Rheumatology Flashcards
What are side effects of methotrexate?
- hepatic toxicity
- pulmonary fibrosis
- haematological: low WCC, thrombocytopenia
Side effects of cyclosporin?
- renal impairment
- HTN
What are side effects and precautions when using Biologics?
- infection
- TB reactivation
- Allergic reaction
- no live vaccines
- CI in active HepB and C
- increase skin cancer
- not good in pregnancy
What is the differential for deforming symmetrical arthropathy?
- RA
- psoriatic arthritis
- SLE (jaccoud arthropathy)
- tophaceous gout
- other seronegative arthropathy
- very severe OA
What are the XR changes of RA?
- soft tissue swelling
- symmetrical joint space narrowing
- marginal joint erosions
- juxta-articular joint osteoporosis
Investigations for RA?
- RF, anti-CCP
- ESR/CRP
- Hb re: anaemia chronic disease
- XR
Management of RA?
Non pharm: Physio, splints, OT Pharm: - NSAID - DMARD: MTX, leflunomide, hydroxychloroquine, cyclo, azathio - Biologics: TNF, non TNF Surgical: joint replacement
What is on the SLE criteria list?
MD SOAP BRAIN Malar rash Discoid rash Serositis Oral ulcers Arthritis Photosensitive rash Blood abnormal: haemolytic anaem, leukopenia Renal disorder: proteinuria, GN ANA Immunologic disorder: dsDNA, anti-Sm, antiphospholipid Neuro disorder: psychosis or seizure
4 or more = dx of SLE
Causes of drug induced lupus?
- hydralazine
- procainamide
- isoniazid
- phenytoin
- methyldopa
Drug induced SLE: anti histone Ab
What are the investigations for SLE?
- ANA, dsDNA, anti-Sm, anti-ro (congenital CHBlock)
- anti U1RNP if MCTD suspected rather than pure SLE
- ESR, C3/C4, CH50
- FBC: hb, low WCC, low play
- UA: proteinuria, blood
- renal biopsy
- APS: anti cardiolipin, B2 glycoprotein, lupus anticoagulant
- MRI and LP if CNS lupus
Treatment of SLE?
- NSAID
- hydroxychloroquine: monitor eyes
- Ca blockers for raynaud
- pred for active disease
- anti coagulation if thrombosis/APS
- OP prevention (pred)
- AZA, cyclophosphamide, or MTX
What are features of Wegeners and Ix?
- lung and kidney involvement
- SOB, cough/haemoptysis, nasal congestion
- crackles throughout lungs
- c-ANCA
- urine: casts, dysmorphic red cells
What are features and Ix for Churg-Strauss?
Churg “Struassthma-panca”
- asthma, allergic rhinitis, eczema, peripheral neuropathy
- p-ANCA
- biopsy
What investigations for scleroderma?
- ESR
- folate, B12 - malabsorption
- anti centromere (CREST)
- anti scl70 (diffuse scleroderma)
- gastroscopy, esophageal manometry
- ILD: PFT, hrCT, 6min walk test
- TTE: pulm HTN
What is the treatment for scleroderma?
- avoid smoking
- PPI
- Ca blocker for Raynaud
- Abx for gut bacterial overgrowth
- PAH Rx: endothelin receptor antagonists, PDE inhibitors
- pred for pericarditis or early ILD
- cyclophosphamide for ILD
- ACEi for renal protection
Clinical features of Dermatomyositis?
- Grottron papules
- shawl sign
- heliotrope rash
- arthritis
- proximal weakness
What is MTCD?
Overlap features of SLE, scleroderma, polymyositis
Extra articular manifestations of ank spond?
6 A's: Atlanto-axial subluxation Anterior uveitis Apical lung fibrosis Aortic regurgitation Amyloidosis (kidneys) Autoimmune bowel disease (UC) (Arthritis)
What antibodies for Dermatomyositis/polymyositis?
Anti jo1
Anti mi2
Anti U1RNP
Anti synthetase
1) Pattern of weakness in Dermatomyositis and polymyositis?
2) Pattern in inclusion body myosotis?
1) proximal
2) proximal and distal
What are the hand XR features of gout?
- tophi
- punched out erosions
- intraosseous lytic lesions
What are XR hand features of psoriatic arthritis?
- pencil in cup deformity
- distal erosive change with bone proliferation
What are extra articular features of RA?
- Raynaud
- dry eyes, scleritis
- neck pain: C1-2 subluxation
- pulmonary fibrosis
- pericarditis, IHD
- peripheral neuropathy
- anaemia
- Vasculitis: ulcers, mononeuritis multiplex
What is Felty Syndrome?
RA + neutropenia + splenomegaly
What are the main causes of death in SLE?
- infection
- renal failure
- lymphoma
- MI
What to test for for anti phospholipid syndrome?
- anti cardiolipin
- lupus anticoagulant
- b2 glycoprotein
How to diagnose anti phospholipid syndrome?
Clinical: > 1 VTE or recurrent miscarriage or low platelets
Lab: antiphospholipid antibodies
