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Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What are the X-ray changes seen in rheumatoid arthritis?

A

Juxta-articular osteopenia
Soft tissue swelling
Joint deformity
Loss of joint space

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2
Q

What are the red flags in a back pain history? 5 things

A 
Night pain
History of malignancy
Neurological disturbance
Abdominal mass
Sphincter disturbance
Saddle anaesthisia
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3
Q

Name 3 early symptoms of rheumatoid arthritis?

A

Swelling
Pain
Stiff small joints worse in the morning
Possible tenosynovitis or bursitis

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4
Q

Name 4 late changes of rheumatoid arthritis?

A

Ulnar deviation of fingers
Boutonnière deformity of fingers
Swan-neck deformity of fingers
Z-deformity of thumb

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5
Q

Give 5 extra-articular signs of rheumatoid arthritis?

A 
Nodules-elbows and lungs
Vasculitis
Pleural and pericardial effusion
Raynauds
Carpal tunnel syndrome
Osteopororis
Fibrosing alveolitis
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6
Q

Which blood test would you take in a suspect rheumatoid patient?

A

Rheumatoid factor (70%)
Anti-CCP (98%)
FBC-anaemia of chronic disease
ESR/CRP/PV-raised in response to synovitis

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7
Q

What is the diagnostic criteria for rheumatoid arthritis?

A 
4/7 of
Morning stiffness (>1 hour lasting >6 weeks duration)
Arthritis in >3 joints
Arthritis of hand joints
Symmetrical arthritis
Rheumatoid nodules
Positive rheumatoid factor
Radio graphic changes
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8
Q

What is the DAS28 and what score is being aimed for?

A

Disease activity score-assesses tenderness and swelling at 28 joints

Aiming for <3

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9
Q

How can you treat rheumatoid arthritis non pharmacologically? 4 things

A 
MDT approach
Support groups
Stop smoking
Encourage regular exercise
Physio
OT for aids, splints etc
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10
Q

What is the class of drugs used as first line long term treatment in Rheumatoid arthritis and give 3 examples?

A

DMARDs

Methotrexate
Sulfasalazine
Hydroxychloroquine

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11
Q

What is a potentially serious SE of DMARDs and how can you avoid it?

A

Myelosuppression

Regular FBC monitoring is required

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12
Q

If a patient fails to respond to DMARDs in RA, what is the next line of drugs? Give examples?

A

TNF alpha inhibitors
Infliximab
Etanercept
Adalimumab

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13
Q

If DMARDs and TNF alpha inhibitors fail to control Rheumatoid arthritis, what’s the next line?

A

Rituximab in combination with Methotrexate

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14
Q

What is the criteria for diagnosing SLE?

A 
>4 of: A RASH POINts an MD
•Arthritis (>2 joints)
•Renal disorder (proteinuria or cellular casts)
•ANA positive
•Serositis (pleuritis or pericarditis)
•Haematological disorder (anaemia, leukopenia, thrombocytopenia)
•Photosensitivity
•Oral ulcers
•Immunological disorder
•Neurological disorder (seizures, psychosis)
•Malar rash
•Discoid rash
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15
Q

Name 4 seronegative arthropathies?

A

Ankylosing spondylitis
Enteropathic spondyloarthropathies
Psoriatic arthritis
Reactive arthritis

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16
Q

What is Sjögren’s syndrome?

A

Autoimmune disease destroying exocrine glands with associated polyarthritis

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17
Q

What tests can be undertaken to monitor the effectiveness of methotrexate? 2 tests

A

Creatinine
FBC
LFTs

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18
Q

What are the symptoms of polymyalgia rheumatica? 4 things

A

•Symmetrical aching, tenderness and morning stiffness in shoulders and proximal limb muscles

  • Mild polyarthritis
  • Tenosynovitis
  • Carpal tunnel syndrome

•Fatigue,fever, weight loss, anorexia and depression.

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19
Q

How do you manage Polymyalgia rheumatica?

A

Prednisalone

Along with PPI and Bisphosphanates (alendronate)

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20
Q

What is polymyalgia rheumatica associated with?

A

Giant cell arteritis

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21
Q

Name 4 symptoms of temporal arteritis?

A 
Headache
Scalp tenderness
Jaw claudication
Temporary loss of vision in one eye
Sudden blindness
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22
Q

How do you treat giant cell arteritis?

A

Prednisalone (40-60mg PO) immediately

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23
Q

What is Feltys syndrome?

A

Association of rheumatoid arthritis with splenomegaly and leukopenia

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24
Q

What organisms are commonly responsible for septic arthritis in infants and sexually active adults?

A

Infants-Haemophilus influenzae

Adults-Neisseria gonorrhoeae

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25
Q

What is the medical term for a sausage shaped toe?

A

Dactylitis

26
Q

What is the test used for checking lumbar flexion?

A

Schober test

27
Q

Give 4 extra skeletal features that could be present in Ankylosing spondylitis?

A 
Anorexia
Fatigue
Weight loss
Fever
Uveitis
Aortic incompetence
Pulmonary fibrosis
28
Q

Give 3 ways you could manage Raynauds?

A

Hand warmers
Battery powered gloves
Oral vasodilators
Sympathectomy

29
Q

What serological abnormality is found in lupus?

A

Raised levels of double stranded DNA

Low C3 and C4 complement levels

30
Q

Give 5 causes of Gout?

A 
Hereditary
High dietary purines
Alcohol excess
Diuretics
Leukaemia
Renal impairment
31
Q

What will light microscopy of synovial fluid show in Gout?

A

Needle shaped Negatively birefringent urate crystals under polarised light

32
Q

What is the treatment of acute Gout?

A

Strong NSAID (diclofenac)
Colchicine - if NSAIDs CI
Steroids - if there is renal impairment

33
Q

How do you prevent Gout?

A 
Lose weight
Avoid alcohol excess
Avoid purine rich foods
Avoid prolonged fasts
Use allopurinol after acute attack
34
Q

What is the difference between Gout and Pseudogout?

A

Gout shows negative bifringent crystals under microscopy whilst Pseudogout shows positive.

35
Q

Give 3 risk factors for developing Rheumatoid A?

A

Smoking
Female
Genetic (HLA DR4)

36
Q

What is pannus in Rheumatoid A?

A

A growth which is composed of thick synovial tissue. This produces enzymes which destroy articular cartilage and attract more inflammatory cells => increasing disease severity

37
Q

How do you treat an acute flare of Rheumatoid Arthritis? 2 things

A

Steroids - Methylprednisalone

NSAIDs (For symptom control) - Ibuprofen, Diclofenac etc.

38
Q

What is the test and give 3 antibodies you can test for in SLE?

A

Immunoflorescence

ANA (Anti-smith and Anti-dsDNA)
Rheumatoid factor

39
Q

Give 3 ways to monitor disease activity in SLE?

A 
Anti-dsDNA titres
Complement levels (decrease in C3/4)
ESR (raised)
40
Q

Give 6 methods to manage SLE starting with simple measures?

A

High factor sun block creams
NSAIDs - treat minor symptoms
Anti-malarial (hydroxychloroquine) - if NSAIDs aren’t working
Low dose steroids - chronic disease
Azathioprine - maintenance
High dose prednisalone - severe flare ups

41
Q

What is Antiphospholipid syndrome? 4 things

A

CLOT
Coagulation defects
Livedo reticularis (capillary dilatation & stasis)
Obstetric complications (recurrent miscarriages)
Thrombocytopoenia

42
Q

How can you treat Anti-phospholipid syndrome? 2 things

A

Aspirin

Warfarin - in recurrent thromboses

43
Q

What is SLE?

A

Antibodies produced against a variety of antigens. Type 3 hypersensitivity leading to immune complexes that deposits in various organs.

44
Q

What is Systemic sclerosis ?

A

Autoimmune disease with increased fibroblast activity => abnormal tissue growth
Characterised by autoantibodies, vascular disease and fibrosis => skin (scleroderma, GI tract & other organs

45
Q

What are the clinical features of Limited systemic sclerosis? 5 things

A

CREST
Calcinosis - calcium deposits in subcutaneous tissue
Raynauds phenomenon
Esophageal and gut dysmotility
Sclerodactyly - thick/tight skin of fingers/toes
Telangiectasia

46
Q

What is the antibody associated with limited systemic sclerosis?

A

Anti-centromere (ACA)

47
Q

What is diffuse systemic sclerosis? Which 2 antibodies are associated?

A

Affects the skin in a difuse pattern
Also fibrosis in lungs, heart and kidneys

Anti-topoisomerase-1 (scl70)
Anti-RNA polymerase

48
Q

How do you treat systemic sclerosis? 4 things

A

No cure
Involve physios & OT
Immunosuppression (organ involvement) - IV cyclophosphamide

Treat complications:
Raynauds - hand warmers
GI - antacids, PPI
Cardiac - antiarrythmics
Renal - ACEi
49
Q

Give 6 clinical features of Sjögren’s syndrome?

A

Lacrimal - Xeropthalmia (low tears), dry eyes
Parotid - Parotid gland swelling, xerostomia, tooth decay
Others - vaginal dryness, dry cough
Systemic features - polyartheritis, raynauds, vasculitis

50
Q

In Sjögren’s syndrome how can you test for conjuctival dryness?

A

Schirmer’s test - Strip of filter paper under lower eyelid. Measure distance tears are absorbed. <5mm in 5mins is positive

51
Q

Who is more likely to present with ankylosing spondylitis and whats the genetic association?

A

Young (s) males

HLA B27

52
Q

Give 4 clinical features of ankylosing spondylitis?

A

Sacroilitis - night back pain, spinal stiffness, loss of movement
Acute anterior uveitits
Enthesitis - pain at tendon/ligament insertion points
Question mark posture

53
Q

Give 3 ways to treat ankylosing spondylitis?

A

Intense exercise (OT & Physios)
Pharmo - NSAIDs, local steroid injections, monoclonal antibodies
Surgery -

54
Q

Give 5 clinical features seen in psoriatic arthritis?

A 
Joints - inflamed, red, tender
Psoriasis
Nail changes - onycholysis, nail pitting
Enthesitis
Dactylitis
55
Q

What X-ray deformity of the hands can be seen in severe Psoriatic arthritis?

A

Pencil in cup deformity

56
Q

What is reactive arthritis characterised by? 3 things

A

Arthritis
Urethritis/Cervicitis
Conjuctivitis

57
Q

What are the different types of vasculitits? 6 things

A

Large vessel - Temporal arteritis, Takayasu’s arteritis
Medium vessel - Polyarteritis nodosa, Kawasaki’s disease
Small vessel:
ANCA +ve (Wegener’s, Churg Strauss syndrome)
ANCA -ve (Goodpastures, Henoch Schonlein purpura)

58
Q

How do you investigate temporal arteritis? If the test is negative should you exclude TA?

A

Temporal artery biopsy

No, as the disease can manifest in skip lesions

59
Q

What is polymyositis and give 2 clinical features?

A

Chronic inflammtory myopathy (inflammation in muscles)

Proximal muscle weakness (unlike PMR which is stiffness)
Muscle weakness (dysphagia, dysphonia)
60
Q

Give 5 clinical features of dermatomyositis?

A 
Macular rash
Lilac purple rash
Nail fold erythema
Gottrons papules (roughened papules over knuckles, elbows and knees)
Mechanic's hands (rough skin cracking)
61
Q

What is the definition of Juvenile idiopathic arthritis?

A

Persistent arthritis lasting for >6weeks with an onset of <16years old

Medicine (17 decks)

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