1. Bisphosphonates first. - Alendronate - Risedronate/elidronate 2. RANK ligand inhibition - INHIBITS OSTEOCLASTS - Denosumab (monoclonal antibody) 3. T-Score - raloxifene

Rheumatology Flashcards by SH Y

What is Familial Mediterranean Fever

Painful inflammation in abdo,chest,joints + fever

Autosomal recessive

Common in Turkish,arabic,armenian

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What is the Treatment of FMF (familial mediterranean fever)

Colchicine to protect kidneys life long

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Causes of AVN

C A S T
C- Chemo
A- Alcohol
S - Steroids long term
T - Trauma

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Choice of investigation for AVN

MRI

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Presentation of OA

Pain on exercise, relieved by rest
Reduction in internal rotation is often first sign

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Presentation of Greater trochanteric pain syndrome (Trochanteric bursitis)

Tenderness over the lateral side of thigh
Repeated movement of the fibroelastic iliotibial band
Common in women

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Presentation of transient idiopathic osteoporosis

Affects trimester pregnancy
Groin pain with limited hip movement
ESR MAY be elevated

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Presentation of reactive arthritis

Can’t see, pee or climb a tree

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Organisms causing reactive arthritis

Post- STI : Chlamydia (common in men)
Post-dysentric: Shigella,salmonella,yersinia,campylobacter

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Presentation of still’s disease in adults

Athralgia,Raised ferritin,Rash (salmon pink), Pyrexia

RF and ANA negative

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Treatment of still’s disease in adults

NSAIDs, Steroids
If persists: Methotrexate, IL-1 or Anti-TNF

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When is Azathioprine used and what is its mechanism?
What test do you have to do to check prone of toxicity?

Immunosuppresant : RA, SLE (in pregnancy), renal transplant rejection

Pro-drug of 6-mecaptopurine (purine analogue that inhibits purine synthesis)

Thiopurine methyltransferase (TPMT)

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Side effects of Azathioprine and what does it interact with?

Myelosuppression - skin cancer and lymphoma
Pancreatitis

Interacts with allopurinol

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Marfan’s syndrome
- Inheritance
- What defect
- Features

Autosomal dominant
Defect in FBN1 gene (fibrillin-1 protein)
- Tall, high arched palate, pectus excavatum, arachnodactyly
- Heart: Dilation of aortic sinus, AR, Mitral valve prolapse
- Eyes: UPWARD lens dislocation, blue sclera, myopia
- Dural ectasia

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Systemic sclerosis antibodies

ANA (90%)
RF (30%)
LIMITED: anti-centromere
DIFFUSE: anti scl-70

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Psoriatic arthropathy - Presentation

Swollen digits

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Key features of adhesive capsulitis

Diabetic, female, external rotation

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Osteoarthritis Mx

1.Topical NSAIDs
2. Oral NSAIDs
paracetamol and codeine are not for OA

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Ankylosing spondilitis
XRAY findings

Sacro-iliitis
Subchondral erosions
Sclerosis
Syndesmophytes-bony growths that form in the ligaments of the spine

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Reactive arthritis Knee aspiration results

No growth

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Osteoporosis Mx

Bisphosphonates first.
- Alendronate
- Risedronate/elidronate
RANK ligand inhibition
- INHIBITS OSTEOCLASTS
- Denosumab (monoclonal antibody)
T-Score - raloxifene

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McArdle’s disease features

SECOND WIND PHENOMENON
rhabo+myoglobulinaemia
low lactate

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Hydroxychloroquine SE

Bulls eye retinopathy

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Safe in pregnancy DMARDs

Hydroxycholoroquine, sulfasalazine

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Where is hydroxychloroquine used

RA , SLE , malaria

Osteomalacia features

Bone pain, waddling, prox myopathy

Osteomalacia blood results

low Ca2+,Phosh raised ALP, PTH

Relapsing polychondritis - what is it?

Cartilage inflammation Affects EARS NOSE AND JOINTS

SLE investigation and monitoring. Complements?

ANA is sensitive Anti-smith,dsDNA are specific Monitoring with ESR C3,C4 are low

Tennis elbow

Lateral epicondylitis

Golfer's elbow

Medial epicondylitis

Pseudogout Xray findings

Chondrocalcinosis

Which conditions are related to pseudogout

Wilsons,haemachromatosis,high PTH, low mg and phosphate, acromegaly

Osteoporosis in men

Low testosterone

MMF and Azathioprine similarities and difference

both inhibit purine synthesis but in different ways.

What to check in Azathioprine

TMPT

What is the test for secondary osteoporosis

Z-score

Fracture risk score

FRAX

Medication that will increase Stress fractures

Alendronate

RA = IgM

IgM targets Fc IgG

Aspirin allergy - what rheumatology medication to be careful due to interaction?

Sulfasalazine

Anti-synthetase syndrome - antibodies

Anti-RNP Anti-Jo Anti-PL7

Anti-synthetase syndrome - features

Myopathy Raynauds ILD Mechanics hand

Collagen types 1-5

1. Osteogenesis imperfecta 2. Cartilage 3. EDS (reticular fibres) 4. Basal lamina (goodpastures, alports) 5. Hair, cell surface

Anti-Jo 1 where is it found

Dermatomyositis <<< polymyositis

SLE pregnant people

Malar rash in fetal + CHB due to anti-ro crossing placenta

SLE sensitive and specific antibodies

Sensitive ANA Specific Anti-sm,dsDNA

Osteopetrosis

Autosomal dominant Malfunction of osteoclasts Scoliosis is a feature Normal bloods Hearing problems

Osteomalacia XRAY findings

Looser's zone- translucent bands/ pseudofractures

Seronegative arthritis

Reactive Ankylosing Enteropathic Psoriatic

Features of psoriatic arthritis

Male = female pitting of the nails dactylitis onycholysis aortitis uveitis amyloidosis

Types of patterns in psoriatic arthritis

1. symmetrical-female 2. asymmetrical - digits 3. spondylitic -men

Psoriasis epidemiological screening tool

PEST - questions

Severe form of psoriatic arthritis

Arthritis Mutilans - osteolysis - fingers get shorter (telescopic finger)

Psoriatic arthritis Mx

NSAIDS DMARD - methotrexate,sulfasalazine Anti-TNF- mabs or etanercept Ustekinumab - monoclonal IL12,23

Test for carpal tunnel

Phalen's test

Test for De Quervain's tenosynovitis

Finkelstein test - Ulnar deviating the wrist grabbing the thumb illicits pain

What is De Quervain's tenosynovitis?

Pain in radial wrist, difficulty in gripping, tender radial styloid process

Raynaud's phenomenon Rx

1. Nifedipine 2. Epoprostenol (prostaglandin)

Bechet's syndrome

Mouth and genital ulcers DVT Aseptic meningitis

Osteomyelitis bacteria

Staph aureus Salmonella in sickle

Methotrexate mechanism

Inhibits dihydrofolate reductase -inhibit purines (cell division)

What antibiotic is CI with methotrexate

co-trimoxazole

Gout prophylaxis and when

1.Allopurinol and after first attack 2. Second line is febuxostat (xanthine oxidase inhibitor)

Gout Rx

1. NSAIDs / colchicine with PPI 2. Can consider steroids if above CI

Mechanism of Colchicine

Inhibits microtubule polymerization by binding to tubulin (Interfering with mitosis) Inhibits neutrophil motility

Sjorgens medications

Pilocarpine (parasympathetic mimetic agent)