Rheumatology Flashcards
1
Q
For which conditions is this antibody positive: anti-CCP
A
Rh arthritis
2
Q
For which conditions is this antibody positive: ANA
A
SLE, sjogren’s, systemic sclerosis, MCTD, autoimmune liver disease
3
Q
For which conditions is this antibody positive: Anti-dsDNA
A
SLE
4
Q
For which conditions is this antibody positive: Anti-Sm
A
SLE
5
Q
For which conditions is this antibody positive: Anti-Ro
A
SLE, sjogren’s
6
Q
For which conditions is this antibody positive: Anti-La
A
sjogren’s
7
Q
For which conditions is this antibody positive: Anti-centromere
A
limited systemic slcerosis
8
Q
For which conditions is this antibody positive: Anti-Scl-70
A
Diffuse systemic sclerosis
9
Q
For which conditions is this antibody positive: Anti-RNP
A
SLE, MCTD
10
Q
For which conditions is this antibody positive: Anti-Jo-1
A
Myositis
11
Q
For which conditions is this antibody positive: Anticardiolipin
A
Anti-phospholipid syndrome
12
Q
For which conditions is this antibody positive: Lupus anti-coagulant
A
Anti-phospholipid syndrome
13
Q
For which conditions is this antibody positive: ANCA
A
Vasculitis (Small vessel)
14
Q
What is the pathophysiology of OA?
A
Joint wear and tear, with an imbalance between joint wear and repair
15
Q
What can predisposes to secondary OA?
A
Deformity, previous injury to joint
16
Q
What is seen on x-ray for OA?
A
LOSS
Loss of joint space, osteophytes, sclerosis, subchondral cysts
17
Q
How is OA treated?
A
Pain control with simple drugs or mild opiates, physio, weight loss, joint replacement
18
Q
What are signs of an inflammatory problems in the joints?
A
Morning stiffness
Joint swelling
Joint pain relived on exercise
19
Q
Which joints does Rh arthritis affect?
A
Small joints of hands and feet first
then big joints
20
Q
Is RhA symmetrical or asymmetrical?
A
Symmetrical
21
Q
Which group is most at risk of RhA?
A
Women aged 35-50
22
Q
What is the pathophysiology of RhA?
A
Immune processes attack the synovium, pannus forms which attacks articular cartilages eading to joint destruction
23
Q
Which criteria can be used to assess RhA?
A
ACR and EULAR
24
Q
How may RhA present?
A
Symmetrical synovitis, pain, morning stiffness, rheumatoid nodules on extensor surfaces
25
What lung involvement can be seen in RhA?
Pleural effusion, interstita. fibrosis and pulmonary nodules
26
What eye involvement can be seen in RhA?
Keratoconjunctivitis sicca, episcleritis, uveitis, nodular scleritis
27
What is seen on FBC in RhA?
Raised CRP, ESR, PV
28
What do X-rays show on RhA?
Periarticular osteopenia, swelling
| Erosions late in the disease
29
What therapies are given for RhA?
DMARD within 3 months of symptom onset (methotrexate); NSAIDs, steroids for pain relief
30
What is a risk of DMARDs?
Bone marrow suppresion
31
If disease unresponse to DMARD therapy what can be used?
Biologics - anti-TNG; toclzumab, tituximab, abatacept
32
When are biologics contraindicated?
Latent TB
33
What does a DAS28 score of <2.6 mean?
Remission
34
What does a DAS28 score of 2.7-3.2 mean?
Low activity
35
What does a DAS28 score of 3.3-5.1 mean
Moderate activity
36
What does a DAS28 score of >5.1 mean?
High activity
37
What gene are most seronegative arthropathy patients positive for?
HLA-B27
38
Which conditions causes chronic inflammation in the spine and SI joints?
Ank spon
39
Who is commonly affected in ank spon?
Men, aged 20-40
40
What happens to the curvature of the back in ank spon?
Loss of lumbar lordosis and increased thoracic kyphosis
41
Which test can be done for ank spon?
Schober's test
42
What will x-rays show in ank spon?
Sclerosis, fusion of SI joints, bony spurs/syndesmophytes, bamboo spine
43
Which condition is a bamboo spine indicative of?
Ank spon
44
How is ank spon treated?
Phyio, NSAIDs, anti-TNF inhibitors if aggressive
45
Should DMARDs be given in ank spon?
Only if peripheral joint involvement, these have no effect on the spine
46
How does psoriatic arthritis manifest?
Asymmetrical arthritis with spondylitis, dactylitis, enthesis and (obvs) co-existing psoriasis
47
What term is given to the specific aggressive destruction of DIP joints in psoriatic arthritis?
Arthritis multicans
48
How is psoriatic arthritis treated?
Methotrexate, moving to anti-TNF if unresponsive
49
Who gets enteropathic arthritis?
Crohn's and Colitis patients
50
When does reactive arthritis occur?
1-3 weeks post infection
51
Which infections most commonly lead to reactive arthiritis?
GU - Chlamydia, neiserria
| GI - salmonella, campylobacter
52
What is Reiter's syndrome?
Urethritis, uveitis, arthritis
53
How is reactive arthritis managed?
Treat the cause
| DMARDs if chronic
54
What criteria is used to assess SLE?
SLICC, >3 must be met with 1 clinical and 1 lab
55
What are the clinical components of the SLICC criteria for SLE? (8)
Cutaneous lupus, oral/nasal ulcers, non-scarring alopecia, arthritis, serositis, anaemia, leukopenia and thrombocytopenia
56
Which groups are more likely to present with SLE?
Women, black, FHx, 20-30s
57
How many SLE present?
Non-specific symptoms, malar rash, arthralgia and photosensitivity
58
What does FBC show with SLE?
Low C3/C4
59
What test should be done in SLE to check for renal involvement?
Urinalysis
60
How is SLE treated?
Hydroxychloroquine, topical steroids, NSAIDs for skin disease and arthralgia
IV steroid and cyclophosphamide in severe
61
What characterises sjogren's syndrome?
Lymphocytic infiltrates in exocrine organs
62
What test is done for Sjogren's syndrome?
Schirmer's test
63
How many Sjogren's present?
Dry eyes, mouth, vagina, arthralgia and parotid swelling
64
How is Sjogren's diagnosed?
Must have 4 of:
| oral symptoms, ocular symptoms, schrimer positive, oral signs, minor salivary gland biopsy positive, antibodies present
65
How is Sjogren's treated?
Symptomatically.
| Lubricating eye drops, saliva replacement, pilocarpine, hydroxychloroquine for arthralgia and disease
66
How many the lungs be involved in systemic sclerosis?
Pulmonary hyper tension, pulmonary fibrosis
67
What are the major features of systemic sclerosis
Sclerosis on arms, face and neck (limited)
68
What is systemic sclerosis?
Abnormal growth of connective tissue
69
What are minor features of systemic sclerosis?
Sclerodactyly, atrophy of finger tips, bilateral lung fibrosis
70
How is systemic sclerosis diagnosed?
1 major and 1 minor criteria must be present
71
What is the difference between diffuse and limited systemic sclerosis?
Diffuse is rapidly growing and involves trunk
| Limited is neck arms. face
72
Which other rheumatological conditions may be seen with systemic sclerosis?
Inflammatory arthritis and myositis
73
How is systemic sclerosis treated?
```
Symptomatically.
Raynaud's: CCBs, iloprost, bosentan
Renal: ACEi
GI: PPI
Lungs: cyclophosphamide
```
74
What is bosentan?
Endothelin receptor antagonist
75
What is catastrophic anti-phospholipid syndrome?
Fatal manifestation of anti-phospholipid syndrome with multiorgan infarctions over days-weeks
76
What might investigated show in anti-phospholipid syndrome?
Thrombocytopenia, long APTT
77
What characterises anti-phospholipid syndrome?
Recurrent venous, arterial thrombosis or foetal loss
78
How is anti-phospholipid syndrome treated?
Anti-coags if there is an episode of thrombosis
| LMWH during pregnancy
79
What is gout?
Arthropathy caused by crystals in a joint
80
What can cause gout?
High uric acid levels (pot. due to renal under-excretion)
81
Where is gout most common
Big toe, first MTP
82
How long does gout last?
7-10 days
83
What are gouty tophi?
Painless accumulations of uric acid
84
What can chronic gout result in?
Erosive arthritis
85
Describe the crystals found in gout
Negatively bifringent needle shaped crystals
86
How is gout treated?
NSAID, corticosteroid and analgesics (colchicine if NSAID intolerant)
87
How is gout prophylactically treated?
Allopurinol, commenced once attack is resovled
88
Describe the crystals in pseudogout
Calcium pyrophosphate crystals
89
What is chondrocalcinosis?
When calcium pyrophosphate crystals deposit in soft tissue with no inflammation
90
Which conditions is psuedogout a/w?
Hyperparathyroidism, hypothyroidism, Wilson's disease, haemochromatosis
91
Where is polymyalgia rheumatica commonly painful?
Proximal hip and shoulder girdle
92
Which vasculitis is polymyalgia rheumatic a/w?
GCA
93
How does polymyalgia rheumatic present?
Myalgia and morning stiffness lasting >1 hour
94
How is polymyalgia rhuematica treated?
15mg prednisolone daily gradually reduced over 18 months
95
Why might a temporal artery biopsy be negative in GCA?
Patchy infiltration
96
How does GCA present?
Visual disturbance, headache, jaw claudication, scalp tenderness, fatigue and fever
97
What is the risk of GCA?
Visual loss
98
How is GCA treated?
Corticosteroids 40mg if no visual impairment, 60mg if visual impairment, taper over 2 years
99
What is polymyositis?
Idiopathic inflammatory myopathy causing symmetrical proximal muscle weakness
100
Who is more likely to get polymyositis?
Women, age 45-60
101
What GI symptoms occurs in 1/3rd of patients?
Dysphagia due to oropharyngeal and oesophageal involvement
102
What investigations should be done in polymyositis?
MRI for muscle abnormality, muscle biopsy and EMG
103
What does the muscle biopsy show in polymyositis?
Inflammation, necrosis and regeneration
104
How is polymyositis treated?
Prednisolone 40mg with methotrexate
105
What is dermatomyositis?
Polymyositis with skin features
106
What are the skin features in dermatomyositis?
V shaped rash over chest, heliotrope rash, Gottron's papules
107
What are dermatomyositis patients more at risk of?
Malignancy
108
How is fibromyalgia diagnosed?
Muscle pain and fatigue for >3 months with no other explanation
109
Which group are more likely to present with fibromyalgia?
Young women
110
What other symptoms occurs in fibromyalgia?
Lower threshold or pain, heat, noise, smell
111
How is fibromyalgia managed
Graded exercise, activity pacing
| Tricyclics (amitriptyline), gabapentin and pregabalin
112
What is vasculitis?
Inflammation of the blood vessels
113
How is vasculitis classified?
Chapel Hill consensus
114
What are the two main types of large vessel vasculitis?
GCA and Takayasu arteritis
115
How does large vessel vasculitis present?
Low-grade fever, malaise, night sweat, arthalgia
116
What can untreated large vessel vasculitis lead to?
Stenosis or aneurysm
117
What do investigations show in large vessel vasculitis?
High inflammatory markers, thickened vessel walls on MRI
118
How is large vessel vasculitis treated?
40-60mg corticosteroid and gradually reduce
119
What is small vessel vasculitis divided into?
ANCA positive and ANCA negative
120
Give three examples of ANCA positive vasculitis
GPA, EGPA and microscopic polyangiitis
121
Give one example of ANCA negative vasculitis
Henoch-Schonlein purpura
122
What are the symptoms of small vessel vasculitis?
Non-specific symptoms, non-blanching rash, arthralgia, lung opacities, GN
123
How does GPA present?
ENT symptoms, haemoptysis, cavitating lesions x-ray
| a/w cANCA and PR3
124
How does EGPA present?
Late onset asthma, rhinitis, raised eosinophils
125
How is small vessel vasculitis treated?
IV steroids and cyclophosphamide
126
What is Henoch-Scholein Purpura (HSP)?
IgA mediated disorder a/w vasculitis of the skin, GI tract, kidneys and joints
127
How does HSP present?
Purpuric rash over buttocks and lower limbs, abdo pain, vomiting, joint pain
