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Summary of Stuff > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Features of Spondyloarthropathies

A
  • HLA B27
  • Associated with spine/joints
  • Enthesitis
  • Extra-articular features
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2
Q

What are the 4 Spondyloarthropathies?

A
  • Ank Spond
  • Psoriatic Arthritis
  • Reactive Arthritis
  • Enteropathic Arthritis
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3
Q

What are the shared Rheumatological features of Spondlyarthrpathies?

A
  • Dactylitis
  • Sacroiliac and spinal involvement
  • Enthesis
  • Inflammatory arthritis
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4
Q

Dactylitis

A

“Sausage fingers”

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5
Q

Enthesis

A
  • Inflammation on the insertion of a tendon into a bone
  • Achilles Tendonitis
  • Plantar Faciitis
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6
Q

Extra-articular shared features of Spondlyarthrpathies?

A
  • Ocular: anterior uveitis, conjunctivitis

- Mucuocutaneous features

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7
Q

Young male, HLA B27, Sacroiliac joint involvement, Enthesopathy

A

Ank Spond

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8
Q

New York Criteria for Ank Spond?

A
  • Limited lumbar motion
  • Lower back pain >3mnths (not improved by rest or relieved by exercise)
  • Reduced chest expansion
  • Bilateral grade 2-4 sacroilitis on x-ray
  • Unilateral grade 3-4 sacroilitis on x-ray
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9
Q

On x-ray:

  • Sacroilitis
  • Bamboo spine
  • Syndesmophytes
A

Ank Spond

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10
Q

On x-ray:

  • Bone density normal in early disease, reduced in late
  • Shiny corners
  • Syndesmphytes
  • Fusion
A

Ank Spond

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11
Q

Hallmark of Ank Spond

A

Sacroiliac joint involvement

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12
Q

Asymmetric sacroilitis, 10-15% do not have psoriasis, nail involvement: pitting and onchylosis, dactylitis, enthesitis

A

Psoriatic Arthritis

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13
Q

Clinical subgroups of psoriatic arthritis

A
  1. Confined to DIP
  2. Symmetrcial polyarteritis (similar to RA)
  3. Spondylitis (spinal involvement)
  4. Asymmetric oligoarthritis with dactylics
  5. Arthritis mutilans
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14
Q 
On x-ray:
"Pencil in cup" deformity
"Marginal erosions" and "whiskering"
Osteolysis
 Enthesitis
A

Psoriatic arthritis

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15
Q

Young adult, HLA B27, Infection induced systemic illness, inflamed synovitis from which viable micro-organisms cannot be cultured, symptoms 1-4wks following infection

A

Reactive Arthritis

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16
Q

Most common infections in reactive arthritis

A
  • Urogenital Chylamdial

- Enterogenic Salmonella

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17
Q

Mucocutaneous features of ??

  • Keratodema Blenorrhagica
  • Circinate balanitis
  • Painless oral ulcers
  • Hyperkeratotic nails
A

Reactive Arthritis

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18
Q

Treatment for Reactive Arthritis

A
  • 90% resolve spontaneously with 6mnths
  • Steroids for eyes
  • Abx for underlying disease
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19
Q

Urethritis
Conjunctivitis/Uveitis/Iritis
Arthritis

A

Reactive Arthritis

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20
Q

Arthritis in several joints, IBD, worsening on symptoms during IBD flare-ups.

  • GI symptoms
  • Pyoderma gangrenous
  • Enthesitis
  • Apthous ulcers
A

Enteropathic arthritis

-Treat underlying IBD

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21
Q

Adverse side effects of Methotrexate

A
  • Leukopaenia
  • Hepatitis/Cirrhosis
  • Pneumonitis
  • Rash
  • Nausea/vomiting
  • Monitor FBC and LFTs
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22
Q

Methotrexate and pregnancy

A
  • Teratogenic

- Must be stopped 3 months before contraception

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23
Q

Use of Sulfasalazine

A

Often used in combination with methotrexate in early inflammatory arthritis

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24
Q

Adverse side effects of Sulfasalazine

A
  • Nausea/
  • Rash/mouth ulcers
  • Hepatitis
  • Low sperm count (reversible)
  • Monitor FBCs and LFTs
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25
Q

Use of Hydroxychloroquine and side effect

A
  • No effect on joint damage
  • SLE, Sjogren’s, RA
  • Retinopathy
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26
Q

Adverse side effects of Sodium aurothiomalate (gold) given IM?

A
  • Bone marrow suppression
  • Glomerulonephritis (urinalysis for proteinuria)
  • Rash
  • Mouth ulcers
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27
Q

What are Anti-TNFs used in?

A

RA, psoriatic arthritis and ankylosing spondylitis

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28
Q

Adverse side effects of Anti-TNF treatment?

A
  • Major risk of infection (esp TB)
  • Question over risk of malignancy (esp skin cancer)
  • Contraindicated in certain situations e.g. pulmonary fibrosis, heart failure
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29
Q

Urate lowering gout prophylaxis drugs

A

Allopurinol
Febuxostat
Uricosurics

30
Q

Adverse side effects of Allopurinol

A
  • Rash (vasculitis) in elderly and renal impairment, lower dose
  • Azathioprine interaction
  • Rarely marrow aplasia
31
Q

Febuxostat indications

A
  • Those who cannot tolerate allopurinol
  • Renal impairment
  • Used with caution in patents with ischaemic heart disease
32
Q

Use of Corticosteroids?

A
  • Connective tissue disease
  • Polymyalgia rheumatica / giant cell arteritis
  • Vasculitis
  • Rheumatoid arthritis
33
Q

Adverse side effects of Corticosteroids

A 
Weight gain - centripetal obesity
Muscle wasting
Skin atrophy
Osteoporosis
Diabetes
Hypertension
Cataract
Glaucoma
Fluid retention
34
Q

What does Methotrexate antagonise?

A

Folic acid synthesis

35
Q

Secondary causes of OA

A
  • RA
  • Previous Injury
  • Acromegally
  • Pseudogout
36
Q

OA: hand features

A
  • Sqauring of the thumbs

- DIP,PIP,CMC

37
Q

OA: spine and knee features

A

Knee: osteophytes and Baker’s cysts

Lumbar spine: osteophytes may cause spinal stenosis

38
Q

OA: Classification

A

Kellegren Lawrence classification

39
Q

Outcome of OA long term on:

a) Hands
b) Knees
c) Hip

A

a) Pain improves over 2years, swelling more marked
b) Knee: 1/3rd improve, 1/3rd stable, 1/3rd deteriorate
c) 10% come off surgical waiting list

40
Q

Treatment in OA

A

Analgesia: Paracetamol and NSAIDs

41
Q

Gout is as a result of uric acid overproduction, 3 causes of overproduction?

A
  • Excess consumption
  • Over production
  • Under excretion
42
Q

Gout: causes of overproduction of uric acid

A
  • Alcohol

- High purine diet (seafood)

43
Q

Gout: causes of under excretion of uric cause

A
  • Renal impairment
  • Diuretics
  • Hypothyroidism
44
Q

How long before gout settles?

A

10 days without treatment

3 days with treatment

45
Q

Chronic joint inflammation, tophi, increased uric acid production, diuretic associated

A

Chronic Tophaceous gout

46
Q

Can serum uric acid be normal during acute attacks of gout?

A

Yes

47
Q

When can you start Allopurinol/Febuxostat?

A

2-4wks after acute attack

48
Q

“Envelope shaped” mildy birifringement, old age, related to OA, acute attacks due to Calcium Pyrophosphate

A

Chondrocalcinosis (pseudo gout)

49
Q

Hydroxyapatite crystal deposition in or around the joint, acute and rapid deterioration females 50-60yrs

A

“Milwaukee shoulder”

50
Q

Increased Oestrogen exposure, malar rash, Jaccoud’s, glomerulonephritis, ANA titre 1:160

A

SLE

51
Q

SLE: treatment for mild, moderate, severe

A

Mild: NSAIDs, topical steroids
Moderate: Aziothioprine, Methotrexate
Severe: IV steroids, Rituximab

52
Q

What is the difference between ulnar deviation in RA and SLE?

A

There is no erosion in SLE

53
Q

Anti-cardiolipin, arterial/venous thrombosis, pregnancy loss with no explanation, lived retinacularis,

A

Anti-Phospholipid syndrome

54
Q

Treatment for Anti-Phospholipid Syndrome

A

Thrombosis: life long anti-coagulation

Pregnancy loss: aspirin and heparin during pregnancy

55
Q

Lymphocytic infiltration of exocrine glands, primary or secondary, ocular or salivary dryness >3mnths, anti-Ro, anti-La

A

Sjrogens

56
Q

Mutation in FOXP3 gene essential for development of T cells, autosomal recessive presenting in childhood, T1Dm, severe eczema, malabsorption

A

IPEX syndrome

57
Q

What class of receptor do all nucleated cells possess?

A

All class 1: HLA-A/B/C

58
Q

What class of receptor do special antigen presenting cell possess?

A

HLA-DR/DQ/DP

59
Q

HLA-B27

A

Ank Spond

60
Q

HLA-DR2

A

Goodpastures

61
Q

HLA-DR3

A

Graves, SLE

62
Q

HLA-DR3/4

A

T1DM

63
Q

HLA-DR4

A

RA

64
Q

What type of hypersensitivity reaction is SLE and RA

A

SLE: Type III
RA: Type IV

65
Q

Mechanism of RA

A
  1. Infiltration of synovium by CD4 cells
  2. Production of cytokines, recruit macrophages and B cells
  3. B cells produce immunoglobulin
  4. Destruction of bone and cartilage by MMPs
66
Q

Important mediators of joint damage in RA?

A

TNF and IL-1

67
Q

What is Rheumatoid Factor?

A

Antibody directed against the common Fc region of human IgG. IgM anti-IgG is most commonly tested

68
Q

Rheumatoid Factor is only associated with RA T/F

A

False. Associated with Sjogrens, PBC and SLE

69
Q

Is there an increased risk of malignancy in Poly/dermatomyositis?

A

Yes- 15% incidence in dermatomyositis, 9% polymyositis

70
Q

Tired muscles, functional difficulty, symmetrical proximal muscle pain, insidious onset worsening over months, raised CK, anti-jo, muscle weakness testing, Electromyography (EMG)

A

Polymyositis

71
Q

Distal muscle weakness, insidious onset, older, asymmetrical weakness, CK levels lower than PM, muscle biopsy shows inclusion bodies, doesn’t respond well to therapy

A

Inclusion body myositis

72
Q

Symmetrical morning stiffness, symmetrical with normal muscle strength

A

Polymyalgia Rheumatica

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