Rheumatology Flashcards
1
Q
Define arthropathy
A
disease of the joint
2
Q
define arthritis
A
inflammation of the joint
3
Q
arthralgia
A
pain in the joint
4
Q
two main categories of arthritis
A
non-inflammatory and inflammatory
5
Q
what are the subtypes of inflammatory arthritis
A
seropositive, seronegative, infectious and crystal induced
6
Q
Give an example of a seropositive arthritis (5)
A
rheumatoid, lupus, scleroderma, vasculitis and Sjogrens
7
Q
give an example of a seronegative arthritis
A
ankylosing spondylitis, psoriatic arthritis, reactive arthritis and IBD arthritis
8
Q
Anti CCP associated with
A
Rheumatoid arthritis
9
Q
Anti-nuclear antibody (ANA) associated with
A
SLE, Sjogrens, systemic sclerosis, MCTD, autoimmune liver disease
10
Q
Anti-double stranded DNA antibody (dsDNA) associated with
A
SLE
11
Q
Anti Sm associated with
A
SLE
12
Q
Anti-Ro associated with
A
SLE, Sjogrens syndrome
13
Q
Anti-centromere antibody
A
systemic sclerosis (limited)
14
Q
Anti-Scl-70 antibody
A
systemic sclerosis (diffuse)
15
Q
anti RNP antibody associated with
A
SLE, MCTD
16
Q
Anti-cardiolipin antibody and lupus anti-coagulant
A
Anti-phospholipid syndrome
17
Q
Anti-neutrophil cytoplasmic antibody (ANCA)
A
small vessel vasculitis
18
Q
does osteoarthritis follow Mendelian inheritance
A
No, no pattern observed and no genetic mutation identified
19
Q
what name is given to osteoarthritis of no known cause
A
primary OA
20
Q
mnemonic for OA x-ray
A
LOSS = Loss of joint space, Osteophytes, Sclerosis, Subchondral cysts
21
Q
Typical management of OA
A
Simple analgesia and mild opiates, physiotherapy.
22
Q
what is the most prevelant seropositive inflammatory arthropathy
A
rheumatoid arthritis
23
Q
what sex is more likely to develop RA
A
women
24
Q
In RA the immune response is initiated against what structure
A
the synovium
25
Lung symptoms of RA
pleural effusions, interstitial fibrosis and pulmonary nodules
26
Ocular involvement of RA
keratoconjunctivitis, sicca, episcleritis, uveitis and nodular scleritis
27
Auto antibody investigations for RA
Rheumatoid factor, anti-CCP
28
are all RA patients seropositive
no, 15-20% are seronegative
29
CRP, ESR and plasma viscosity in RA are usually ..
raised
30
in RA an xray taken at the onset of symptoms will show
no joint abnormalities
31
early features of RA on xray are
peri-articular osteopenia
32
Late stage disease RA will show what on xray?
peri-articular erosions
33
why is ultrasound useful in RA?
detecting synovial inflammation , particularly useful if there is clinical uncertainty about RA as a diagnosis
34
what group of drugs are recommended for RA within 3 months of onset of symptoms
DMARDs
35
short term symptom relief of RA involves:
simple analgesics, NSAIDs and intramuscular/intraarticular or oral steroids
36
first line DMARD for RA
methotrexate
37
other DMARD examples:
sulphasalazine, hydroxychloroquine and leflunamide
38
what are the risks of using DMARDs
immunosuppression, risk of infection and bone marrow surpression
39
If RA does not respond to regular DMARD therapy the patient may be eligible for what therapy next, what is an example?
biologic agents, anti-TNF alpha drugs are first line
40
ankylosing spondylitis effects what joints
spine and sacro-iliac joints
41
typical presentation of AS
male, 20-40yo, spinal pain, loss of lumbar lordosis and increased thoracic kyphosis
42
describe schobers test
testing lumbar spine flexion: measure 10cm above and 5 cm below the posterior superior iliac crests
43
are all AS sufferers HLA-B27 positive
no, only 90% are
44
psoriatic arthritis occurs in all people with psoriasis
no. it only occurs in 30% of patients with psoriasis
45
treatment of psoriatic arthritis
DMARDs (methotrexate), Anti TNF therapy, joint replacement for larger joints
46
Enteropathic arthritis usually effects the
peripheral joints, sometimes spine.
47
what is reactive arthritis
arthritis is response to an infection in another part of the body, usually 1-3 weeks after infection
48
What is the triad of Reiters syndrome
urethritis, uveitis/conjunctivitis and arthritis
49
what would you expect to see from an FBC looking for SLE
anaemia, leucopenia and thrombocytopenia
50
what antibody is checked regularly in patients with SLE and why?
anti-dsDNA and complement, these vary with disease activity and usually point to disease flares
51
why do we request urinalysis for patients with SLE?
to check for presence of blood or protein which may indicated glomerulonephritis
52
what is Sjogrens syndrome
an autoimmune condition characterised by lymphocyctic infiltrates in exocrine organs
53
how can we diagnose Sjogrens
Schirmers test (ocular dryness), positive anti-RO and anti-La
54
what are the typical characterisitics of systemic sclerosis
Raynauds, fibrosis and atrophy of the skin and subcutaneous tissue
55
what are the 3 phases of cutaneous involvement within SSc
oesmatous, indurative and atrophic
56
describe major SSc
centrally located skin sclerosis that affects the arms, face/neck
57
describe minor SSc
included sclerodactyly, atrophy of the fingertips and bilateral lung fibrosis
58
what criteria needs to be met to diagnose a patient with SSc
patient must have 1 major and 2 minor features
59
what is limited systemic sclerosis
skin involvement is confined to face, hands/feet and forearms, Anti-centromere antibody presence. Organ involvement occurs later
60
what is diffuse systemic sclerosis
skin changes develop more rapidly and may involve the trunk, early organ involvement. ANti-Scl-70 antibody involvement
61
how does Anti-phospholipid syndrome manifest clinically
recurrent venous/arterial thrombosis and/or foetal loss
62
what is gout caused by
deposition of urate crystals within a joint due to high serum uric acid levels
63
where is classic site of gout?
first MTP joint (Podagra), ankle and knee
64
how do we diagnose gout?
sample synovial fluid with polarised microscopy
65
what is pseudogout
like gout but caused by calcium pyrophosphate crystals
66
what is chondrocalcinosis
when calcium pyrophosphate deposition occurs in cartilage and other soft tissues without inflammation
67
what is polymyalgia rhematica
proximal myalgia of the hip and shoulder girdles with morning stiffness that lasts more than 1 hour
68
giant cell arteritis effects what layer of the blood vessels
intima media and adventitia
69
what diagnostic test is used to diagnose GCA
temporal artery biopsy
70
what is polymyositis
an idiopathic inflammatory myopathy, causes symmetrical, proximal muscle weakness
71
what is dermatomyositis
clinically similar to polymyositis but also has cutaneous involvement
72
what cells are involved in polymyositis
T-cells, CD8 cells and macrophages
73
investigations into suspected polymyositis
inflammatory markers, serum creatine kinase, ANA, Anti-Jo-1 and anti-SRP, MRI scan, EMG, muscle biopsy
74
is dermatomyositis pre-malignant?
yes, malignancy should be screened for at the time of diagnosis
75
small/medium vasculitis can be further divided into what two groups
ANCA positive and negative conditions
76
what are the types of ANCA positive vasculitis
Granulomatosis with polyangitis, microscopic polyangitis, renal limited vasculitis, Churg-strauss syndrome
77
what is Henoch-Schonlein purpura
an acute IGA mediated disorder involving generalised vasculitis, common in children. usually presents 3 weeks after an upper RTI and follows with a purpuric rash over the buttocks, limbs. abdominal pain, vomiting and joint pain
78
which sex is RA more common in
females
79
which age group is RA most common in
30-50yo
80
what is feltys syndrome
RA, neutropenia (Low WCC) and splenomegaly
81
is someone who smokes more or less likely to respond to treatment
less likely
82
describe the distribution of RA
symmetrical polyarthritis
83
patients with OA have an increase in what immunological cells
cytokines; IL-1, TNF and metalloproteins, prostaglandins
84
what are the names of the bony enlargements seen at the DIPs
Heberdens nodes
85
what are the bony enlargements at the PIPs
Bouchards nodes
86
what name is given to a fluid filled cyst in the popliteal fossa
Bakers cyst
87
how is OA graded
Kellgren-lawrence grading scale
88
what is Milwaukee shoulder
Hydroxyapatite
89
how does Milwaukee shoulder happen?
Hydroxyapatite crystal deposition in or around the joint
90
are males or females more likely to have AS
males
91
clinical findings in AK
loss of lumbar lordosis and increased thoracic kyphosis
92
explain the treatment plan of AK
physio, NSAIDs and anti-TNFs
93
treatment for psoriatic arthritis
DMARDs
94
describe the rash seen in SLE
butterfly rash
95
hair symptoms in SLE
alopecia
96
hand symptoms in SLE
Raynauds
97
microbiology of synovial fluid in gout appearance
needle shaped, negative birefringence, change from yellow to blue when lined across the direction of polarisation
98
giant cell arteritis is most commonly associated with
polymyalgia rheumatica
99
what condition is a hellotrope rash seen in? describe the rash
dermatomyotosis, like a butterfly flash but covers the eyelids
