Rheumatology Flashcards
What are the criteria for diagnosis for GCA and how many do you need to mail a diagnosis?
Symptoms - jaw claudication, scalp tenderness, headaches
Investigations - positive temporal artery biopsy (skip lesions), raised ESR (with normal Hb)
3 of the 5 are required for positive diagnosis
What are the XR findings in osteoarthritis?
Loss of joint space
Osteohpytes
Subchondral cysts
Subchondral sclerosis
What are the XR findings in rheumatoid arthritis?
Loss of joint space Soft tissue swelling Periarticular osteopenia Deformity Subluxation
What are the XR findings in gout?
Soft tissue swelling
Periarticular erosions - “punched out erosions”
List the 4 signs of active rheumatological disease (i.e. active inflammation)
Early morning stiffness
Boggy swelling
Red hot joints
Tender to palpation
Name some of the deformities found in rheumatoid hands
Swan neck Boutonniere's Z-thumb Ulnar deviation of fingers Dorsal subluxation
List some of the features of rheumatoid arthritis
Arthritis - symmetrical, deforming inflammatory polyarthritis (affects PIPs first) Nodules - often on elbows Tenosynovitis Autoimmune associations Pericarditis Carpal tunnel syndrome Reynauld's Felty's syndrome
What is Felty’s syndrome?
Triad of: rheumatoid arthritis, splenomegaly and neutropenia
Name some of the deformities found in osteoarthritis hands
Heberden’s nodes (distal)
Bouchard’s nodes (proximal)
List some drugs that can cause gout (HINT: think CANT LEAP)
Cyclosporin Alcohol Nicotinic acid Thiazide diuretics Loop diuretics Ethambutol Aspirin Pyrazinamide
On polarised light microscopy, what is the difference between gout and pseudogout?
Gout - negatively birefringent needle-shaped crystals
Pseudogout - positively birefringenet rhomboid-shaped crystals
List the three classical symptoms of Reiter’s disease (reactive arthritis)
Urethritis (can’t pee)
Uveitis (can’t see)
Arthritis (can’t climb a tree)
Which CTDs are RF (rheumatoid factor) positive?
Rheumatoid arthritis
Sjogren’s syndrome
Felty’s disease
Which CTDs are ANA (antinuclear antigen) positive?
SLE
Sjogren’s
Which CTD is dsDNA positive?
SLE
Which CTD is centromere positive?
CREST syndrome (limited systemic sclerosis)
Which CTDs are Ro positive?
SLE
Sjogren’s
Which CTDs are La positive?
SLE
Sjogren’s
Which CTD is Sm positive?
SLE
Which CTD is RNP positive?
SLE
Which CTDs are Jo-1 positive?
Polymyositis
Dermatomyositis
Which CTD is Scl70 positive?
Diffuse systemic sclerosis
Which CTD is RNA pol positive?
Diffuse systemic scleorisis
Which autoantibodies are found in SLE?
dsDNA ANA Ro La Sm RNP
Which autoantibodies are found in RA?
RF
Anti-CCP
ANA
Which autoantibodies are found in Sjogren’s?
RF
ANA
Ro
La
Which autoantibodies are found in poly/dermatomyositis?
Jo-1
Which autoantibodies are found in diffuse systemic sclerosis?
Scl70
RNA polymerase
Which autoantibodies are found in limited systemic sclerosis (CREST syndrome)?
Centromere
List the classical symptoms of Sjogren’s
Dryness - dry eyes, dry mouth, vaginal dryness etc.
Outline the colour change seen in Raynaud’s hands
White –> Blue –> Red (crimson)
List the features of limited systemic sclerosis
Calcinosis Raynaud's Esophageal dysmotility (GORD) Sclerodactyly Telangiectasia
What are the signs of active disease in SLE (i.e. which markers are altered in active SLE)?
High ESR (high CRP would mean infection)
LOW C3, C4
High dsDNA titre
What is the major diagnostic feature of idiopathic inflammatory myopathies (eg: polymyositis and dermatomyositis)?
Progressive, symmetrical proximal muscle weakness
Name the three ANCA positive vasculitidies
Granulomatous polyangitis (Wegener’s)
Churg-Strauss
Microscopic polyangitis
Which vasculitidies are cANCA positive?
Granulomatous polyangitis (Wegener’s)
Which vasculitidies are pANCA positive?
Churg-Struass
Microscopic polyangitis
Which antibodies are found in Goodpastures syndrome?
Anti-GBM (glomerular basement membrane)
