Rheumatology Flashcards
most specific marker for RA?
anti CCP
treatment for inflammatory arthritis / moderate organ involvement in SLE?
Azathioprine
treatment for severe organ involvement in SLE? what if is it resistant to this?
IV Steroids
IV Ig if resistant
Tx for arthralgia in Sjogrens ?
Hydroxychloroquine
systemic sclerosis can cause hypertension - which causes failure of which organ?
the kidneys
what organs are affected by systemic sclerosis?
lungs
cardiac muscle
kidneys - due to persistant hypertension
what does CREST stand for in systemic sclerosis?
Calcification deposits on skin Reynauds Eosophageal - acid reflux and poor motility Sclerodactyly Telangiactasia
3 features of Antiphospholipid Syndrome
fetal death
recurrent thrombolytic events
thrombocytopaenia
** MIGRANES ALSO VERY COMMON ***
in what condition does Livedo reticularis occur in?
anti phospholipid
a pregnant women with anti phospholipid syndrome will be on what drugs?
normally - anticoagulants
now = LMWH and aspirin
(warfarin is teratogenic)
3 features of dermatomyositis
heliotrope and shawl rashes
gottion finger papules
gabapentin can be given for fibromyalgia. what class of drug is it?
an anti-epileptic
what is the main immune molecule in HSP?
IgA
what are the 2 non anca small cell vasculitises?
HSP
Cryoglobulinaemia
where do GPA and EGPA affect?
resp tract and small / medium vessels
sally has a raised, non blanching purpuric rash, arthralgia and
Mononeuritis multiplex. what could she have ?
any small cell vasculitis
stavri has a severe kidney infection, a vasculitic rash, SOB and a shaddle shaped nose. what do you think she has?
GPA is the most likely small cell vasculitis because of the saddle shaped nose - due to cartilage ischaemia.
how do you treat small cell ANCA vasculitis?
IV steroids
Cyclophosphamide (chemo drug)
how do you treat non ANCA vasculitis?
you don’t
resolves in 8 weeks
keep doing urinalysis tho :)
Robbie has a purpuric rash over his bum and legs. he has a sore tummy. He has been sick 4 times in the last 24 hours. what do you expect in his recent PMH?
Robbie has HSP
- acute onset is important
- also ask if he had an URTI or GI infection in the last few weeks
- classically a G.A.S infection
what is more specific for sjogrens?
a) Anti Ro
b) Anti La
it is B - anti La.
Anti Ro can be positive in sjogrens and SLE.
tests positive for anti-cardiolipin?
anti phospholipid
tests positive for lupus anticoagulant
a) SLE
b) systemic sclerosis
c) anti phospholipid
C - antiphospholipid
MCTD has 2 markers but they aren’t very specific because lots of other diseases are + for them too. what are they?
- ANA
2. Anti RNP
Susie’s systemic sclerosis is only on her forearms and shins. what antibody is positive?
anti-centromere
she has limited SS.
Jamie has developed and thick tight atrophic skin all over his body in last 6 weeks. he has been SOB suddenly in the last 3 weeks. what antibody is positive?
diffuse SSc
anti-SCl-70 is positive
what causes organ damage in Systemic sclerosis?
excessive calcification deposits - renal and lung mainly!! pulmonary hypertension is serious - 12% of SSc deaths.
facial features of systemic sclerosis?
tightening of the skin of the nose = beaking
tight lips
telangiectasia (T of CREST)
in SSc what is the skin like before it goes atrophic?
oedematous to begin with.
in hands - almost always have Reynaulds early on!!
what is anti-Jo1 positive for?
a) SLE?
b) MCTD?
c) anti phospholipid syndrome?
d) myositis?
D = myositis. only
what type of immune response is SLE?
type 3 - complexes attack basement membranes
pattern of psoriatic arthritis
asymmetrical
elbow,wrists,palms
knees,ankles, toes
development of RA..
1. first joints affected:
2 then:
3. in severe disease:
1 - small joints of hands and feet, not DIP
2- large joints - knees shoulders elbows
3 - cervical spine, risk of A.A subluxation.
extra-articular features of RA
- elbows
- lungs
- CVS
- eyes
- rheumatoid nodules
- pulm nodules. effusions and fibrosis
- worsens CVS health
- common eg uveitis
what DAS 28 score do you need to be able to have biologics?
over 5.1 !!! (severe)
is a DAS 28 score of 3.7 in the low or moderate category?
MODERATE (3.3 - 5.1)
is a DAS 28 score of 2.9 in remission??
NO
in remission is < 2.6
low is 2.6 – 3.2
are DMARDS recommended for ankylosing spondylitis?
not for treating spinal disease - only if there is peripheral joint inflammation.
hand features of psoriatic arthritis?
pitting
onycholysis - lifting off the nailbed.
dactylitis also
Tx for psoriatic arthritis
DMARDs are good.
antiTNF if unresponsive
potentially replacement
pattern of enteropathic arthritis
asymmetrical large joints - spine included.
treatment of reactive arthritis
1 - acute
2 - chronic
1 - treat the infection. symptomatic relief (including steroid injections)
2 - DMARDS sometimes used
treatment of sjogrens 1 - eyes 2- mouth 3- teeth 4- arthralgia 5- fatigue 6 - ILD
1- eyedrops 2- saliva stimulation / replacement 3- very good dental care 4 - hydroxychloroquine 5- hydroxychloroquine 6- other immunosuppression.
what is a spinal complication of RA?
atlano-axial subluxation
how do you investigate RA?
- autoantibodies - RFactor and anti CCP
- inflammatory markers - raised CRP, PV and ESR
- X ray - early signs are uncommon, look for peri-articular osteopenia and soft tissue swelling
how do you treat RA?
- most importantly, start DMARDS (methotrexate) within 3 months of onset
- consider NSAIDS and other steroids for pain relief
- if unresponsive - antiTNF biologics (if DAS 28 score is over 5.1 as severe)
what are the potential side effects of RA treatment?
immunosuppression - infection
steroids - lots, inc osteoporosis, weight gain
biologics - reactivation of latent TB
what is HLA B27 ?
a marker of seronegative arthropathies
age and gender of typical ankylosing spondylitis patient?
male (3:1) and 20-40 years old
in ank spon, in addition to uveitis, amyloidosis and pulmonary fibrosis, what else occurs?
aortitis
treatment of ank spondylitis
physio
NSAIDS
anti TNF
peripheral arthritis adittionally –> give DMARDS
1st and 2nd line Tx for psoriatic arthrisis?
- DMARDS
2. anti TNF
3 features of Reiters?
reactive arthriss…
- uvieitis
- urethritis
- arthritis
treatment of acute reactive arthritis?
just treat the underlying infection and give steroids for symptomatic relief
DMARDS ONLY FOR CHRONIC !!!
how do you treat someone with raynauds caused by systemic sclerosis?
calcium channel blockers
how do you treat someone who’s renal system is affected by systemic sclerosis, causing hypertension?
ACE inhibitors
how do you treat someone with pulmonary fibrosis caused by systemic sclerosis?
immunosuppression, usually with cyclophosphamide.
what is the criteria for a diagnosis of systemic sclerosis/
1 major and 2 minor features
in systemic sclerosis, WHERE are the….
- “major” features?
- “minor” features??
Major: skin sclerosis that affects the arms, face, and/or neck
Minor: sclerodactyly +atrophy of the fingertips and bilateral lung fibrosis.
causes of gout? (3)
build up of uric acid
- poor renal excretion - made worse by renal failure or diuretics
- excessive intake via red meat, wine
- may be a genetic cause
what is podagra?
gout in the 1st MTP joint
2nd and 3rd most common gout sites?
ankle and knee
Tx of acute gout?
NSAIDs, corticosteroids, opioid analgesics and colchicine for patients who cannot tolerate NSAID
cause of pseudogout?
build up of calcium pyrophosphate
what is chondrocalcinosis?
a term for calcium pyrophosphate deposition (pseudogout)
without inflammation
S/E of allopurinol in psueudogout
trick question - allopurinol isn’t used for pseudogout, there is no prophylaxis for it at all
which is postivive / negative birefringent….
- gout
- pesudogout
gout= negative
pseudo = positive
what cancer is predisposed with sjogrens?
lymphoma
what is NOT a cause of chest pain in SLE?
- a. Pleurisy
b. Myocardial infarction
c. Pulmonary embolus
d. Pericarditis
e. Pneumothorax
E = pneumothorax
what heart defect can occur in seronegative arthropathies?
aortic valve incompetence
what do you expect to find on aspiration of a reactive arthritis?
nothing!!
sterile = reactive
positive for microorg = septic!!
s/e of corticosteroids
a. Wheeze
b. Constipation
c. Dyspepsia
d. Renal impairment
e. Increased cardiovascular risk
C,D and E
constipation - more common in opiates
6 “A”s of ankylosing spondylitis
head to toe
anterior uveitis axial arthritis apical fibrosis aortic regurgitation amyloidosis achilles tendonitis
SLE treatment
- skin
- arthropathy + organs
- severe organ
- unresponsive
skin = topical steroids, NSAIDS
arthropathy/ organs - Azathioprine / short time steroids
severe organ - IV steroids, cyclophosphamide
unresponsive - IV Immunoglobulins / antiTNFa Ritixumab
what is CAPS?
catastrophic anti phospholipid syndrome
multiple organ infarctions in short period
50% fatal
treatment of Anti phospholipid syndrome?
when #preggers ?
lifetime of anticoagulation
pregnant = LMWH + aspirin throughout
