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Ask Doctor Clarke 2018 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Symptoms of inflammatory arthropathy

A

Early morning stiffness > 20 mins

worse after resting, eased by movement

soft tissue swelling, loss of knuckle valleys

raised ESR, CRP

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2
Q

Features of RA

A

symmetrical, peripheral destructive Arthropathy

small joints of hands or feet

also hips, elbows, knees

palmar subluxation and ulnar deviation at MCP

rheumatoid nodules

active synovitis- red, swollen joints

young adults 3:1 female:male

HLA DR4 associated

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3
Q

Palmar features of RA

A

Palmar erythema

wasting of thenar eminence- carpal tunnel

fixed flexion contracture

specific Abnormalities- swan neck, button hole, z-thumb

rheumatoiod tenosynovitis

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4
Q

Anatomy of boutonnière deformity

A
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5
Q

Anatomy of swan neck deformity

A
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6
Q

What is rheumatoid factor?

A

IgM against your own IgG

3% of healthy

high titres associated with progressive disease- DMARDs early

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7
Q

Seronegative rheumatoid?

A

Identical disease presentation to seropositive

1/3 are seronegative

most unlikely to have nodules/ extra-articular

less likely to be rapidly progressive

most have non-classical rheumatoid factors

usually IgG vs IgG

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8
Q

Extra-articular features of RA

A

FACEBOOKS

Felty’s syndrome

Atlanto-axial subluxation

Caplans syndrome and pulmonary nodules

Effusions (pleural exudates)

Blood – normochromic normocytic anaemia

Olecronon bursitis

Oral dryness (sicca syndrome)

Kidneys (amyloid, gold and penicilliame)

Sensory neuropathy and scleromalacia

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9
Q

DMARDs

A

Methotrexate- folate antagonist, single weekly dose

sulfasalazine- Inhibits TNF and cytokines production

leflunomide- inhibits B and T cell function

biologicals

steroids

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10
Q

Side effects of methotrexate

A

Pulmonary fibrosis- spirometry

liver toxicity- LFTs

bone marrow suppression- FBCs

interaction- excretion inhibited by NSAIDs- toxicity

Trimethoprim is contraindicated- another folate antagonist

folic Acidosis rescue often given as a single weekly dose on non-MTX day - decrease symptoms

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11
Q

Differential diagnosis of RA

A

RA

psoriatic arthropathy

SLE

osteoarthritis with inflammatory component

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12
Q

5 types of psoriatic arthropathy

A

oligoarthritis 70%

distal (classical) 15%

rheumatoid pattern 15%

arthritis mutilans

sacroilitis may be a feature

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13
Q

Psoriatic arthropathy: treatment options

A
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14
Q

Radio graphic features of RA

A

SPADES

Soft tissue swelling

Peri-articular osteoporosis

Absent osteophytes

Deformity

Erosions

Subluxation

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15
Q

XRay features of OA

A

LOSS

Loss of joint space

Osteophytes

Subchondral cysts

Subchondral Sclerosis

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16
Q

Examination features of scleroderma

A

Hands- sclerodactyly- tight waxy skin, telamgiectasia, raynaud’s, evidence of ulceration

temperature, skin thethering, subcutaneous calcification (extensor aspects)

‘function of hands

face, upper arms, chest- diffuse

three finger test for microstomia

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17
Q

Features of diffuse cutaneous scleroderma

A

More extensive together with internal organ involvement (lung, GI, heart, Renal)

mask like face, waxy skin around a small mouth

tethering of skin over nose

interstitial pulmonary fibrosis (restrictive)

renal involvement (hypertension, impaired renal function)

atonic oesophagitis (reflux and aspiration)

1/3 ANA+ve

anti-Scl70 in 1/3

RNA polymerase

18
Q

Features of limited cutaneous Sclerosis

A

CREST

Calcinosis

Raynaud’s

Esophageal involvement

Sclerodactyly

Telangiectasia

19
Q

Questions to ask in scleroderma

A

Do your hands change colour in the cold?

do you get breathless ?

do you get indigestion or heartburn?

20
Q

Scleroderma management

A

Raynaud’s- nifedipine

digital ulcers- bosentan or IV prostanoids

skin- methotrexate (?cyclophosphamide, mycophenylate)

GI- PPI

renal Crisis- ACEi

Pulmonary hypertension- bosentan, sildenafil

21
Q

Anti- CCP

A

95% specificity

70% sensitivity

antigen derived from collagen

40% of seronegative RA

22
Q

Features of seronegative arthritis

A

Different from seronegative rheumatoid arthritis

psoriatic, Reiter’s, post-dysentery, enteropathic, ankylosing spondylitis

asymmetrical oligoarthritis often associated with sacroiliitis

underlying pathophysiology is an enthesopathy

HLA B27 associated

anyerior uveitis is associated

23
Q

Features of SLE

A

immune complexes

non-specific presentation e.g. fever, weight loss, anaemia

light sensitive rash

nail fold vasculitis

splinter haemorrhages

small joint arthritis

24
Q

Complications of SLE

A

Hypertension

renal impairment

nephrotic syndrome

pleurisy/pericarditis

cerebral lupus

25
Q

Features of hyperuricaemia

A

Commonly assymptomatic

associated with hypertryglyceridaemia and hypertension

usually idiopathic, also: thiazides, cytotoxics, CKD, neoplasms

may cause acute gout (treat with NSAIDs, colchicine, rarely steroids)

few suffer from accumulation of irate deposits: tophi

26
Q

What is chronic tophaceous gout?

A

Destruction of articulation cartilages

punched out erosions on xray

asymmetrical small joint arthropathy

affecting hands and feet

indicates need for prophylaxis

allopurinol-several weeks after acute attack

initial NSAIDs

27
Q

SLE antibodies

A

anti-dsDNA

Anti-sm

28
Q

Drug induced lupus Antibodies

A

anti-histone

29
Q

Sjogrens antibodies

A
30
Q

Diffuse cutaneous antibodies

A

anti-scl70

31
Q

CREST antibodies

A
32
Q

Myositis autoantibodies

A
33
Q

Primary biliary sclerosos

A
34
Q

Anti-smooth muscle antibody

A

chronic active hepatitis

35
Q

PANCA

A
36
Q

cANCA

A

wegner’s

37
Q

RA antibodies

A

RF

ANA

anti-CCP

38
Q

Tests scleroderma

A

Dipstick and u&es - renal involvement

PFTs- fibrosis

BP-hypertensive

  • ANA- 2/3 in limited
  • ANti-centromere- limited cutaneous

anti-scl 70m- diffuse

39
Q

Tests lupus

A
  • anti dsDNA
  • low c3,c4
  • ESR

BP- HTN

Urine- casts, protein (lupus nephritis)

fBC, U&E, LFT,

CRP (normal)

40
Q

Lupus criteria

A

>3/11

  1. malar rash
  2. discoid rash
  3. Photosensitive
  4. Oral ulcers
  5. Arthritis
  6. Serositis- pleurisy, pericardial
  7. Renal- nephrotic
  8. CNs- seizures, psychosis
  9. Haem - anaemia, leukopenia, lymphopenia, thrombocytopenia
  10. Immunological - antidsDNA, anti-sm, APL
  11. ANA +ve

Ask Doctor Clarke 2018 (12 decks)

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