Rheumatology Flashcards
Define arthropathy
disease of the joint
define arthritis
inflammation of the joint
arthralgia
pain in the joint
two main categories of arthritis
non-inflammatory and inflammatory
what are the subtypes of inflammatory arthritis
seropositive, seronegative, infectious and crystal induced
Give an example of a seropositive arthritis (5)
rheumatoid, lupus, scleroderma, vasculitis and Sjogrens
give an example of a seronegative arthritis
ankylosing spondylitis, psoriatic arthritis, reactive arthritis and IBD arthritis
Anti CCP associated with
Rheumatoid arthritis
Anti-nuclear antibody (ANA) associated with
SLE, Sjogrens, systemic sclerosis, MCTD, autoimmune liver disease
Anti-double stranded DNA antibody (dsDNA) associated with
SLE
Anti Sm associated with
SLE
Anti-Ro associated with
SLE, Sjogrens syndrome
Anti-centromere antibody
systemic sclerosis (limited)
Anti-Scl-70 antibody
systemic sclerosis (diffuse)
anti RNP antibody associated with
SLE, MCTD
Anti-cardiolipin antibody and lupus anti-coagulant
Anti-phospholipid syndrome
Anti-neutrophil cytoplasmic antibody (ANCA)
small vessel vasculitis
does osteoarthritis follow Mendelian inheritance
No, no pattern observed and no genetic mutation identified
what name is given to osteoarthritis of no known cause
primary OA
mnemonic for OA x-ray
LOSS = Loss of joint space, Osteophytes, Sclerosis, Subchondral cysts
Typical management of OA
Simple analgesia and mild opiates, physiotherapy.
what is the most prevelant seropositive inflammatory arthropathy
rheumatoid arthritis
what sex is more likely to develop RA
women
In RA the immune response is initiated against what structure
the synovium
Lung symptoms of RA
pleural effusions, interstitial fibrosis and pulmonary nodules
Ocular involvement of RA
keratoconjunctivitis, sicca, episcleritis, uveitis and nodular scleritis
Auto antibody investigations for RA
Rheumatoid factor, anti-CCP
are all RA patients seropositive
no, 15-20% are seronegative
CRP, ESR and plasma viscosity in RA are usually ..
raised
in RA an xray taken at the onset of symptoms will show
no joint abnormalities
early features of RA on xray are
peri-articular osteopenia
Late stage disease RA will show what on xray?
peri-articular erosions
why is ultrasound useful in RA?
detecting synovial inflammation , particularly useful if there is clinical uncertainty about RA as a diagnosis
what group of drugs are recommended for RA within 3 months of onset of symptoms
DMARDs
short term symptom relief of RA involves:
simple analgesics, NSAIDs and intramuscular/intraarticular or oral steroids
first line DMARD for RA
methotrexate
other DMARD examples:
sulphasalazine, hydroxychloroquine and leflunamide
what are the risks of using DMARDs
immunosuppression, risk of infection and bone marrow surpression
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
ankylosing spondylitis effects what joints
spine and sacro-iliac joints
typical presentation of AS
male, 20-40yo, spinal pain, loss of lumbar lordosis and increased thoracic kyphosis
describe schobers test
testing lumbar spine flexion: measure 10cm above and 5 cm below the posterior superior iliac crests
are all AS sufferers HLA-B27 positive
no, only 90% are
psoriatic arthritis occurs in all people with psoriasis
no. it only occurs in 30% of patients with psoriasis
treatment of psoriatic arthritis
DMARDs (methotrexate), Anti TNF therapy, joint replacement for larger joints
Enteropathic arthritis usually effects the
peripheral joints, sometimes spine.
what is reactive arthritis
arthritis is response to an infection in another part of the body, usually 1-3 weeks after infection
What is the triad of Reiters syndrome
urethritis, uveitis/conjunctivitis and arthritis
what would you expect to see from an FBC looking for SLE
anaemia, leucopenia and thrombocytopenia
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
why do we request urinalysis for patients with SLE?
to check for presence of blood or protein which may indicated glomerulonephritis
what is Sjogrens syndrome
an autoimmune condition characterised by lymphocyctic infiltrates in exocrine organs
how can we diagnose Sjogrens
Schirmers test (ocular dryness), positive anti-RO and anti-La
what are the typical characterisitics of systemic sclerosis
Raynauds, fibrosis and atrophy of the skin and subcutaneous tissue
what are the 3 phases of cutaneous involvement within SSc
oesmatous, indurative and atrophic
describe major SSc
centrally located skin sclerosis that affects the arms, face/neck
describe minor SSc
included sclerodactyly, atrophy of the fingertips and bilateral lung fibrosis
what criteria needs to be met to diagnose a patient with SSc
patient must have 1 major and 2 minor features
what is limited systemic sclerosis
skin involvement is confined to face, hands/feet and forearms, Anti-centromere antibody presence. Organ involvement occurs later
what is diffuse systemic sclerosis
skin changes develop more rapidly and may involve the trunk, early organ involvement. ANti-Scl-70 antibody involvement
how does Anti-phospholipid syndrome manifest clinically
recurrent venous/arterial thrombosis and/or foetal loss
what is gout caused by
deposition of urate crystals within a joint due to high serum uric acid levels
where is classic site of gout?
first MTP joint (Podagra), ankle and knee
how do we diagnose gout?
sample synovial fluid with polarised microscopy
what is pseudogout
like gout but caused by calcium pyrophosphate crystals
what is chondrocalcinosis
when calcium pyrophosphate deposition occurs in cartilage and other soft tissues without inflammation
what is polymyalgia rhematica
proximal myalgia of the hip and shoulder girdles with morning stiffness that lasts more than 1 hour
giant cell arteritis effects what layer of the blood vessels
intima media and adventitia
what diagnostic test is used to diagnose GCA
temporal artery biopsy
what is polymyositis
an idiopathic inflammatory myopathy, causes symmetrical, proximal muscle weakness
what is dermatomyositis
clinically similar to polymyositis but also has cutaneous involvement
what cells are involved in polymyositis
T-cells, CD8 cells and macrophages
investigations into suspected polymyositis
inflammatory markers, serum creatine kinase, ANA, Anti-Jo-1 and anti-SRP, MRI scan, EMG, muscle biopsy
is dermatomyositis pre-malignant?
yes, malignancy should be screened for at the time of diagnosis
small/medium vasculitis can be further divided into what two groups
ANCA positive and negative conditions
what are the types of ANCA positive vasculitis
Granulomatosis with polyangitis, microscopic polyangitis, renal limited vasculitis, Churg-strauss syndrome
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
which sex is RA more common in
females
which age group is RA most common in
30-50yo
what is feltys syndrome
RA, neutropenia (Low WCC) and splenomegaly
is someone who smokes more or less likely to respond to treatment
less likely
describe the distribution of RA
symmetrical polyarthritis
patients with OA have an increase in what immunological cells
cytokines; IL-1, TNF and metalloproteins, prostaglandins
what are the names of the bony enlargements seen at the DIPs
Heberdens nodes
what are the bony enlargements at the PIPs
Bouchards nodes
what name is given to a fluid filled cyst in the popliteal fossa
Bakers cyst
how is OA graded
Kellgren-lawrence grading scale
what is Milwaukee shoulder
Hydroxyapatite
how does Milwaukee shoulder happen?
Hydroxyapatite crystal deposition in or around the joint
are males or females more likely to have AS
males
clinical findings in AK
loss of lumbar lordosis and increased thoracic kyphosis
explain the treatment plan of AK
physio, NSAIDs and anti-TNFs
treatment for psoriatic arthritis
DMARDs
describe the rash seen in SLE
butterfly rash
hair symptoms in SLE
alopecia
hand symptoms in SLE
Raynauds
microbiology of synovial fluid in gout appearance
needle shaped, negative birefringence, change from yellow to blue when lined across the direction of polarisation
giant cell arteritis is most commonly associated with
polymyalgia rheumatica
what condition is a hellotrope rash seen in? describe the rash
dermatomyotosis, like a butterfly flash but covers the eyelids
