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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
What condition accompanies polymyositis? What s+s does it have in addition?
Dermatomyositis Purple helitrope rash on eyelids with oedema Rough papules on fingers - gottrons Nailfold erythema
26
Complications of poly and dermato myositis
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
27
Diagnosis of poly and dermatomyositis
- raised muscle enzymes - CK, lactate dehydroginase - ana, rf - emg - mri - muscle biopsy
28
Treatment of poly and dermatomyositis
High dose prednisolone Taper and cover with steroid sparing agent IV immunoglobulins Bed rest
29
Pain distribution in fibromyalgia?
Pain above and below the waist Aching and constant Tender trigger points
30
Associated symptoms in fibromyalgia
``` Fatigue Depression Sleep disturbance IBS, ME Headaches ```
31
Treatment of fibromyalgia?
Reassurance Exercise Depression treatment Pain relief (gabapentin, amitryptyline, nsaids)
32
What is scleroderma? What are the subdivisions?
Systemic sclerosis. Limited cutaneous scleroderma Diffuse cutaneous scleroderma
33
Features of limited cutaneous scleroderma?
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
34
What is diffuse cutanious sclerosis?
Global tight thick skin | Organ fibrosis - lungs (fibrosis), heart, GI (atony), renal (htn),
35
What tests may be positive in scleroderma?
Anaemia Rf Ana Anti centromere antibodies
36
Other than bloods what other tests should be done in suspected scleroderma?
Cxr and spirometry | Barium swallow
37
Management of scleroderma?
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
Conditions associated with raynauds
``` Idiopathic RA Scleroderma SLE Sjogrens Poly and dermatomyositis Anorexia nevosa Athrosclerosis Beta blockers Exposure to vibration Trauma Malignancy ```
39
Treatment of raynauds
Hand warmers Avoid rapid temp change Calcium channel blockers
40
What is the pathology behind SLE?
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
Generic characteristics of the seronegative arthropathies?
``` -RF Associated with HLA B27 Effect the spine and SI joint Asymmetrical arthritis Enthesis Dactylitis Iritis, aortic regurgitation, oral ulcers, IBD ```
42
What are the seronegative spondyloarthropathies?
AS Reactive arthritis Psoriatic arthritis
43
Pathology of ankalosing spondylitis?
Immune cell infiltration of bones and ligaments Causes erosions and enthesitis New bone forms over where ligaments were
44
Presentation of ankalosing spondylitis back pain?
``` 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
Tendons most commonly effected by enthesitis in AS?
Achilles | Plantar
46
Signs of ankalosing spondylitis
``` +ve schobers Kyphosis Retains lumber lordosis when bending forwards Question mark posture Bamboo spine ```
47
What chest problems effect ankalosing spondylitis patients?
Costochondritis Lack of expansion Pulmonary fibrosis
48
Treatment of ankylosing spondylitis
``` Physiotherapy Nsaids Local steroids Methotrexate for peripheral arthritis Infliximab if persistent ```
49
What proportionof psoriasis patients develop psoriatic psoriasis?
5-8%
50
How does psoriatic arthritis present (arthritis only!)?
Asymetrical oligoarthritis Effects the dipj Effects the spine in 15%
51
Associated features of psoriatic arthritis?
Dactylitis | Psoriasis!
52
Radiological changes in psoriatic arthritis?
Central erosions forming pencil in cup
53
Treatment of psoriatic arthritis?
Nsaids Intraarticular steroids Dmards - methotrexate, sulphasalazine Anti tnf
54
Issue with using nsaids in psoriatic arthritis?
Can worsten skin
55
What infections does reactive arthritis tend to follow?
Urethritis STIs - gonorrhoea Dysentry
56
How does reactive arthritis present?
Asymetrical lower limb arthritis | Days to weeks after infection
57
What is reactive arthritis associated with? Triad?
``` Cant see (conjunctivitis), cant pee (urethritis), cant bend the knee (arthritis) Enthesitis Sacroillitis Spondylitis Skin lesions ```
58
What skin lesions appear in reactive arthritis?
Balanitis Psoriasis like lesions Nail dystrophy
59
Treatment of reactive arthritis?
Nsaids and intra articular steroids Splint Stool culture and sti screen If persistant dmards and anti tnf
60
How can small vessel vasculitis be subdivided? What conditions fall into each?
ANCA -ve - henkch schonlein purpura | ANCA +ve - granulomatosis with polyangiitis, churg strauss
61
What is henoch schonlein purpura? How does it present? Treatment? Prognosis?
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
What condition is on the spectrum of henoch schonlein purpura?
IgA nephropathy
63
Presentation of granulomatosis with polyangiitis
General malaise Upper resp - rhinorrhoea, nasal ulceration Lungs - cough, haemoptysis, pleuritic pain Kidneys - haematauria, proteinurea
64
CXR findings of granulomatosis with polyangiitis
Cxr - nodular masses and cavitation that migrate!
65
Blood tests results on granulomatosis with polyangiitis
cANCA +++ | pANCA +
66
Management of granulomatosis with polyangiitis
Steroids Methotrexate Azathioprine Rituximab
67
Presentation of churg strauss
``` General malaise and fever Rhinitis Asthma Eosinophilia Vasculitis - purpura, digital ischemia Subcutanious nodules ```
68
Blood tests in churg strauss
pANCA +++ | cANCA +
69
Treatment of churg strauss
Corticosteroids
70
Name two medium vessel vasculitis?
Polyarthritis nodosa | Kawasakis disease
71
How does kawasakis present?
``` Fever >5 days Bilateral conjunctiva reddening Dry red lips and oral cavity Cervical lymphadenopathy Redness and oedema to palms and soles ```
72
Treatment of kawasakis? Complication of disease? Complication of treatment?
Iv immunoglobulins and high dose aspirin Coronary artery disease Reyes syndrome
73
At risk groups for kawasakis?
Under 5 Japanese Post infection
74
Two large vessel vasculitis disease
Polymyalgia rheumitica | Giant cell arteritis
75
Presentation of polymyalgia rheumitica
Sudden onset symmetrical proximal limb pain (shoulders, hips) Normal strength Worse in morning, eases over day Systemic weight loss, fatigue, fever
76
Investigation findings in polymyalgia rheumitica
Raised crp and esr Anaemia Raised alp and ggt
77
Treatment of polymyalgia rheumitica
Corticosteroids
78
Prognosis of polymyalgia rheumitica?
Rapid (days) reduction in symptoms | May need long term steroids or steroid sparing agents to slowly reduce dose
79
Presentation of giant cell arthritis?
``` Severe headache Worse on chewing Tender scalp eg on brushing hair Jaw claudication Painless sudden loss of vision in one eye ```
80
Examination findings in temporal arteritis?
Tenderness and swelling to temporal artery | Loss of pulsatile temporal artery
81
Bloods in giant cell arteritis?
Crp ++++ | High plasma viscosity
82
Problem with temporal artery biopsy for diagnosing temporal arteritis?
Lesions are patchy so can be missed
83
Treatment for giant cell arteritis
High dose prednisolone with bone protection | Steroid sparing agents long term
84
Who is at risk of giant cell arteritis
People with previous polymyalgia rheumitica
85
What is Bechet's? How does it present?
Inflammation of blood vessels Genital and mouth ulcers, red painful eyes, spots, headaches, arthralgia
86
Who is most effected by Behcets?
Mediteranian and middle eastern
87
What is Bechet's? How does it present?
Inflammation of blood vessels Genital and mouth ulcers, red painful eyes, spots, headaches, arthralgia
88
Who is most effected by Behcets?
Mediteranian and middle eastern

IPE (17 decks)

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