Rheumatology Flashcards
Type 1 immune reaction
Anaphylatic
IgE, basophils, mast cells
Asthma, allergic rhinitis, anaphylaxis
Type 2 immune reaction
Cytotoxic
Antibody formation, phagocytosis of oponised cells
autoimmune haemolytic anaemia, Goodpasture’s syndrome, Grave’s disease, pernicious anaemia
Type 3 immune reaction
Immune complex
Antibody-complement formation, attract inflammatory cells
SLE, PAN, PSGN
Type 4 immune reaction
Cell-mediated/delayed hypersensitivity
T-cell mediated
Contact dermatitis
HLA-B27
Ankylosing spondylitis
Reactive arthritis
Enteropathic arthritis
HLA-DR4, DR1
Rheumatoid arthritis
HLA-DR3
Sjogren’s syndrome
SLE
Non-rheumatic diseases (celiacs, DM1, graves)
Joint Pain causes (SOFTER TISSUE)
Sepsis OA Fracture Tendon/muscle Epiphyseal Referred Tumour Ischaemia Seropositive arthritis Seronegative arthritis Urate Extra-articular rheumatism
Seropositive disease
Rheumatoid arthritis SLE/antiphospholipid syndrome Scleroderma Dermatomyositis/polymyositis Sjogren's syndrome Mixed connective tissue disease
Seronegative disease
Ankylosing spondylitis
Enteropathic arthritis
Reactive arthritis
Psoriatic arthritis
Seropositive features
Female predominance
Symmetrical affecting small and large joints
Does not affect spine or enthesis.
Others: rheumatoid nodules, vasculitis (SLE), dryness (Sjogren’s), Raynaud’s (scleroderma)
Seronegative
Predominantly males
Usually assymetrical affecting larger joints. Affects axial and enthesis.
Others: iritis (reactive), dactylitis, DIP (psoartic), oral ulcers, GI (enteropathic), skin conditions
SLE antibodies
ANA RhF anti-dsDNA Anti-SM Lupus anticoagulant Anti-cardiolipin
Sjogern’s antibodies
ANA
RhF
Anti-La
Anti-Ro
CREST antibodies
Anti-centromere
ANA
Dermatomyositis, polymyositis antibodies
Anti-Jo
Rheumatoid arthritis antibodies
RhF
Anti-CCP
Negatively birefringent
Monosodium urate
Positively birefringent, rhomboid shape
Calcium pyrophosphate dihydrate
OA radiographic signs
Joint space narrowing
Subchondral sclerosis
Subchondral cysts
Osteophytes
Vasculitides (seropositive)
Small: non-ANCA associated, Sjogern’s (Wegener’s granulomatosis)
Medium: polyarteritis nodosa, Kawasaki’s
Large: giant cell arteritis, Takayasu’s
Anti-neutrophil cytoplasmic antibodies (ANCAs)
Wegener’s granulomatosis
Microscopic polyangiitis
Primary pauci-immune necrotizing crescentic glomerulonephritis Churg-Strauss syndrome
Drug induced vasculitides
Antiphospholipid syndrome antibodies
Lupus anticoagulant
Anti-cardiolipin
Wegener’s granulomatosis antibodies
c-ANCA
SLE (MD SOAP BRAIN)
Malar rash Discoid rash Serositis Oral ulcers ANA Photosensitivity Blood Renal Arthritis Immune Neurological
Antiphospholipid syndrome
Thromboembolic events
Spontaneous abortions
Thrombocytopenia
Raynauds phenomen causes (COLD HAND)
Cryoglobulins Obstruction/Occupation Lupus erythematous Diabetes/Drugs Haematologic Arterial Neurologic Disease of unknown origin
CREST syndrome
Calcinosis Raynauds Esophageal dysfunction Sclerodactyl Telangiectasia
PM/DM
Symmetric proximal muscle weakness (shoulders, hips)
Elevated muscle enzymes (CK, LDH, AST, ALT)
EMG changes
Muscle biopsy (necrosis, regeneration, perivascular inflammation)
Rash (Gottron’s papules, helitrope rash, shawl sign)
Associated malignancies: breast, lung, colon, ovaries
Sjogern’s triad
Dry eyes
Dry mouth/dysphagia
Arthritis
Wegener’s granulomatosis
Nasal/oral involvement (inflammation, ulcers, epistaxis)
Abnormal CXR (nodules, cavitations)
Urinary sediment (protein RBC casts)
Biopsy (granulomas in lung, necrotising segmantal GN)
c-ANCA positive, small vessel vasculitis
Polyarteritis Nodosa
Weight loss Mylagias/weakness Livedo reticularis Neuropathy Testicular pain Diastolic BP >90 Elevated Cr Hep B positive Arteriography abnormal Biopsy of artery
ANCA negative, medium vessel vasculitis
Giant cell arteritis
Age >50 New headache/loss of vision/jaw claudication Temporal artery abnormality Elevated CRP Abnormal biopsy
Large vessel vasculitis
Ankylosing spondylitis
Age onset 20's Axial, LE distribution Sacroilitis Enthesitis Aorticic regurge HLA-B27
Psoriatic arthritis
Age onset 35-45 Peripheral arthritis Any distribution Dactylitis, enthesitis Psoriasis Uveitis, urethritis
Reactive arthritis
Age onset 20's Peripheral arthritis, LE Sacroilitis Dactylitis, enthesitis Urethritis, aortic regurge HLA-B27
Onset: post Shigella, Salmonella, Campylobacter, Yersinia, Chlamydia, Mycoplasma
Enteropathic arthritis
Peripheral arthritis, LE
Pyoderma, erythema nodosum
IBD
AS extra-articular manifestations (6 A’s)
Atlanto-axial subluxation Anterior uveitis Apical lung fibrosis Aortic incompetence Amyloidosis (kidneys) Autoimmune BD (UC)
Gout
First MTP
Erosion of bone
Tophi, gout nephropathy
Pseudogout
Knee, wrist, polyarticular
Chondrocalcinosis, OA
Gout precipitants (drugs are FACT, foods are SALT)
Furosemide
Aspirin/alcohol
Cytotoxic drugs
Thiazide diuretics
Shellfish Anchovies Liver and Kidney Turkey Sardines
Polymyalgia Rheumatica
Pain and stiffness of the proximal extremities, fever, weight loss mylagia Age >50 Bilateral aching/morning stiffness Increased ESR Rapid response to corticosteroids
Fibromylagia
Chronic, widespread pain with tender points (occiput, trapezius, low cervical, lateral epicondyle, gluteal, greater trochanter)
