Rheumatology Flashcards
1
Q
Features of Spondyloarthropathies
A
- HLA B27
- Associated with spine/joints
- Enthesitis
- Extra-articular features
2
Q
What are the 4 Spondyloarthropathies?
A
- Ank Spond
- Psoriatic Arthritis
- Reactive Arthritis
- Enteropathic Arthritis
3
Q
What are the shared Rheumatological features of Spondlyarthrpathies?
A
- Dactylitis
- Sacroiliac and spinal involvement
- Enthesis
- Inflammatory arthritis
4
Q
Dactylitis
A
“Sausage fingers”
5
Q
Enthesis
A
- Inflammation on the insertion of a tendon into a bone
- Achilles Tendonitis
- Plantar Faciitis
6
Q
Extra-articular shared features of Spondlyarthrpathies?
A
- Ocular: anterior uveitis, conjunctivitis
- Mucuocutaneous features
7
Q
Young male, HLA B27, Sacroiliac joint involvement, Enthesopathy
A
Ank Spond
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
9
Q
On x-ray:
- Sacroilitis
- Bamboo spine
- Syndesmophytes
A
Ank Spond
10
Q
On x-ray:
- Bone density normal in early disease, reduced in late
- Shiny corners
- Syndesmphytes
- Fusion
A
Ank Spond
11
Q
Hallmark of Ank Spond
A
Sacroiliac joint involvement
12
Q
Asymmetric sacroilitis, 10-15% do not have psoriasis, nail involvement: pitting and onchylosis, dactylitis, enthesitis
A
Psoriatic Arthritis
13
Q
Clinical subgroups of psoriatic arthritis
A
- Confined to DIP
- Symmetrcial polyarteritis (similar to RA)
- Spondylitis (spinal involvement)
- Asymmetric oligoarthritis with dactylics
- Arthritis mutilans
14
Q
On x-ray: "Pencil in cup" deformity "Marginal erosions" and "whiskering" Osteolysis Enthesitis
A
Psoriatic arthritis
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
16
Q
Most common infections in reactive arthritis
A
- Urogenital Chylamdial
- Enterogenic Salmonella
17
Q
Mucocutaneous features of ??
- Keratodema Blenorrhagica
- Circinate balanitis
- Painless oral ulcers
- Hyperkeratotic nails
A
Reactive Arthritis
18
Q
Treatment for Reactive Arthritis
A
- 90% resolve spontaneously with 6mnths
- Steroids for eyes
- Abx for underlying disease
19
Q
Urethritis
Conjunctivitis/Uveitis/Iritis
Arthritis
A
Reactive Arthritis
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
21
Q
Adverse side effects of Methotrexate
A
- Leukopaenia
- Hepatitis/Cirrhosis
- Pneumonitis
- Rash
- Nausea/vomiting
- Monitor FBC and LFTs
22
Q
Methotrexate and pregnancy
A
- Teratogenic
- Must be stopped 3 months before contraception
23
Q
Use of Sulfasalazine
A
Often used in combination with methotrexate in early inflammatory arthritis
24
Q
Adverse side effects of Sulfasalazine
A
- Nausea/
- Rash/mouth ulcers
- Hepatitis
- Low sperm count (reversible)
- Monitor FBCs and LFTs
25
Use of Hydroxychloroquine and side effect
- No effect on joint damage
- SLE, Sjogren's, RA
- Retinopathy
26
Adverse side effects of Sodium aurothiomalate (gold) given IM?
- Bone marrow suppression
- Glomerulonephritis (urinalysis for proteinuria)
- Rash
- Mouth ulcers
27
What are Anti-TNFs used in?
RA, psoriatic arthritis and ankylosing spondylitis
28
Adverse side effects of Anti-TNF treatment?
- Major risk of infection (esp TB)
- Question over risk of malignancy (esp skin cancer)
- Contraindicated in certain situations e.g. pulmonary fibrosis, heart failure
29
Urate lowering gout prophylaxis drugs
Allopurinol
Febuxostat
Uricosurics
30
Adverse side effects of Allopurinol
- Rash (vasculitis) in elderly and renal impairment, lower dose
- Azathioprine interaction
- Rarely marrow aplasia
31
Febuxostat indications
- Those who cannot tolerate allopurinol
- Renal impairment
- Used with caution in patents with ischaemic heart disease
32
Use of Corticosteroids?
- Connective tissue disease
- Polymyalgia rheumatica / giant cell arteritis
- Vasculitis
- Rheumatoid arthritis
33
Adverse side effects of Corticosteroids
```
Weight gain - centripetal obesity
Muscle wasting
Skin atrophy
Osteoporosis
Diabetes
Hypertension
Cataract
Glaucoma
Fluid retention
```
34
What does Methotrexate antagonise?
Folic acid synthesis
35
Secondary causes of OA
- RA
- Previous Injury
- Acromegally
- Pseudogout
36
OA: hand features
- Sqauring of the thumbs
| - DIP,PIP,CMC
37
OA: spine and knee features
Knee: osteophytes and Baker's cysts
| Lumbar spine: osteophytes may cause spinal stenosis
38
OA: Classification
Kellegren Lawrence classification
39
Outcome of OA long term on:
a) Hands
b) Knees
c) Hip
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
Treatment in OA
Analgesia: Paracetamol and NSAIDs
41
Gout is as a result of uric acid overproduction, 3 causes of overproduction?
- Excess consumption
- Over production
- Under excretion
42
Gout: causes of overproduction of uric acid
- Alcohol
| - High purine diet (seafood)
43
Gout: causes of under excretion of uric cause
- Renal impairment
- Diuretics
- Hypothyroidism
44
How long before gout settles?
10 days without treatment
| 3 days with treatment
45
Chronic joint inflammation, tophi, increased uric acid production, diuretic associated
Chronic Tophaceous gout
46
Can serum uric acid be normal during acute attacks of gout?
Yes
47
When can you start Allopurinol/Febuxostat?
2-4wks after acute attack
48
"Envelope shaped" mildy birifringement, old age, related to OA, acute attacks due to Calcium Pyrophosphate
Chondrocalcinosis (pseudo gout)
49
Hydroxyapatite crystal deposition in or around the joint, acute and rapid deterioration females 50-60yrs
“Milwaukee shoulder”
50
Increased Oestrogen exposure, malar rash, Jaccoud's, glomerulonephritis, ANA titre 1:160
SLE
51
SLE: treatment for mild, moderate, severe
Mild: NSAIDs, topical steroids
Moderate: Aziothioprine, Methotrexate
Severe: IV steroids, Rituximab
52
What is the difference between ulnar deviation in RA and SLE?
There is no erosion in SLE
53
Anti-cardiolipin, arterial/venous thrombosis, pregnancy loss with no explanation, lived retinacularis,
Anti-Phospholipid syndrome
54
Treatment for Anti-Phospholipid Syndrome
Thrombosis: life long anti-coagulation
| Pregnancy loss: aspirin and heparin during pregnancy
55
Lymphocytic infiltration of exocrine glands, primary or secondary, ocular or salivary dryness >3mnths, anti-Ro, anti-La
Sjrogens
56
Mutation in FOXP3 gene essential for development of T cells, autosomal recessive presenting in childhood, T1Dm, severe eczema, malabsorption
IPEX syndrome
57
What class of receptor do all nucleated cells possess?
All class 1: HLA-A/B/C
58
What class of receptor do special antigen presenting cell possess?
HLA-DR/DQ/DP
59
HLA-B27
Ank Spond
60
HLA-DR2
Goodpastures
61
HLA-DR3
Graves, SLE
62
HLA-DR3/4
T1DM
63
HLA-DR4
RA
64
What type of hypersensitivity reaction is SLE and RA
SLE: Type III
RA: Type IV
65
Mechanism of RA
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
Important mediators of joint damage in RA?
TNF and IL-1
67
What is Rheumatoid Factor?
Antibody directed against the common Fc region of human IgG. IgM anti-IgG is most commonly tested
68
Rheumatoid Factor is only associated with RA T/F
False. Associated with Sjogrens, PBC and SLE
69
Is there an increased risk of malignancy in Poly/dermatomyositis?
Yes- 15% incidence in dermatomyositis, 9% polymyositis
70
Tired muscles, functional difficulty, symmetrical proximal muscle pain, insidious onset worsening over months, raised CK, anti-jo, muscle weakness testing, Electromyography (EMG)
Polymyositis
71
Distal muscle weakness, insidious onset, older, asymmetrical weakness, CK levels lower than PM, muscle biopsy shows inclusion bodies, doesn't respond well to therapy
Inclusion body myositis
72
Symmetrical morning stiffness, symmetrical with normal muscle strength
Polymyalgia Rheumatica
