Rheumatology

Question 1

Name 4 heritable connective tissue disorders

Answer 1

1. Marfans
2. Ehlers danlos
3. Osteogenesis imperfecta
4. Stickler syndrome

Question 2

5 autoimmune connective tissue disorders

Answer 2

1. Rheumatoid arthritis
2. SLE
3. Sjogrens
4. Systemic sclerosis (diffuse and limited)
5. Mixed CTD

Question 3

What % get PA?

What are 5 categories?

How treat in early stages?

What drugs treat both arthritis and psoriasis?

Answer 3

10%

1. Asymmetric - OA like (70%)
2. Symmetric - RA like
3. Small joints - Distal IPJs
4. Spondylitis - Ank spond type inflammation with stiffness of the neck, lower back, sacroiliac or spinal vertebrae
5. Arthrtis mutilans - severe, deforming and destructive

NSAIDs and sulphasalazine

MTX, CyA, Anti-tnf

Question 4

Ank Spond

Describe pathophysiology + joints most affectd

Signs and symptoms? What extra articular features seen?

Management options?

Answer 4

Infm arthropathy and enthesopathy, predom affect axial spine/SIJ, shoulders and hips

EMS, low back pain and later ? appearance

7 A’s:

Apical Fibrosis (pulmonary), Anterior uveitis (iritis), Aortic regurg, achilles tendonitis, AVN block

Exercise, physio, NSAIDs; Anti-TNF for axial and MTX/SFZ for peripheral

Question 5

What are spondyloarthropathies?

Which are associated with HLA-B27

Answer 5

Joint disease of the vertebral column

1. Ankylosing spondylitis
2. Psoriatic Arthritis
3. Reiter’s/reactive arthritis
4. Enteropathic arthropathy - IBD
5. Undifferentiated spondyloarthropathy

Question 6

What is your differential for an acute inflamed monoarthritis?

Answer 6

1. OA
2. RA
3. Seronegative
4. Gout
5. Pseudogout - calcium pyrophosphate
6. Septic
7. Haemarthrosis - e.g. warfarin or clot disorder
8. Trauma
9. reactive