Rheumatology Flashcards
Which Ab has been shown to be a marker for malignancy associated myositis?
Anti-p155/140
More severe cutaneous involvement and increased risk of malignancy in DM
Osteomalacia: Aetiology, Presentation, Ix?
Impaired bone mineralization of bone
Aetiology:
Vitamin D def
Abnormal metabolism of Vit D e.g. liver disease, Kidney disease - RTA
Poor absorption
Low phosphate levels
Presence of bone mineralization inhibitors e.g. aluminium
Presentation:
Pain
Deformity
Proximal myopathy
Ix:
Ca low
Ph low
ALP high
Tx:
Calcium and Vit D if def
Phopshate wasting conditions - give phosphate
Removal of tumour
where does discoid lupus typically affect?
Face and causes scarring
Seldom associated with arthritis
What is subcutaneous lupus erythematosis? Where does it occur? Ab associated with it? Tx?
A variant form of SLE
Photosensitive distribution
systemically unwell and arthritis common
Ix:
Ro (SSA) positive
ANA strongly positive
dsDNA -ve
Tx:
Anti-malarials
Does not respond to steroids
What is the most common neuro presentation of Eosinophilic granulomatosis with polyangiitis?
Foot drop or wrsit drop
Associated with symptoms pf asthma which precedes the rash.
Dx by skin biopsy showing leucocytoclastic vacultitis
ANA is negative
50% +ve for ANCA
Polyarteritis nodosa (PAN): What Presentation Histopath Known associations
Necrotising vasculitis affecting small to medium sized arteries.
Presentation: Myalgia Livedo reticularis HT Abdominal pain- post prandial Lower limb claudications Renal failure MI
Histopath:
polymorphonuclear infiltrate and a homogenous eosinophilic (so called fibrinoid necrosis) appearance to the necrosed vessel walls.
Associated with Hepatitis B. A known pathological link to PAN.
Granulomatous inflammation does not occur.
LUNGS are spared.
List the HLA - B27 associated diseases?
Enthesitis associated areas?
Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis
IBD associated
Enthesitis: Uveitis Sacroiliitis Achilles tendonitis Aortic regurgitation
What is the leading cause of mortality in scleroderma?
Respiratory disease - ILD and PHT
Followed by Cardiac disease
Common complications of RA?
Carpel tunnel syndrome - median nerve (sensory loss over palmar aspect of thumb, index, middle and radial surface of ring finger + weakness of wrist flexion)
Tendon rupture
Cervical myelopathy
Vasculitis
C6 radiculopathy. Presentation?
Weakness in wrist extension, elbow flexion.
Indications for Tx for OP in post menopausal women.
Recommended Ca intake to prevent fractures?
Low trauma fracture
Age > 75 or T score lower than -2.5
Tx with bisphophonate or Denosumab.
Ca 1200 mg/day.
CaCo3 otherwise
Ca citrate if on PPI
Sjogren’s syndrome. Most common presentation?
Peripheral neuropathy, sensory most common. Painful peripheral dysaesthesia and Raynaud’s.
MCTD ab associated?
Anti-RNP
Polymyositis. Ab associated?
Anti-Jo
Anti-jo +ve is the strongest predictor of ILD
- pulmonary disease is the most frequent cause of death
Viral myopathy. Weakness proximal or distal?
Proximal
Markers of SLE activity?
dsDNA
Low C4, somteimes C3
ESR
OA. Aspirate shows WCC>1000?
No, not OA if there is >1000 WC
Paget’s causes inflammatory arthritis?
No
Psoriasis signs on XR?
thickened bony cortex
fluffy periostitis
Pencil in cup deformity
Fibromylagia:
Age group
Presentation
Middle aged women Classic hx: Widespread pain Dramatic descriptions Fatigues +++ Poor sleep Non refreshing sleep Emotional distress Multiple tender points - 18
Normal inflammatory markers
Polymylagia rheumatica: Age group Presentation Ix Tx
Elderly
Presentation: Marked inflammatory hx, proximal girdle - early morning stiffness++ - improves after a few hours Pain/limited active shoulder movement Normal passive movement
Ix:
ESR elevated
CRP and CK normal
Tx:
Very responsive to steroids!
Adhesive capsulitis aka Frozen shoulder: Age group Presentation RF Ix Tx
50-60y
Globally limited active and passive movement
RF:
DM
post traumatic
Protease Inhib
Ix:
XR and US to exclude OA and rotator cuff injury
Tx:
Resolves completely after 18-24 months
corticosteroid injections have limited effectiveness
Pain on internal rotation in abduction. Dx?
Bursitis
Normal passive range of motion but reduced active movements in certain directions (usually pain). Dx?
Rotator cuff injury
Synovial fluid WCC. Following ranges correspond to:
WCC 50 000
WCC 50 000 = septic
Excluding vaculitis, what other condition is associated with a +ve ANCA?
Glomerulonephritis
Causes of Avascular necrosis?
Steroids Heavy EtOH SLE, HIV (watch interaction steroid and ritonavor) Antiphospholipid syndrome Trauma Bisphosphonates
Temporal arteritis. What age group does it never occur in?
What is the commonest cause of a Baker’s cyst?
OA
Mass in politeal fossa
Bursa behind medial head of gastrocnemius
Directly communicates with knee joint
MCD:
Presentation
Ix
Overlap synrome with features of SLE, Scleroderma and RA Raynaud's common Oedema Puffy hands Arthalgia Arthritis Myositis Fibrosing alveolitis Pul HT 50% have Sjogren's syndrome
Ix: ANA+ speckled U1 RNP +ve SSA/ro +ve Leucopenia thrombocytopenia ESR elevated RF +ve 70%
If RNP +ve and dsDNA +ve. Dx?
SLE
Not MCTD
Pt presents with polyartharlgia and fatigue. A negative ANA is most useful in excluding?
SLE
Sensitive 99.9%
5% of normal population with have +ve ANA
Increases with age, 10% of pts 70-80y
leucocytoclastic vasculitis in post capillary venules with IgA deposition. Dx?
HSP
Presents with fever, arthralgia, abdo pain and rash
The most common cause of primary hyperuricaemia is?
Decreased renal excretion of uric acid, 85-90%
10-15% due to other causes
- inherited defect in ourine synthesis
- ATP metabolism defect
- Increased cell turnover
- overproducers
2/3 of hyperuricaemic patients remain asymptomatic
Tx of acute GOUT. If renal impairment, which drug do you avoid?
Colchicine and NSAIDs
High dose colchicine no better than low dose colchicine!
XR changes in Gout vs. Psoriatic arthritis
Gout:
punched out erosions and overhanging edges
Soft tissue swelling an deposition tophi
Joint space narrowing preserved (unless very advanced)
Psoriatic:
Pencil in cup deformity
Ankylosis of joint
Loss of joint space
In a pt with GOUT and HT which antihypertensive is most likely going to help control the Gout?
Losartan
What is febuxostat?
Xanthine oxidase inhibitor
Which diuretics raise plasma urate?
Which CTx drugs raise plasma urate?
Diuretics:
Thiazide
Loop
CTx:
Cylosporin
Tacrolimus
Uricosuric drugs that can be used to as hypouricaemic drug therapy.
Probenecid, benzbromarone, lesinurad
Losartan, fenofibrate
What is the most specific sign of temporal arteritis?
Jaw claudication
Pt with all of the following antibodies +ve. Dx? ANA dsDNA RF Anticardiolipin and lupus anticoagulant Anti-RNP SSA and SSB
SLE
dsDNA specific
What is the best feature for distinguishing ankylosing spondylitis from mechanical back pain?
Early morning stiffness
+ve antihistone associated with?
Drug induced SLE.
Five main drugs are hydralazine, isoniazide, procainamide, penicillinamine and anti-TNFalpha.
