation of aortic sinuses (90%) → aortic aneurysm, aortic dissection, aortic regurgitation
  • Mitral valve prolapse (75%)
103
Q

Marfans syndrome eye lesions

A
  • Upwards lens dislocation
  • Blue sclera
  • Myopia
104
Q

Adverse effects methotrexate

A
  • Mucositis
  • Myelosuppression
  • Pneumonitis
  • Pulmonary fibrosis
  • Liver fibrosis
105
Q

Features methotrexate induce pneumonitis

A

Typically within year of starting treatment, acute or subacute
- Non productive cough
- Dyspnoea
- Malaise
- Fever

106
Q

Pregnancy methotrexate

A

Avoid pregnancy for 6 months after treatment (including men)

107
Q

Co-prescribe with methotrexate?

A

Folic acid 5mg weekly, taken more than 24hours after methotrexate

108
Q

Interactions methotrexate

A

Trimethoprim/co-trim (increased risk of marrow aplasia)
High dose aspirin (increased risk of methotrexate toxicity)

109
Q

Treatment methotrexate toxicity

A

Folinic acid

110
Q

Features of myopathies

A
  • Symmetrical muscle weakness, proximal > distal
  • Common problems rising from chair, getting out of bath
  • Sensation normal, reflexes normal, no fasciculation
111
Q

Causes myopathies

A

Inflammatory - polymyositis
Inherited - Duchennes/Beckers muscular dystrophy, myotonic dystrophy
Endocrine - Cushing’s, thyrotoxicosis
Alcohol

112
Q

When osteoarthritis can be diagnosed clinically w/ no investigations

A

Patient >45 years
Exercise related pain
No morning stiffness, or morning stiffness lasting <30 mins

113
Q

First line treatment osteoarthritis

A

Topical NSAIDs

114
Q

Second line treatment osteoarthritis

A

Oral NSAIDs

115
Q

Role of paracetamol or weak opioids osteoarthritis

A

Do not offer unless infrequently for short term pain relief, or other options contraindicated/not tolerated/ineffective

116
Q

Options of NSAIDs ineffective osteoarthritis

A

Intra-articular steroid infection
Joint replacement

117
Q

X-ray changes osteoarthritis

A

Loss of joint space
Osteophytes forming at joint margins
Subchondral sclerosis
Subchondral cysts

118
Q

Inheritance osteogenesis imperfecta

A

Autosomal dominant

119
Q

Features osteogenesis imperfecta

A

Presents in childhood
Fractures after minor trauma
Blue sclera
Deafness secondary to otosclerosis
Dental imperfections

120
Q

What is osteomalacia

A

Softening of bones secondary to low vitamin D levels leading to decreased bone mineral content

121
Q

Osteomalacia vs rickets

A

Osteomalacia in adults, rickets in children

122
Q

Causes osteomalacia

A
  • Vitamin D deficiency - malabsorption, lack of sunlight, diet
  • CKD
  • Drug induced
  • Inherited
  • Liver disease, e.g. cirrhosis
  • Coeliac disease
123
Q

Drugs causing osteomalacia

A

Anticonvulsants

124
Q

Features osteomalacia

A

Bone pain
Bone/muscle tenderness
Fractures, esp femoral neck
Proximal myopathy

125
Q

Blood findings osteomalacia

A

Low vit D
Low calcium and phosphate
Raised ALP

126
Q

X-ray findings osteomalacia

A

Translucent bands

127
Q

Main risk factors osteoporosis

A
  • History of glucocorticoid use
  • Rheumatoid arthritis
  • Alcohol excess
  • History of parental hip fracture
  • Low BMI
  • current smoking
128
Q

Medications worsening osteoporosis

A
  • Glucocorticoids
  • SSRIs
  • Antiepileptics
  • PPIs
  • Glitazones
  • Long term heparin therapy
  • Aromatase inhibitors, e.g. anastrozolee
129
Q

First line osteoporosis treatment

A

Bisphosphonates - alendronate, risedronate

130
Q

Second line osteoporosis treatment

A

Denosumab

131
Q

Other treatment options osteoporosis

A

Strontium ranelate
Raloxifene
Teriparatide
Tomosozumab

132
Q

What is Paget’s disease of bone

A

Disease of increased but uncontrolled bone turnover

133
Q

Paget’s disease features

A

Only 5% symptomatic

  • Bone pain - pelvis, lumbar spine femur
  • Bowing of tibia
  • Bossing of skull
134
Q

X-rays Paget’s disease

A

Osteolysis in early disease → mixed lytic/sclerotic lesions later
Skull - thickened vault, osteoporosis circumscripta

135
Q

Bloods Paget’s disease of bone

A

Isolated rise ALP

136
Q

Bone scintigraphy Paget’s disease of bone

A

Increased uptake focally at sites of active bone lesions

137
Q

Complications Paget’s disease of bone

A
  • Deafness (CN entrapment)
  • Bone sarcoma
  • Fractures
  • Skull thickening
  • High output cardiac failure
138
Q

What is polyarteritis nodosa

A

Vasculitis affecting medium-sized arteries with necrotising inflammation leading to aneurysm formation

139
Q

Infection associated with polyarteritis nodosa

A

Hep B

140
Q

Features polyarteritis nodosa

A
  • Fever, malaise, arthralgia
  • Weight loss
  • Hypertension
  • Mononeuritis multiplex, sensorimotor polyneuropathy
  • Testicular pain
  • Livedo reticularis
  • Haematuria, renal failure
141
Q

Antibody associated with polyarteritis nodosa

A

pANCA (20%)

142
Q

Features polymyalgia rheumatica

A

Typically >60 years
Usually rapid onset (<1 month)
Aching, morning stiffness in proximal limb muscles
Mild polyarthralgia
Lethargy
Depression
Low grade fever
Anorexia
Night sweats

Not weakness

143
Q

Treatment PMR

A

Pred

144
Q

What is pseudogout

A

Form of microcrystal synovitis caused by the deposition of calcium pyrophosphate dihydrate crystals in the synovium

145
Q

Risk factors pseudogout

A
  • Increasing age
  • Haemochromatosis
  • Hyperparathyroidism, low phosphate
  • Acromegaly, Wilson’s disease
146
Q

Most common sites pseudogout

A

Knee, wrist, and shoulders

147
Q

Joint aspiration pseudogout

A

Weakly positively birefringent rhomboid-shaped crystals

148
Q

What is Raynaud’s phenomenon

A

Exaggerated vasoconstrictive response of the digital arteries and cutaneous arteriole to the cold or emotional stress

149
Q

Raynaud’s phenomenon vs Raynaud’s disease

A

Raynaud’s disease is primary, Raynaud’s phenomenon is secondary

150
Q

Secondary causes of Raynaud’s phenomenon

A
  • Connective tissue disorders, e.g. scleroderma, RA, SLE
  • Leukaemia
  • Type I cryoglobulinaemia, cold agglutinins
  • Use of vibrating tools
  • Drugs
  • Cervical rib
151
Q

Drugs causing Raynaud’s

A
  • OCP
  • Ergot
152
Q

Factors suggesting underlying connective tissue disease in Raynaud’s

A
  • Onset after 40 years
  • Unilateral symptoms
  • Rashes
  • Presence of autoantibodies
  • Digital ulcers or calcinosis
153
Q

Management Raynaud’s

A

All patients should be referred to secondary care

First line - CCBs, nifedipine
Second line - IV prostacyclin infusions

154
Q

Genetic association reactive arthritis

A

HLA-B27

155
Q

Features reactive arthritis

A
  • Urethritis
  • Conjunctivitis, anterior uveitis
  • Arthritis
  • Dactylitis
156
Q

Categories of reactive arthritis

A

Post-dysenteric form
Post-STI form

157
Q

Organisms causing post-dysenteric reactive arthritis

A

Shigella flexneri
Salmonella typhi and enteritidis
Yersina enterocolitica
Campylobacter

158
Q

Organisms causing post-STI reactive arthritis

A

Chlamydia trachomatis

159
Q

Management reactive arthritis

A

Analgesia
NSAIDs
Intra-articular steroids
Sulfasalazine and methotrexate sometimes used for persistent disease

160
Q

Pattern of arthritis in reactive arthritis

A

Typically asymmetrical oligoarthritis of lower limb

161
Q

Skin manifestations reactive arthritis

A

Circinate balanitis
Keratoderma blenorrhagica

162
Q

What is circinate balanitis

A

Painless vesicles on coronal margin of prepuce

163
Q

What is keratoderma blenorrhagica

A

Waxy yellow/brown papules on palms and soles

164
Q

Methotrexate side effects

A

Myelosuppression
Liver cirrhosis
Pneumonitis

165
Q

Sulfasalazine side effects

A

Rashes
Oligospermia
Heinz body anaemia
Interstitial lung diseas

166
Q

Side effects leflunamide

A

Liver impairment
Interstitial lung disease
Hypertension

167
Q

Side effects leflunomide

A

Liver impairment
Interstitial lung disease
Hypertension

168
Q

Side effects hydroxycholoroquine

A

Retinopathy
Corneal deposits

169
Q

Side effects prednisolone

A

Cushingoid features
Osteoporosis
Impaired glucose tolerance
Hypertension
Cataracts

170
Q

Side effects gold

A

Proteinuria

171
Q

Side effects penicillamine

A

Proteinuria
Exacerbation of myasthenia gravis

172
Q

Side effects etanercept

A

Demyelination
Reactivation of TB

173
Q

Side effects of infliximab

A

Reactivation of TB

174
Q

Side effects adalimumab

A

Reactivation of TB

175
Q

Side effects rituximab

A

Infusion reaction common

176
Q

Antibodies associated with rheumatoid arthritis

A

Rheumatoid arthritis
Anti-CCP

177
Q

What other conditions are associated with positive RF

A

Felty’s syndrome
Sjorgens syndrome
Infective endocarditis
SLE
Systemic sclerosis
General population (5%)

178
Q

Role of CCP in RA diagnosis

A

May be detected 10 years before development, allows for early detection of patients suitable for aggressive anti-TNF therapy

Recommended in suspected RA with neg RF

179
Q

First line treatment RA

A

DMARD monotherapy +/- short course of bridging prednisolone

180
Q

Choices for initial DMARD RA

A

Methotrexate (most widely used)
Sulfasalazine
Leflunomide
Hydroxychloroquine (only if mild or palindromic)

181
Q

Disease monitoring RA

A

Combination of CRP and disease activity

182
Q

Management of flares of RA

A

Corticosteroids - oral and IM

183
Q

Indication for TNF-inhibitor in RA

A

Inadequate response to at least 2 DMARDs including methotrexate

184
Q

Poor prognostic features RA

A

RF positive
Anti-CCP antibodies
Poor functional status at presentation
Early erosions on x-ray (<2 years)
Extra articular features, e.g. nodules
HLA DR4
Insidious onset

185
Q

X-ray findings RA

A

Loss of joint space
Juxta-articular osteoporosis
Soft tissue swelling
Periarticular erosions
Subluxation

186
Q

Most common organism septic arthritis

A

Staphylococcus aureus

187
Q

Most common organism septic arthritis in young people

A

Neisseria gonorrhoeae

188
Q

Most common location septic arthritis adults

A

Knee

189
Q

Synovial fluid findings septic arthritis

A

Leucocytosis with neutrophil predominance
Gram stain neg in 30-50% cases

190
Q

Treatment septic arthritis

A

IV fluclox (clinda if allergic)
4-6 week treatment, typically switched to oral at 2 weeks

Needle aspiration to decompress joint
Arthroscopic lavage may be required

191
Q

Features Sjorgen’s syndrome

A

Dry eyes
Dry mouth
Vaginal dryness
Arthralgia
Raynaud’s, myalgia
Sensory polyneuropathy
Recurrent parotidis
Renal tubular acidosis

192
Q

Antibodies in Sjorgen’s syndrome

A

RF - 50%
ANA - 70%
Anti-Ro - 70%
Anti-La - 30%

193
Q

Management Sjorgens syndrome

A

Artificial saliva and tears
Pilocarpine (stimualte saliva production)

194
Q

Cautions sulfasalazine

A

G6PD deficiency
Allergy to aspirin or sulphonamides (cross sensitivity)

195
Q

Adverse effects sulfasalazine

A
  • Oligospermia
  • Stevens-Johnson syndrome
  • Pneumonitis/lung fibrosis
  • Myelosuppression, Heinz body anaemia, megaloblastic anaemia
  • May colour tears
195
Q

SLE skin features

A

Malar rash - spare nasolabial folds
Discoid rash - scaly, erythematous, well demarcated rash in sun exposed areas, may progress to become pigmented and hyperkeratotic before becoming atrophic
Photosensitivity
Raynaud’s phenomenon
Livedo reticularis
Non-scarring alopecia

196
Q

Sulfasalazine in pregnancy/breastfeeding

A

Safe to use

197
Q

SLE MSK features

A

Arthralgia
Non-erosive arthritis

198
Q

Cardiovascular features SLE

A

Pericarditis, myocarditis

199
Q

Respiratory features SLE

A

Pleurisy
Fibrosing alveolitis

200
Q

Renal features SLE

A

Proteinuria
Glomerulonephritis

201
Q

Neuropsychiatric features SLE

A

Anxiety and depression
Psychosis
Seizures

202
Q

SLE antibodies

A

ANA - 99%
RF - 20%
Anti-dsDNA and anti-Smith - high specificity, low sensitivity

203
Q

Patterns of disease systemic sclerosis

A

Limited cutaneous systemic sclerosis
Diffuse cutaneous systemic sclerosis
Scleroderma (without organ involvement)

204
Q

Features limited cutaneous systemic sclerosis

A

Raynaud’s (may be first sign)
Scleroderma affecting face and distal limbs

205
Q

Antibodies associated with limited cutaneous systemic sclerosis

A

Anti-centromere

206
Q

Subtype limited cutaneous systemic sclerosis

A

CREST syndrome

207
Q

Features CREST syndrome

A

Calcinosis
Raynaud’s phenomenon
Oesophageal dysmotility
Sclerodactlyl
Telangiectasia

208
Q

Features diffuse cutaneous systemic sclerosis

A

Scleroderma affects trunk and proximal limbs
Respiratory involvement - interstitial lung disease, pulmonary arterial hypertension
Renal disease and hypertension

209
Q

Antibodies associated with diffuse cutaneous systemic sclerosis

A

Anti scl-70

210
Q

Treatment renal disease diffuse cutaneous systemic sclerosis

A

ACE inhibitor - captopril typically used

211
Q

Features scleroderma

A

Tightening and fibrosis of skin
Plaques or linear

212
Q

Antibodies associated with systemic sclerosis

A

ANA positive 90%
RF positive 30%

213
Q

Visual features temporal arteritis

A

Anterior ischaemic optic neuropathy (most common)
Diplopia

214
Q

Treatment temporal arteritis

A
  • Urgent high dose glucocorticoids as soon as diagnosis suspected
  • Urgent opthal review
215
Q

Steroid choice temporal arteritis

A

If no visual loss, high dose pred used
If evolving visual loss, IV methylpred

216
Q

Who needs vit D supplementation

A

All pregnant and breastfeeding women
All children aged 6 months - 5 years unless formula fed >500ml/day
Adults >65y
Housebound patients

1 - MSRA (17 decks)

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