Rheumatology Flashcards
Is gout more common in M of F
Men
Causes of hyperuricaemia?
psoriasis, haemolytic disorders, alcohol, purine intake
treatment of acute gout
NSAIDs/colchicine
corticosteroids
opiod analgesics
treatment of chronic gout
allopurinol (febuxostat if can’t tolerate allopurinol i.e. renal impairment)
What is calcium pyrophosphate deposition disease related to? who gets it? where does it affect? treatment?
related to OA
elderly get it
affects knee, wrist and ankle
treatment = NSAIDS, colchicine, steroids, rehydration
What is chondrocalcinosis?
calcium pyrophosphate deposition in cartilage/soft tissues without inflammation
What is scleroderma?
excessive fibrosis of organs and tissues
What is scleroderma associated with?
CREST
- calcinosis
- Raynauds
- oEsophageal dysfunction
- sclerodactyly
- telangiectasia
Limited scleroderma
- which antibody
- where is skin involvement
- organ involvement early or late
anti centromere antibody
skin: face, hands, forearms, feet
Diffuse scleroderma
- which antibody
- where is skin involvement
- organ involvement early or late
anti scl 70 antibody
skin: trunk
early significant organ involvement
Environmental factors in SLE?
UV light
silica dust
viruses e.g. EBV
SLE - which type of hypersensitivity?
type 3
type of endocarditis assoc with SLE
Libman Sachs
Antibodies in SLE
anti ds DNA = specific
ANA - +ve but not specific
anti sm - specific but low sensitivity
high or low c3/c4 in active SLE?
low
SLE
treatment for skin disease & arthralgia
treatment in severe organ disease
treatment in unresponsive disease
skin disease & arthralgia: hydroxychloroquine, topical steroids, NSAIDs
severe organ disease: cyclophosphamide + IV steroids
unresponsive: Iv immunoglobulin + rituximab
Antibodies in anti phospholipid syndrome?
anti cardiolipin
anti beta 2 glycoprotein
features of anti phospholipid syndrome
i.e. skin appearance? condition of veins? etc
foetal loss recurrent thrombosis superficial thrombophlebitis migranes livedo reticular
mainstay treatment of APS?
anti coagulation
LMWH during pregnancy! warfarin = teratogenic
Sjogrens symptoms? increased risk of what? antibodies? test? treatment?
dry mouth, dry eyes
(also: arthralgia, vaginal dryness, fatigue, parotid gland swelling, ILD, neuropathy)
increased risk of lymphoma
anti RO and LA
schrimmers test
tx = eye drops, saliva replacement (pilocarpine), regular dental care because ^ risk of caries, hydroxychloroquine for arthralgia and fatigue
Side effect of pilocarpine?
flushing
Symptoms of IPEX syndrome
v early onset DM severe malabsorption syndrome severe infections eczema autoimmune thyroid disease, haemolytic anaemia
mutation that causes IPEX syndrome?
FOXP3
is being male or being female a poor prognosic indicator for RA?
male
Lung problems associated with RA
bronchiectasis
pulmonary fibrosis
pleural effusions
pulmonary nodules
Specific antibody for RA?
ANTI CCP
treatment of RA?
DMARD within 3 months of symptom onset and steroid to cover lag phase
biologics e.g. anti tnf (infliximab, adalimumab) if unresponsive
Antibody associated with mixed connective tissue disease?
Anti RNP
Signs of dermatomyositis
Gottrons sign - red + scaly over MCP and PIP
heliotrope rash - red over eyelids
shawl sign - red over back of neck and in v down front of chest
antibodies associated with polymyositis?
anti jo
anti srp
how does polymyositis affect the muscles?
symmetrical proximal muscle weakness
treatment of polymyositis?
prednisolone
immunosuppression (MTX)
what is there risk of in poly and demo - myositis?
malignancy! (9% in poly; 15% in dermato)
Pattern of muscle weakness in inclusion body myositis?
distal muscle weakness
inclusion body myositis - more common in males or females?
males
Relationship between PMR and GCA?
50% of people with GCA have PMR
15% of people with PMR develop GCA
Characteristics of PMR?
early morning stiffness + pain usually symmetrical shoulder girdle and hip muscle power NORMAL seen almost exclusively in over 50s
what does PRM respond dramatically to?
low dose steroids
what 2 inflammatory conditions is fibromyalgia associated with?
seen in 50% of SLE and 25% of RA
Enteropathic arthritis
- what is it associated with
- how is it treated?
associated with IBD DONT GIVE NSAIDS - may exacerbate IBD treat the IBD! paracetamol, cododamol steroids DMARDs Anti TNF
Reactive arthritis – Reiter’s
what is the classic triad?
what infections commonly predispose it?
treatment
classic triad - urethritis, uveitis, arthritis "can't see, can't pee, can't climb a tree" infections: chlamydia, neisseria, salmonella, campylobacter tx: 90% resolve spontaneously in 6 months NSAIDs corticosteroids AB for underlying infection DMARDs if resistant/chronic
what type of arthritis are psoriatic, enteropathic and reactive usually?
reactive = asymmetric MONOarthritis
psoriatic and enteropathic = asymmetric OLIGOarthritis
X-ray signs of psoriatic arthritis
marginal erosions and whispering
pencil in cup deformity
osteolysis
what is the hallmark of ank spond?
sacroiliitis
ank spond more common in M or F?
Men
Ank spond = the ‘A’ disease, what are the ‘A’s?
Axial arthritis Aortic regurgitation Anterior uveitis Apical fibrosis Amyloidosis Achilles tendonitis plAntar fasciitis
Which HLA is and spond assoc with
HLA B27
1st line treatment for ank spond
whats the tx if there is peripheral joint involvement?
NSAIDs
DMARDs only if peripheral joint involvement
what neuro condition is GPA associated with?
mononeuritis multiplex
GPA - which type of ANCA?
cANCA
EGPA and MPA - which type of ANCA?
pANCA
What is seen in 90% of patients with microscopic polyangitis (MPA)?
glomerulonephritis
main treatment of large vessel vasculitis?
corticosteroids
What immunoglobulin mediates Henoch-Schonlein Purpura?
IgA
what do over 75% of kids with Henoch-Schonlein Purport have beforehand?
URTI, pharyngeal infection or GI infection
GAS is most common
What is it essential to check in HSP?
urinalysis because there’s renal involvement in 50%
