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CORTEXT > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

For which conditions is this antibody positive: anti-CCP

A

Rh arthritis

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2
Q

For which conditions is this antibody positive: ANA

A

SLE, sjogren’s, systemic sclerosis, MCTD, autoimmune liver disease

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3
Q

For which conditions is this antibody positive: Anti-dsDNA

A

SLE

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4
Q

For which conditions is this antibody positive: Anti-Sm

A

SLE

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5
Q

For which conditions is this antibody positive: Anti-Ro

A

SLE, sjogren’s

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6
Q

For which conditions is this antibody positive: Anti-La

A

sjogren’s

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7
Q

For which conditions is this antibody positive: Anti-centromere

A

limited systemic slcerosis

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8
Q

For which conditions is this antibody positive: Anti-Scl-70

A

Diffuse systemic sclerosis

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9
Q

For which conditions is this antibody positive: Anti-RNP

A

SLE, MCTD

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10
Q

For which conditions is this antibody positive: Anti-Jo-1

A

Myositis

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11
Q

For which conditions is this antibody positive: Anticardiolipin

A

Anti-phospholipid syndrome

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12
Q

For which conditions is this antibody positive: Lupus anti-coagulant

A

Anti-phospholipid syndrome

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13
Q

For which conditions is this antibody positive: ANCA

A

Vasculitis (Small vessel)

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14
Q

What is the pathophysiology of OA?

A

Joint wear and tear, with an imbalance between joint wear and repair

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15
Q

What can predisposes to secondary OA?

A

Deformity, previous injury to joint

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16
Q

What is seen on x-ray for OA?

A

LOSS

Loss of joint space, osteophytes, sclerosis, subchondral cysts

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17
Q

How is OA treated?

A

Pain control with simple drugs or mild opiates, physio, weight loss, joint replacement

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18
Q

What are signs of an inflammatory problems in the joints?

A

Morning stiffness
Joint swelling
Joint pain relived on exercise

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19
Q

Which joints does Rh arthritis affect?

A

Small joints of hands and feet first

then big joints

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20
Q

Is RhA symmetrical or asymmetrical?

A

Symmetrical

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21
Q

Which group is most at risk of RhA?

A

Women aged 35-50

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22
Q

What is the pathophysiology of RhA?

A

Immune processes attack the synovium, pannus forms which attacks articular cartilages eading to joint destruction

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23
Q

Which criteria can be used to assess RhA?

A

ACR and EULAR

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24
Q

How may RhA present?

A

Symmetrical synovitis, pain, morning stiffness, rheumatoid nodules on extensor surfaces

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25
Q

What lung involvement can be seen in RhA?

A

Pleural effusion, interstita. fibrosis and pulmonary nodules

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26
Q

What eye involvement can be seen in RhA?

A

Keratoconjunctivitis sicca, episcleritis, uveitis, nodular scleritis

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27
Q

What is seen on FBC in RhA?

A

Raised CRP, ESR, PV

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28
Q

What do X-rays show on RhA?

A

Periarticular osteopenia, swelling

Erosions late in the disease

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29
Q

What therapies are given for RhA?

A

DMARD within 3 months of symptom onset (methotrexate); NSAIDs, steroids for pain relief

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30
Q

What is a risk of DMARDs?

A

Bone marrow suppresion

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31
Q

If disease unresponse to DMARD therapy what can be used?

A

Biologics - anti-TNG; toclzumab, tituximab, abatacept

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32
Q

When are biologics contraindicated?

A

Latent TB

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33
Q

What does a DAS28 score of <2.6 mean?

A

Remission

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34
Q

What does a DAS28 score of 2.7-3.2 mean?

A

Low activity

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35
Q

What does a DAS28 score of 3.3-5.1 mean

A

Moderate activity

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36
Q

What does a DAS28 score of >5.1 mean?

A

High activity

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37
Q

What gene are most seronegative arthropathy patients positive for?

A

HLA-B27

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38
Q

Which conditions causes chronic inflammation in the spine and SI joints?

A

Ank spon

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39
Q

Who is commonly affected in ank spon?

A

Men, aged 20-40

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40
Q

What happens to the curvature of the back in ank spon?

A

Loss of lumbar lordosis and increased thoracic kyphosis

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41
Q

Which test can be done for ank spon?

A

Schober’s test

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42
Q

What will x-rays show in ank spon?

A

Sclerosis, fusion of SI joints, bony spurs/syndesmophytes, bamboo spine

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43
Q

Which condition is a bamboo spine indicative of?

A

Ank spon

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44
Q

How is ank spon treated?

A

Phyio, NSAIDs, anti-TNF inhibitors if aggressive

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45
Q

Should DMARDs be given in ank spon?

A

Only if peripheral joint involvement, these have no effect on the spine

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46
Q

How does psoriatic arthritis manifest?

A

Asymmetrical arthritis with spondylitis, dactylitis, enthesis and (obvs) co-existing psoriasis

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47
Q

What term is given to the specific aggressive destruction of DIP joints in psoriatic arthritis?

A

Arthritis multicans

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48
Q

How is psoriatic arthritis treated?

A

Methotrexate, moving to anti-TNF if unresponsive

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49
Q

Who gets enteropathic arthritis?

A

Crohn’s and Colitis patients

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50
Q

When does reactive arthritis occur?

A

1-3 weeks post infection

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51
Q

Which infections most commonly lead to reactive arthiritis?

A

GU - Chlamydia, neiserria

GI - salmonella, campylobacter

52
Q

What is Reiter’s syndrome?

A

Urethritis, uveitis, arthritis

53
Q

How is reactive arthritis managed?

A

Treat the cause

DMARDs if chronic

54
Q

What criteria is used to assess SLE?

A

SLICC, >3 must be met with 1 clinical and 1 lab

55
Q

What are the clinical components of the SLICC criteria for SLE? (8)

A

Cutaneous lupus, oral/nasal ulcers, non-scarring alopecia, arthritis, serositis, anaemia, leukopenia and thrombocytopenia

56
Q

Which groups are more likely to present with SLE?

A

Women, black, FHx, 20-30s

57
Q

How many SLE present?

A

Non-specific symptoms, malar rash, arthralgia and photosensitivity

58
Q

What does FBC show with SLE?

A

Low C3/C4

59
Q

What test should be done in SLE to check for renal involvement?

A

Urinalysis

60
Q

How is SLE treated?

A

Hydroxychloroquine, topical steroids, NSAIDs for skin disease and arthralgia
IV steroid and cyclophosphamide in severe

61
Q

What characterises sjogren’s syndrome?

A

Lymphocytic infiltrates in exocrine organs

62
Q

What test is done for Sjogren’s syndrome?

A

Schirmer’s test

63
Q

How many Sjogren’s present?

A

Dry eyes, mouth, vagina, arthralgia and parotid swelling

64
Q

How is Sjogren’s diagnosed?

A

Must have 4 of:

oral symptoms, ocular symptoms, schrimer positive, oral signs, minor salivary gland biopsy positive, antibodies present

65
Q

How is Sjogren’s treated?

A

Symptomatically.

Lubricating eye drops, saliva replacement, pilocarpine, hydroxychloroquine for arthralgia and disease

66
Q

How many the lungs be involved in systemic sclerosis?

A

Pulmonary hyper tension, pulmonary fibrosis

67
Q

What are the major features of systemic sclerosis

A

Sclerosis on arms, face and neck (limited)

68
Q

What is systemic sclerosis?

A

Abnormal growth of connective tissue

69
Q

What are minor features of systemic sclerosis?

A

Sclerodactyly, atrophy of finger tips, bilateral lung fibrosis

70
Q

How is systemic sclerosis diagnosed?

A

1 major and 1 minor criteria must be present

71
Q

What is the difference between diffuse and limited systemic sclerosis?

A

Diffuse is rapidly growing and involves trunk

Limited is neck arms. face

72
Q

Which other rheumatological conditions may be seen with systemic sclerosis?

A

Inflammatory arthritis and myositis

73
Q

How is systemic sclerosis treated?

A 
Symptomatically. 
Raynaud's: CCBs, iloprost, bosentan
Renal: ACEi
GI: PPI
Lungs: cyclophosphamide
74
Q

What is bosentan?

A

Endothelin receptor antagonist

75
Q

What is catastrophic anti-phospholipid syndrome?

A

Fatal manifestation of anti-phospholipid syndrome with multiorgan infarctions over days-weeks

76
Q

What might investigated show in anti-phospholipid syndrome?

A

Thrombocytopenia, long APTT

77
Q

What characterises anti-phospholipid syndrome?

A

Recurrent venous, arterial thrombosis or foetal loss

78
Q

How is anti-phospholipid syndrome treated?

A

Anti-coags if there is an episode of thrombosis

LMWH during pregnancy

79
Q

What is gout?

A

Arthropathy caused by crystals in a joint

80
Q

What can cause gout?

A

High uric acid levels (pot. due to renal under-excretion)

81
Q

Where is gout most common

A

Big toe, first MTP

82
Q

How long does gout last?

A

7-10 days

83
Q

What are gouty tophi?

A

Painless accumulations of uric acid

84
Q

What can chronic gout result in?

A

Erosive arthritis

85
Q

Describe the crystals found in gout

A

Negatively bifringent needle shaped crystals

86
Q

How is gout treated?

A

NSAID, corticosteroid and analgesics (colchicine if NSAID intolerant)

87
Q

How is gout prophylactically treated?

A

Allopurinol, commenced once attack is resovled

88
Q

Describe the crystals in pseudogout

A

Calcium pyrophosphate crystals

89
Q

What is chondrocalcinosis?

A

When calcium pyrophosphate crystals deposit in soft tissue with no inflammation

90
Q

Which conditions is psuedogout a/w?

A

Hyperparathyroidism, hypothyroidism, Wilson’s disease, haemochromatosis

91
Q

Where is polymyalgia rheumatica commonly painful?

A

Proximal hip and shoulder girdle

92
Q

Which vasculitis is polymyalgia rheumatic a/w?

A

GCA

93
Q

How does polymyalgia rheumatic present?

A

Myalgia and morning stiffness lasting >1 hour

94
Q

How is polymyalgia rhuematica treated?

A

15mg prednisolone daily gradually reduced over 18 months

95
Q

Why might a temporal artery biopsy be negative in GCA?

A

Patchy infiltration

96
Q

How does GCA present?

A

Visual disturbance, headache, jaw claudication, scalp tenderness, fatigue and fever

97
Q

What is the risk of GCA?

A

Visual loss

98
Q

How is GCA treated?

A

Corticosteroids 40mg if no visual impairment, 60mg if visual impairment, taper over 2 years

99
Q

What is polymyositis?

A

Idiopathic inflammatory myopathy causing symmetrical proximal muscle weakness

100
Q

Who is more likely to get polymyositis?

A

Women, age 45-60

101
Q

What GI symptoms occurs in 1/3rd of patients?

A

Dysphagia due to oropharyngeal and oesophageal involvement

102
Q

What investigations should be done in polymyositis?

A

MRI for muscle abnormality, muscle biopsy and EMG

103
Q

What does the muscle biopsy show in polymyositis?

A

Inflammation, necrosis and regeneration

104
Q

How is polymyositis treated?

A

Prednisolone 40mg with methotrexate

105
Q

What is dermatomyositis?

A

Polymyositis with skin features

106
Q

What are the skin features in dermatomyositis?

A

V shaped rash over chest, heliotrope rash, Gottron’s papules

107
Q

What are dermatomyositis patients more at risk of?

A

Malignancy

108
Q

How is fibromyalgia diagnosed?

A

Muscle pain and fatigue for >3 months with no other explanation

109
Q

Which group are more likely to present with fibromyalgia?

A

Young women

110
Q

What other symptoms occurs in fibromyalgia?

A

Lower threshold or pain, heat, noise, smell

111
Q

How is fibromyalgia managed

A

Graded exercise, activity pacing

Tricyclics (amitriptyline), gabapentin and pregabalin

112
Q

What is vasculitis?

A

Inflammation of the blood vessels

113
Q

How is vasculitis classified?

A

Chapel Hill consensus

114
Q

What are the two main types of large vessel vasculitis?

A

GCA and Takayasu arteritis

115
Q

How does large vessel vasculitis present?

A

Low-grade fever, malaise, night sweat, arthalgia

116
Q

What can untreated large vessel vasculitis lead to?

A

Stenosis or aneurysm

117
Q

What do investigations show in large vessel vasculitis?

A

High inflammatory markers, thickened vessel walls on MRI

118
Q

How is large vessel vasculitis treated?

A

40-60mg corticosteroid and gradually reduce

119
Q

What is small vessel vasculitis divided into?

A

ANCA positive and ANCA negative

120
Q

Give three examples of ANCA positive vasculitis

A

GPA, EGPA and microscopic polyangiitis

121
Q

Give one example of ANCA negative vasculitis

A

Henoch-Schonlein purpura

122
Q

What are the symptoms of small vessel vasculitis?

A

Non-specific symptoms, non-blanching rash, arthralgia, lung opacities, GN

123
Q

How does GPA present?

A

ENT symptoms, haemoptysis, cavitating lesions x-ray

a/w cANCA and PR3

124
Q

How does EGPA present?

A

Late onset asthma, rhinitis, raised eosinophils

125
Q

How is small vessel vasculitis treated?

A

IV steroids and cyclophosphamide

126
Q

What is Henoch-Scholein Purpura (HSP)?

A

IgA mediated disorder a/w vasculitis of the skin, GI tract, kidneys and joints

127
Q

How does HSP present?

A

Purpuric rash over buttocks and lower limbs, abdo pain, vomiting, joint pain

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