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IPE > Rheumatology 2 > Flashcards

Rheumatology 2 Flashcards

1
Q

General groups of symptoms suffered by sle patients?

A

General - fatigue, malaise, fever
Skin - malar rash, photosensitivity, discoid rash
Vessels - raynauds, purpuria
Blood - haemeolytic anaemia
Joints - arthritis
Muscles - myalgia
Hair - alopecia
Lungs - pleurisy, pnemonitis, fibrosis
Heart - pericariditis, valve disease, ihd/cve, venous thrombosis
Kidney - nephrotic or nephritic syndrome, renal artery stenosis
Cns - depression, epilepsy, migraines, cn lesion
Eyes - sjogrens,
Gi - mouth ulcers, autoimmune hepititis

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2
Q

Markers of SLE?

A

ANA +ve -95%
DsDNA +ve - 60%
ENA +ve - 15-30%

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3
Q

Clues of sle on normal bloods?

A 
Esr raised, crp normal 
Complement low (used up)
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4
Q

Why may ANA be raised?

A 
SLE
RA
Sjogrens
Scleroderma
Normal varient
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5
Q

How is ana expressed? What does this mean?

A

As a titre - the number of times it can be diluted and still detectable thus 1:160 is more significant that 1:40

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6
Q

What may cause a raised RF?

A 
Sjogrens
RA 
SLE
Infection
Normal
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7
Q

What are ENA? Main types?

A 
Anti-extractable nuclear antigen
Anti-la
Anti-ro
Anti-sm
Anti-jo
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8
Q

What conditions can caused raised ena anti-ro/la/sm?

A

Sjogrens, sle,

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9
Q

What conditions will cause a raised anti-jo?

A

Polymyositis, dermatomyositis

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10
Q

Causes of SLE?

A

Hereditary

Drug induced

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11
Q

Risk factors for SLE

A 
Female
Uv light
EBV
Afrocaribbean 
HLA +ve
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12
Q

Arthritis pattern in SLE?

A

RA like - small joints, symmetrical

Not erosive nor does it cause deformity

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13
Q

Treatments of SLE generally

A

NSAIDS
Topical corticosteroids
Oral corticosteroids for flares
Immunosupressants - hydroxychloroquinine, azothioprine, methotrexate, ciclosporin.

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14
Q

What would indicate the need for high dose corticosteroids in a lupus flare?

A

Renal problems
Cerebral problems
Haemolytic ananemia

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15
Q

In lupus where does the malar rash spare?

A

Nasolabial folds

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16
Q

What condition is frequently associated with SLE? What is it?

A

Antiphospholipid syndrome

Again, autoantibodies against apoptotic blebs

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17
Q

What does antiphospholipid syndrome cause?

A

Arterial and venous thrombosis

Recurrent miscarriage

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18
Q

What test is positive in antiphospholipid syndrome?

A

Antiphospholipid antibodies - uses dilute russel viper venom time drvvt

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19
Q

Treatment for antiphospholipid syndrome

A

Low dose aspirin
Warfarin if previous thrombosis
Sc heparin and aspirin when pregnant

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20
Q

What condition is frequently associated with RA? What is it?

A

Sjogrens syndrome

Autoimmune reaction against glands

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21
Q

What symptoms with sjogrens syndrome?

A 
Dry eyes
Dry mouth 
Dry skin 
Dry vagina
Raynauds 
Fatigue
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22
Q

Positive tests in sjogrens?

A

Schirmers tear test

Ana, anti-ro and anti-la

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23
Q

Treatment of sjogrens

A

Artificial tears
Saliva replacement
Hydroxycholoroquinine for fatigue or arthralgia

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24
Q

What condition causes malaise weight loss and fever accompanied by symmetrical shoulder and pelvis muscle weakness and waisting?

A

Polymyositis

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25
Q

What condition accompanies polymyositis? What s+s does it have in addition?

A

Dermatomyositis
Purple helitrope rash on eyelids with oedema
Rough papules on fingers - gottrons
Nailfold erythema

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26
Q

Complications of poly and dermato myositis

A

Resp failure from resp muscle involvement
Dysphonia from laryngeal muscle involvement
Dysphagia from oesophageal muscle involvement
High risk of malignancy - either predating onset or following

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27
Q

Diagnosis of poly and dermatomyositis

A
  • raised muscle enzymes - CK, lactate dehydroginase
  • ana, rf
  • emg
  • mri
  • muscle biopsy
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28
Q

Treatment of poly and dermatomyositis

A

High dose prednisolone
Taper and cover with steroid sparing agent
IV immunoglobulins
Bed rest

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29
Q

Pain distribution in fibromyalgia?

A

Pain above and below the waist
Aching and constant
Tender trigger points

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30
Q

Associated symptoms in fibromyalgia

A 
Fatigue
Depression
Sleep disturbance
IBS, ME
Headaches
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31
Q

Treatment of fibromyalgia?

A

Reassurance
Exercise
Depression treatment
Pain relief (gabapentin, amitryptyline, nsaids)

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32
Q

What is scleroderma? What are the subdivisions?

A

Systemic sclerosis.
Limited cutaneous scleroderma
Diffuse cutaneous scleroderma

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33
Q

Features of limited cutaneous scleroderma?

A

C - calcinosis
R - raynauds
E - esophogeal involvement
S - sclerodactyly (swollen tight digits)
T - telangiectasia (visible blood vessels in the cheeks)
Tight skin on hands, feet and face with microstomia and flexion deformities of fingers.
Can cause pulmonary hypertension

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34
Q

What is diffuse cutanious sclerosis?

A

Global tight thick skin

Organ fibrosis - lungs (fibrosis), heart, GI (atony), renal (htn),

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35
Q

What tests may be positive in scleroderma?

A

Anaemia
Rf
Ana
Anti centromere antibodies

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36
Q

Other than bloods what other tests should be done in suspected scleroderma?

A

Cxr and spirometry

Barium swallow

37
Q

Management of scleroderma?

A

Symptomatically
Lubrication and stretches for skin
Steroids or immunosupression if lungs involved
PPI and prokinetic drugs for gi involvement
Supplementation for malabsorption
ACEi and steroids for kidneys
Vasodilators for pulmonary hypertension

38
Q

Conditions associated with raynauds

A 
Idiopathic 
RA
Scleroderma
SLE
Sjogrens
Poly and dermatomyositis
Anorexia nevosa 
Athrosclerosis 
Beta blockers
Exposure to vibration
Trauma
Malignancy
39
Q

Treatment of raynauds

A

Hand warmers
Avoid rapid temp change
Calcium channel blockers

40
Q

What is the pathology behind SLE?

A

Apoptotic bleb removal inefficient so taken up by lymphocytes
Results in autoantibody production by lymphocytes
Lack of recognition of self antibodies in thymus
Immune complexes form in circulation, complement activated, cytokines increase.

41
Q

Generic characteristics of the seronegative arthropathies?

A 
-RF
Associated with HLA B27
Effect the spine and SI joint
Asymmetrical arthritis
Enthesis 
Dactylitis
Iritis, aortic regurgitation, oral ulcers, IBD
42
Q

What are the seronegative spondyloarthropathies?

A

AS
Reactive arthritis
Psoriatic arthritis

43
Q

Pathology of ankalosing spondylitis?

A

Immune cell infiltration of bones and ligaments
Causes erosions and enthesitis
New bone forms over where ligaments were

44
Q

Presentation of ankalosing spondylitis back pain?

A 
Gradual onset lower back pains
Worse overnight and in the mornings
Relieved by exercise
Radiates to hip and buttocks
Loss of spinal movement in all directions
45
Q

Tendons most commonly effected by enthesitis in AS?

A

Achilles

Plantar

46
Q

Signs of ankalosing spondylitis

A 
\+ve schobers
Kyphosis
Retains lumber lordosis when bending forwards
Question mark posture
Bamboo spine
47
Q

What chest problems effect ankalosing spondylitis patients?

A

Costochondritis
Lack of expansion
Pulmonary fibrosis

48
Q

Treatment of ankylosing spondylitis

A 
Physiotherapy
Nsaids
Local steroids
Methotrexate for peripheral arthritis
Infliximab if persistent
49
Q

What proportionof psoriasis patients develop psoriatic psoriasis?

A

5-8%

50
Q

How does psoriatic arthritis present (arthritis only!)?

A

Asymetrical oligoarthritis
Effects the dipj
Effects the spine in 15%

51
Q

Associated features of psoriatic arthritis?

A

Dactylitis

Psoriasis!

52
Q

Radiological changes in psoriatic arthritis?

A

Central erosions forming pencil in cup

53
Q

Treatment of psoriatic arthritis?

A

Nsaids
Intraarticular steroids
Dmards - methotrexate, sulphasalazine
Anti tnf

54
Q

Issue with using nsaids in psoriatic arthritis?

A

Can worsten skin

55
Q

What infections does reactive arthritis tend to follow?

A

Urethritis
STIs - gonorrhoea
Dysentry

56
Q

How does reactive arthritis present?

A

Asymetrical lower limb arthritis

Days to weeks after infection

57
Q

What is reactive arthritis associated with? Triad?

A 
Cant see (conjunctivitis), cant pee (urethritis), cant bend the knee (arthritis)
Enthesitis
Sacroillitis
Spondylitis 
Skin lesions
58
Q

What skin lesions appear in reactive arthritis?

A

Balanitis
Psoriasis like lesions
Nail dystrophy

59
Q

Treatment of reactive arthritis?

A

Nsaids and intra articular steroids
Splint
Stool culture and sti screen
If persistant dmards and anti tnf

60
Q

How can small vessel vasculitis be subdivided? What conditions fall into each?

A

ANCA -ve - henkch schonlein purpura

ANCA +ve - granulomatosis with polyangiitis, churg strauss

61
Q

What is henoch schonlein purpura? How does it present? Treatment? Prognosis?

A

IgA deposition in small vessels following respiratory infection
Presents with - lower limb purpura, transient polyarthritis, abdominal pain, glomerulonephritis
Supportive treatment
1% develop chronic renal damage

62
Q

What condition is on the spectrum of henoch schonlein purpura?

A

IgA nephropathy

63
Q

Presentation of granulomatosis with polyangiitis

A

General malaise
Upper resp - rhinorrhoea, nasal ulceration
Lungs - cough, haemoptysis, pleuritic pain
Kidneys - haematauria, proteinurea

64
Q

CXR findings of granulomatosis with polyangiitis

A

Cxr - nodular masses and cavitation that migrate!

65
Q

Blood tests results on granulomatosis with polyangiitis

A

cANCA +++

pANCA +

66
Q

Management of granulomatosis with polyangiitis

A

Steroids
Methotrexate
Azathioprine
Rituximab

67
Q

Presentation of churg strauss

A 
General malaise and fever
Rhinitis
Asthma
Eosinophilia
Vasculitis - purpura, digital ischemia
Subcutanious nodules
68
Q

Blood tests in churg strauss

A

pANCA +++

cANCA +

69
Q

Treatment of churg strauss

A

Corticosteroids

70
Q

Name two medium vessel vasculitis?

A

Polyarthritis nodosa

Kawasakis disease

71
Q

How does kawasakis present?

A 
Fever >5 days
Bilateral conjunctiva reddening
Dry red lips and oral cavity
Cervical lymphadenopathy
Redness and oedema to palms and soles
72
Q

Treatment of kawasakis?
Complication of disease?
Complication of treatment?

A

Iv immunoglobulins and high dose aspirin
Coronary artery disease
Reyes syndrome

73
Q

At risk groups for kawasakis?

A

Under 5
Japanese
Post infection

74
Q

Two large vessel vasculitis disease

A

Polymyalgia rheumitica

Giant cell arteritis

75
Q

Presentation of polymyalgia rheumitica

A

Sudden onset symmetrical proximal limb pain (shoulders, hips)
Normal strength
Worse in morning, eases over day
Systemic weight loss, fatigue, fever

76
Q

Investigation findings in polymyalgia rheumitica

A

Raised crp and esr
Anaemia
Raised alp and ggt

77
Q

Treatment of polymyalgia rheumitica

A

Corticosteroids

78
Q

Prognosis of polymyalgia rheumitica?

A

Rapid (days) reduction in symptoms

May need long term steroids or steroid sparing agents to slowly reduce dose

79
Q

Presentation of giant cell arthritis?

A 
Severe headache 
Worse on chewing
Tender scalp eg on brushing hair
Jaw claudication
Painless sudden loss of vision in one eye
80
Q

Examination findings in temporal arteritis?

A

Tenderness and swelling to temporal artery

Loss of pulsatile temporal artery

81
Q

Bloods in giant cell arteritis?

A

Crp ++++

High plasma viscosity

82
Q

Problem with temporal artery biopsy for diagnosing temporal arteritis?

A

Lesions are patchy so can be missed

83
Q

Treatment for giant cell arteritis

A

High dose prednisolone with bone protection

Steroid sparing agents long term

84
Q

Who is at risk of giant cell arteritis

A

People with previous polymyalgia rheumitica

85
Q

What is Bechet’s? How does it present?

A

Inflammation of blood vessels

Genital and mouth ulcers, red painful eyes, spots, headaches, arthralgia

86
Q

Who is most effected by Behcets?

A

Mediteranian and middle eastern

87
Q

What is Bechet’s? How does it present?

A

Inflammation of blood vessels

Genital and mouth ulcers, red painful eyes, spots, headaches, arthralgia

88
Q

Who is most effected by Behcets?

A

Mediteranian and middle eastern

IPE (17 decks)

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