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My MSK flashcards > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

most specific marker for RA?

A

anti CCP

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2
Q

treatment for inflammatory arthritis / moderate organ involvement in SLE?

A

Azathioprine

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3
Q

treatment for severe organ involvement in SLE? what if is it resistant to this?

A

IV Steroids

IV Ig if resistant

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4
Q

Tx for arthralgia in Sjogrens ?

A

Hydroxychloroquine

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5
Q

systemic sclerosis can cause hypertension - which causes failure of which organ?

A

the kidneys

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6
Q

what organs are affected by systemic sclerosis?

A

lungs
cardiac muscle
kidneys - due to persistant hypertension

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7
Q

what does CREST stand for in systemic sclerosis?

A 
Calcification deposits on skin
Reynauds
Eosophageal - acid reflux and poor motility
Sclerodactyly
Telangiactasia
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8
Q

3 features of Antiphospholipid Syndrome

A

fetal death
recurrent thrombolytic events
thrombocytopaenia
** MIGRANES ALSO VERY COMMON ***

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9
Q

in what condition does Livedo reticularis occur in?

A

anti phospholipid

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10
Q

a pregnant women with anti phospholipid syndrome will be on what drugs?

A

normally - anticoagulants
now = LMWH and aspirin
(warfarin is teratogenic)

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11
Q

3 features of dermatomyositis

A

heliotrope and shawl rashes

gottion finger papules

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12
Q

gabapentin can be given for fibromyalgia. what class of drug is it?

A

an anti-epileptic

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13
Q

what is the main immune molecule in HSP?

A

IgA

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14
Q

what are the 2 non anca small cell vasculitises?

A

HSP

Cryoglobulinaemia

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15
Q

where do GPA and EGPA affect?

A

resp tract and small / medium vessels

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16
Q

sally has a raised, non blanching purpuric rash, arthralgia and
Mononeuritis multiplex. what could she have ?

A

any small cell vasculitis

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17
Q

stavri has a severe kidney infection, a vasculitic rash, SOB and a shaddle shaped nose. what do you think she has?

A

GPA is the most likely small cell vasculitis because of the saddle shaped nose - due to cartilage ischaemia.

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18
Q

how do you treat small cell ANCA vasculitis?

A

IV steroids

Cyclophosphamide (chemo drug)

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19
Q

how do you treat non ANCA vasculitis?

A

you don’t
resolves in 8 weeks
keep doing urinalysis tho :)

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20
Q

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?

A

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
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21
Q

what is more specific for sjogrens?

a) Anti Ro
b) Anti La

A

it is B - anti La.

Anti Ro can be positive in sjogrens and SLE.

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22
Q

tests positive for anti-cardiolipin?

A

anti phospholipid

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23
Q

tests positive for lupus anticoagulant

a) SLE
b) systemic sclerosis
c) anti phospholipid

A

C - antiphospholipid

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24
Q

MCTD has 2 markers but they aren’t very specific because lots of other diseases are + for them too. what are they?

A
  1. ANA

2. Anti RNP

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25
Q

Susie’s systemic sclerosis is only on her forearms and shins. what antibody is positive?

A

anti-centromere

she has limited SS.

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26
Q

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?

A

diffuse SSc

anti-SCl-70 is positive

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27
Q

what causes organ damage in Systemic sclerosis?

A

excessive calcification deposits - renal and lung mainly!! pulmonary hypertension is serious - 12% of SSc deaths.

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28
Q

facial features of systemic sclerosis?

A

tightening of the skin of the nose = beaking
tight lips
telangiectasia (T of CREST)

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29
Q

in SSc what is the skin like before it goes atrophic?

A

oedematous to begin with.

in hands - almost always have Reynaulds early on!!

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30
Q

what is anti-Jo1 positive for?

a) SLE?
b) MCTD?
c) anti phospholipid syndrome?
d) myositis?

A

D = myositis. only

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31
Q

what type of immune response is SLE?

A

type 3 - complexes attack basement membranes

32
Q

pattern of psoriatic arthritis

A

asymmetrical
elbow,wrists,palms
knees,ankles, toes

33
Q

development of RA..
1. first joints affected:
2 then:
3. in severe disease:

A

1 - small joints of hands and feet, not DIP
2- large joints - knees shoulders elbows
3 - cervical spine, risk of A.A subluxation.

34
Q

extra-articular features of RA

  • elbows
  • lungs
  • CVS
  • eyes
A
  • rheumatoid nodules
  • pulm nodules. effusions and fibrosis
  • worsens CVS health
  • common eg uveitis
35
Q

what DAS 28 score do you need to be able to have biologics?

A

over 5.1 !!! (severe)

36
Q

is a DAS 28 score of 3.7 in the low or moderate category?

A

MODERATE (3.3 - 5.1)

37
Q

is a DAS 28 score of 2.9 in remission??

A

NO
in remission is < 2.6

low is 2.6 – 3.2

38
Q

are DMARDS recommended for ankylosing spondylitis?

A

not for treating spinal disease - only if there is peripheral joint inflammation.

39
Q

hand features of psoriatic arthritis?

A

pitting
onycholysis - lifting off the nailbed.
dactylitis also

40
Q

Tx for psoriatic arthritis

A

DMARDs are good.
antiTNF if unresponsive
potentially replacement

41
Q

pattern of enteropathic arthritis

A

asymmetrical large joints - spine included.

42
Q

treatment of reactive arthritis
1 - acute
2 - chronic

A

1 - treat the infection. symptomatic relief (including steroid injections)
2 - DMARDS sometimes used

43
Q 
treatment of sjogrens
1 - eyes
2- mouth
3- teeth
4- arthralgia
5- fatigue
6 - ILD
A 
1- eyedrops
2- saliva stimulation / replacement
3- very good dental care
4 - hydroxychloroquine
5- hydroxychloroquine
6- other immunosuppression.
44
Q

what is a spinal complication of RA?

A

atlano-axial subluxation

45
Q

how do you investigate RA?

A
  1. autoantibodies - RFactor and anti CCP
  2. inflammatory markers - raised CRP, PV and ESR
  3. X ray - early signs are uncommon, look for peri-articular osteopenia and soft tissue swelling
46
Q

how do you treat RA?

A
  1. most importantly, start DMARDS (methotrexate) within 3 months of onset
  2. consider NSAIDS and other steroids for pain relief
  3. if unresponsive - antiTNF biologics (if DAS 28 score is over 5.1 as severe)
47
Q

what are the potential side effects of RA treatment?

A

immunosuppression - infection
steroids - lots, inc osteoporosis, weight gain
biologics - reactivation of latent TB

48
Q

what is HLA B27 ?

A

a marker of seronegative arthropathies

49
Q

age and gender of typical ankylosing spondylitis patient?

A

male (3:1) and 20-40 years old

50
Q

in ank spon, in addition to uveitis, amyloidosis and pulmonary fibrosis, what else occurs?

A

aortitis

51
Q

treatment of ank spondylitis

A

physio
NSAIDS
anti TNF
peripheral arthritis adittionally –> give DMARDS

52
Q

1st and 2nd line Tx for psoriatic arthrisis?

A
  1. DMARDS

2. anti TNF

53
Q

3 features of Reiters?

A

reactive arthriss…

  1. uvieitis
  2. urethritis
  3. arthritis
54
Q

treatment of acute reactive arthritis?

A

just treat the underlying infection and give steroids for symptomatic relief
DMARDS ONLY FOR CHRONIC !!!

55
Q

how do you treat someone with raynauds caused by systemic sclerosis?

A

calcium channel blockers

56
Q

how do you treat someone who’s renal system is affected by systemic sclerosis, causing hypertension?

A

ACE inhibitors

57
Q

how do you treat someone with pulmonary fibrosis caused by systemic sclerosis?

A

immunosuppression, usually with cyclophosphamide.

58
Q

what is the criteria for a diagnosis of systemic sclerosis/

A

1 major and 2 minor features

59
Q

in systemic sclerosis, WHERE are the….
- “major” features?

  • “minor” features??
A

Major: skin sclerosis that affects the arms, face, and/or neck

Minor: sclerodactyly +atrophy of the fingertips and bilateral lung fibrosis.

60
Q

causes of gout? (3)

A

build up of uric acid

  1. poor renal excretion - made worse by renal failure or diuretics
  2. excessive intake via red meat, wine
  3. may be a genetic cause
61
Q

what is podagra?

A

gout in the 1st MTP joint

62
Q

2nd and 3rd most common gout sites?

A

ankle and knee

63
Q

Tx of acute gout?

A

NSAIDs, corticosteroids, opioid analgesics and colchicine for patients who cannot tolerate NSAID

64
Q

cause of pseudogout?

A

build up of calcium pyrophosphate

65
Q

what is chondrocalcinosis?

A

a term for calcium pyrophosphate deposition (pseudogout)

without inflammation

66
Q

S/E of allopurinol in psueudogout

A

trick question - allopurinol isn’t used for pseudogout, there is no prophylaxis for it at all

67
Q

which is postivive / negative birefringent….

  • gout
  • pesudogout
A

gout= negative

pseudo = positive

68
Q

what cancer is predisposed with sjogrens?

A

lymphoma

69
Q

what is NOT a cause of chest pain in SLE?

  • a. Pleurisy
    b. Myocardial infarction
    c. Pulmonary embolus
    d. Pericarditis
    e. Pneumothorax
A

E = pneumothorax

70
Q

what heart defect can occur in seronegative arthropathies?

A

aortic valve incompetence

71
Q

what do you expect to find on aspiration of a reactive arthritis?

A

nothing!!
sterile = reactive
positive for microorg = septic!!

72
Q

s/e of corticosteroids

a. Wheeze
b. Constipation
c. Dyspepsia
d. Renal impairment
e. Increased cardiovascular risk

A

C,D and E

constipation - more common in opiates

73
Q

6 “A”s of ankylosing spondylitis

head to toe

A 
anterior uveitis
axial arthritis
apical fibrosis
aortic regurgitation
amyloidosis
achilles tendonitis
74
Q

SLE treatment

  • skin
  • arthropathy + organs
  • severe organ
  • unresponsive
A

skin = topical steroids, NSAIDS
arthropathy/ organs - Azathioprine / short time steroids
severe organ - IV steroids, cyclophosphamide
unresponsive - IV Immunoglobulins / antiTNFa Ritixumab

75
Q

what is CAPS?

A

catastrophic anti phospholipid syndrome
multiple organ infarctions in short period
50% fatal

76
Q

treatment of Anti phospholipid syndrome?

when #preggers ?

A

lifetime of anticoagulation

pregnant = LMWH + aspirin throughout

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