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Meddygaeth B > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What are the 4 types of inflammatory arthritis?

A

Seropositive, seronegative, infectious, crystal induced

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2
Q

What are the 5 types of seropositive arthritis

A

Rheumatoid arthritis, Lupus, Scleroderma, Vasculitis, Sjorgen’s

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3
Q

What are the types of seronegative arthritis?

A

Ankylosing spondylitis, psoriatic arthritis, reactive arthtitis, enteropathic arthritis

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4
Q

Define vasculitis

A

Inflammatory disorder of blood vessel walls causing damage e.g aneurysm, fibrosis, stenosis.

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5
Q

What are the two main types of large vessel arteritis?

A

Giant cell arteritis (AKA temporal arteritis)

Takayasu’s arteritis (AKA aortic arch syndrome, pulseless disease)

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6
Q

What are the symptoms of Giant cell arteritis

A

Scalp tenderness, raised temporal artery, headache, fever, jaw claudication and amaurosis fugax

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7
Q

Define amaurosis fugax

A

A painless temporary loss of vision in one or both eyes described as ‘curtain passing ober the eye’. Usally indicative of transient retinal ischaemia

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8
Q

What are investigations for giant cell arteritis?

A

Raised ESR and CRP

Temporal artery biopsy to look for granulomatous lesions

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9
Q

What is treatment for giant cell arteritis?

A

Prednisolone 60mg/ d po for 2 years due to risk of recurrance
Also give PPI and bisphosphonate

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10
Q

What are the three types ofvmedium vessel vasculitis?

A

Polyarteritis nodosa, Kawasaki disease, buerger’s disease

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11
Q

What is buerger’s disease? (Thromboangiitis obliterans)

A

Rare condition affecting distal limb vessels , clots in medium sized arteries lead to tisdue ischaemia in fingers and toes. Caused by smoking treated by smoking cessation!

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12
Q

What is polyarteritis nodosa?

A

Systemic necrotising vasculitis of medium arteries, associated with hep B. Renal disease seen in 70% of cases

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13
Q

What organs does PAN spare?

A

The lungs

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14
Q

Investigations for PAN?

A

Raised WCC, ESR, CRP, mild eosinophilia (30%) and anaemia

Renal or mesenteric angiography (check for microaneurisms), renal biopsy.

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15
Q

Treatment for PAN?

A

Corticosteroids, cyclophosphomide and anti-hypertensives

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16
Q

What is Kawasaki’s disease?

A

Juvenile form of PAN, children <5, most common type of all vaculitides

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17
Q

What are the symptoms of Kawasaki disease?

A

Fever resistant to antipyretics > 5 days, strawberry tongue, painful erythema of hsnds and feet, maculopapular rash

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18
Q

What is main complication of kawasaki disease?

A

Coronary artery aneurysm

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19
Q

How treat kawasaki disease?

A

IVIG, aspirin and corticosteroids

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20
Q

What are the types of small vessel vasculitis?

A

ANCA Positive:
granulomatosis with polyangitis
Eosinophilic granulomatosis with polyangitis
Microscopic polyangitis
ANCA Negative:
Henoch-Schonlein purpura, goodpasture’s syndrome

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21
Q

What is ANCA?

A

Anti-neutrophil-cytoplasmic-antibody. They attack the antigens in the cytoplasm of neutrophils within blood vessels, causing inflammation and/or granuloma formation

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22
Q

Granulomatosis with polyangitis (GPA) affects what with what type of anca?

A

Nasopharynx, lungs and kidneys

c-ANCA antibodies

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23
Q

Microscopic polyangitis affects what with what type of anca?

A

Lung and kidneys only

P-ANCA

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24
Q

Eosinophilic Granulomatosis with polyangitis (EGPA) affects what with what type of anca?

A

Asthma, eosinophilia, vasculitis

P-ANCA

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25
Q

What is goodpasture’s syndrome?

A

Not ANCA, auto-antibodies (anti-GBM) attack the alpha-3 subunit of type IV collagen. Affects only lung and kidneys

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26
Q

What is treatment for Goodpasture’s Syndrome

A

Plasmapheresis, steroids, cyclophosphomide, rituximab. Azathioprine for remission

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27
Q

Tell me about Behcet’s disease!

A

Affects all vessels! Cardinal triad of oral ulcers, genital ulcers and uveitis

28
Q

Name some connective tissue disorder

A

Systemic lupus erythematosus
Sjörgen’s syndrome
Idiopathic inflammatory myopathies
Mixed, relapsing polychondritis, behcet’s disease

29
Q

What are lupus classics?

A

Butterfly rash, photosensitivity, dry mouth, raynauds phenomenon, nephritis, pleural effusion, protein and hematuria

30
Q

What is lupus

A

Autoimmune multisystem connective tissue disease characterised by auto antibodies attacking cell nuclei. ANA then form antigen-antibody complexes that travel around the body depositing in vessels and organs leading to type 3 hypersensitivity reaction

31
Q

What is management of lupus ?

A

Focus on preventing flares and reducing their severity
Lifestyle advice to avoid sunlight and other triggers
Limit severity with corticosteroids and immunosuppressants

32
Q

What is sjögren’s syndrome?

A

Autoimmune connective tissue disease that is rheumatoid factor positive. Dry mouth and eyes most common

33
Q

What is systemic sclerosis?

A

Unknown aetiology, hardened, sclerotic skin. Can be limited, diffuse or without internal organ involvrment

34
Q

What are the types of arthritis?

A

Inflammatory, non inflammatory (osteoarthritis), septic, crystal (gout/pseudogout)

35
Q

Early morning stiffness of >30 minutes suggests what?

A

Inflammatory arthritis

36
Q

What does a ‘boggy’ swelling of the joint indicate?

A

Suggestive of synovitis which occurs in inflammatory arthritis

37
Q

What joints does rheumatoid arthritis normally effect?

A

Wrists, metacarpal phalanges, and proximal interphalangeal joint (not distal). Involve the is usually symmetrical

38
Q

Describe swan neck deformities and in what condition they are found

A

Hyper extension of proximal interphalangeal joint and flexion of the distal interphalangeal joint. Rheumatoid arthritis

39
Q

Describe Boutonniere deformity and what condition causes it

A

Flexion of the proximal interphalangeal joint and hyperextension of the distal interphalangeal joint. Rheumatoid arthritis

40
Q

Define guttering

A

Muscle wasting seen over the dorsum of the hand

41
Q

If you’re a GP and you think someone has rheumatoid arthritis what do you do?

A

Prescribe analgesia for symptomatic relief and refer urgently to rheumatology. Rapid treatment improves long term outcomes, by maintaining function and quality of life

42
Q

What blood tests would you complete to confirm rheumatoid diagnosis?

A

Rheumatoid factor and anti-CCP antibody. Antinuclear antibody may ) di Cate connective tissue disease
Baseline blood tests (FBC, U&E, LFTs), TFTs, plain radiographs of the hands and feet

43
Q

How is rheumatoid arthritis diagnosed

A

By a rheumatologist and according to ACR classification criteria
Basically duration, number and type of joints involved, antibody tests and CRP and ESR

44
Q

How’s is disease activity in rheumatoid arthritis monitored?

A

Using the disease activity score - DAS28

45
Q

What is the treatment for active rheumatoid arthritis?

A

Combination of DMARDs (disease monitoring anti-rheumatic drug), normally methotrexate and hydroxychloroquine, AND with a corticosteroid

46
Q

Names some DMARDs

A

Methotrexate and hydroxychloroquine are the most common

Others include leflunomide and sulphasalazine

47
Q

What are some of the known complication of rheumatoid arthritis?

A

Carpal tunnel syndrome, haemolytic anaemia

Felty’s syndrome (combination of RA, splenomegaly and neutropenia)

48
Q

What is the onset for psoriatic arthritis?

A

Mono arthritis that gradually gets worse

49
Q

What are the crystals found in gout?

A

Monosodium urate that are needle shaped and strongly negatively birefringent- yellow under polarized light

50
Q

Describe the crystals found in pseudo gout I

A

CPPD crystals positively birefringent rhomboid crystals - blue under polarized light

51
Q

What tests do you need to do if you suspect gout?

A

FBC, U&E, LFTs, CRP AND ESR (helps monitor response to treatment esp in septic arthritis), serum urate (low/normal does not rule out gout). Joint aspiration and synovial fluid analysis microscopy-GOLD STANDARD!

52
Q

Is warfarin a contraindication for joint aspiration?

A

No

53
Q

How is an acute attack of gout treated?

A

Naproxen - but not in renal impairment, and may need gastroprotectors
Colchicine, start asap when NSAIDs don’t work. Start at low dose to avoid diarrhoea
Prednisolone intra-articular v effective if not responding to other treatment - but not in diabetics!

54
Q

What are the conditions necessary to begin patient on prophylactic treatment for gout?

A 
Established diagnosis of gout AND one of:
Two or more gout attacks per year
Tophus by clinical imaging study
CKD Stage 2 or worse
Urolithiasis
55
Q

What is the aim of prophylactic gout therapy?

A

To maintain a lower serum uric acid (sUA)<300 micromoles/L

Lower the sUA greater chance of dissolution of tophi

56
Q

When should urate lowering therapy be introduced following. An acute attack of gout?

A

2-4 weeks after attack has subsided

57
Q

What is the prophylactic treatment for gout?

A

Allopurinol- a xanthine oxidase inhibitor and first drug of choice
Start at 100mg then work up until sUA at desired levels
Continue lifelong, alternative is febuxostat

58
Q

What are the sideffects of allopurinol?

A

May cause early increase in gout attacks- therefore give colchicine for two weeks before starting
10% develop rashes
Allopurinol hypersensitivity syndrome (mortality 20-25%)

59
Q

What are the lifestyle advice for people with gout?

A

Weight loss, avoid alcohol, avoid sugar sweetened drinks , avoid heavy meals and excessive intake of meat and seafood
Eat low- fat diary produce, vitamin C and exercise regularly

60
Q

For how long must a patient be on prophylactic colchicine along side allopurinol?

A

6 months

61
Q

Define fibromyalgia

A

Chronic widespread pain >3months in duration

Both sides of the body, above and below waist and along axial spine

62
Q

What are alternative diagnosis and things to look out for in patient you may think has fibromyalgia?

A

Hypothyroidism - hair thinning, weight gain
SLE - malar rash, photosensitvity
Addison’s disease- hyper pigmentation
Lymphoma/infection- posterior cervical lymph node enlargement

63
Q

What tests would you do to rule out anything that isn’t fibromyalgia?

A

TSH, 25-hydroxy vitamin D level, vitamin B12 level, iron studies,
Magnesium, ESR/CRP

64
Q

What is the treatment for fibromyalgia?

A

Exercise- the only management option with strong evidence
CBT, Hydrotherpy, acupuncture
Screen for anxiety and depression
Duloxetine, pregabalin, tramadol

65
Q

What are the risk factors for fibromyalgia?

A

Low household income, lack of further education, female, FH of fibromyalgia, going through a traumatic event, rheumatoid arthritis

66
Q

What are the x-ray changes of rheumatoid arthritis?

A 
Loss of joint space
Junta-articular osteoporosis
Soft-tissue swelling
periarticulat erosions
Subluxation

Meddygaeth B (9 decks)

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