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Rheumatology Flashcards

1
Q

What is an arthropathy?

A

DIsease of the joint

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2
Q

What is an arthritis?

A

Inflammation of the joint

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3
Q

What is arthralgia?

A

Pain in the joint

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4
Q

What is osteoarthritis?

A

Erosion of the joint cartilage

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5
Q

What causes OA?

A

Can be primary due to use or secondary to most things that damage joints

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6
Q

What should you look for on an XR for OA?

A

Loss of joint space
Osteophytes
Sclerosis
Subchondral cysts

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7
Q

How do you treat OA?

A

Pain management: analgesia and opiates
Physio
Joint replacement

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8
Q

What are the two broad categories of arthritis?

A

Inflammatory and non-inflammatory

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9
Q

What is the main form of non-inflammatory arthritis

A

Osteoarthritis

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10
Q

What are the four subcategories of inflammatory arthritis?

A

Seropositive
Seronegative
Infectious
Crystal induced

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11
Q

What are the two forms of crystal induced arthropathies?

A

Gout

Pseudogout

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12
Q

What is gout?

A

Negatively bifringic urate crystals deposit in joints

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13
Q

What causes gout?

A

Hyperuricemia- Renal disease, red meat, alcohol and seafood

Precipitation triggered by: dehydration, trauma or surgery

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14
Q

How does gout present?

A

Intense pain, redness, heat and swelling that lasts for 7-10 days.
Most common site is 1st MTP joint

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15
Q

How do you diagnose gout?

A

Look for negatively bifringic needle shaped crystals in synovial fluid

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16
Q

How do you treat gout?

A 
NSAIDs
Steroids
Analgesia
Colchicine
Allopurinol- to lower urate but can make flare worse so don't start when having one.
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17
Q

What is pseudogout?

A

Calcium pyrophosphate crystals in joint

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18
Q

Where is pseudogout often seen?

A

Knee
Wrist
Ankle

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19
Q

What causes pseudogout?

A

Cause unknown but often seen with OA

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20
Q

How do you treat pseudogout?

A

NSAIDs
Steroids
Colchicine

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21
Q

What is the main form of infectious arthritis?

A

Septic arthritis

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22
Q

What is septic arthritis?

A

Infection in the joint capsule

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23
Q

How can the joint capsule get infected?

A

Direct inoculation
Hematogenous spread
SPread from bone or soft tissue infection

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24
Q

What bacteria commonly cause septic arthritis?

A

S. Aureus
Strep
Coag -ive staph
Neisseria gonorrhoeae

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25
How does septic arthritis present?
Severe pain Redness Swelling Limited movement
26
How do you diagnose septic arthritis?
Look for bacteria in synovial fluid and exclude crystal arthropathies
27
How do you treat septic arthritis?
Presume S. Aureus so start high does flucloxacillin then switch to appropriate when diagnosed If <5YO Ceftriaxone
28
What is rheumatoid arthritis?
Production of autoantibodies against synovial lining which can also attach articular cartilage and tendons
29
What antibodies are seen in RA?
Anti-CCP
30
How does RA present?
Mainly affects small joints- PIP not DIP Symmetrical synovitis Pain Morning stiffness that takes >30 mins to ease
31
How can RA progress?
To large joints | C1/2 very problamatic
32
How do you diagnose RA?
Anti-CCP (prefered) or Rheumatoid factor Raised CRP, ESR and plasma viscosity Periarticular osteopenia and soft tissue swelling US for inflammation
33
How do you treat RA?
DMARDs w/in 3 months of symptoms Short term analgesia, NSAIDs and steroids Biological therapy if resistant Physio and OT etc
34
Give some examples of DMARDs
Methotrexate- 1st line but do NOT give in pregnancy | Sulfasalazine
35
Give some examples of biological agents
Anti-TNF alpha | Drugs ending in '-mab'
36
What does the DAS28 score measure?
RA disease state
37
What are the categories in DAS28?
<2.6- remision 2.7-5.1- Active >5.1- Highly active
38
What is the DAS28 cut off score for receiving biological therapies?
>5.1
39
What are the four seronegative arthropathies?
Ankylosing Spondylitis Enteropathic Arthritis Reactive Arthritis Psoriatic Arthritis
40
Which antigen is often elevated in seronegative arthropathies?
HLA‐B27 | CRP and ESR also elevated
41
What is Ankylosing Spondylitis?
Chronic inflammation of spine and SI joints
42
How does Ankylosing Spondylitis present?
Spine pain and stiffness Morning stiffness which eases with exercise Knee/hip arthritis '?' spine- loss of lumbar lordosis and increased thoracic kyphosis
43
How do you diagnose Ankylosing Spondylitis?
HLA‐B27 test Bamboo spine on XR Spinal movement with Schober's test (line 5cm below and 10cm above PSIC)
44
What complications can accompany ankylosing spondylitis?
Uvitis Aoritis Pulmonary fibrosis Amyloidosis
45
How do you treat ankylosing spondylitis?
Physio, exercise, NSAIDs, anti-TNF inhibitors | Surgery for knee/hip
46
What is enteropathic arthritis?
Inflammatory arthritis of peripheral joints in patients with IBD
47
How does enteropathic arthritis present?
Asymmetrical large joint oligoarthritis
48
How do you treat enteropathic arthritis?
Manage underlying condition
49
What is reactive arthritis?
Arthritis in response to infection in other part of body- usually STI or GI
50
How does reactive arthritis present?
Large joint inflammation 1-3 weeks after infection
51
What is Reiter's syndrome?
Uveitis, urethritis and arthritis combo associated with reactive arthritis.
52
What triad of complications is associated with reactive arthritis?
Uveitis, urethritis and arthritis- Reiter's syndrome
53
How do you treat reactive arthritis?
Usually self limiting but can relapse. | Treat underlying infection and relieve symptoms.
54
What is psoriatic arthritis?
Can occur w/ or w/o skin psoriasis
55
How does psoriatic arthritis present?
Usually asymmetrical but can mimic RA in hands | Nail pitting and lifting (onycholysis)
56
What complications are associated with psoriatic arthritis?
Spondylitis Dactylitis Enthesitis
57
How do you treat psoriatic arthritis?
DMARDs Anti-TNF alpha Joint replacement
58
What are the five seropositive arthropathies we need to know?
``` Rheumatoid Arthritis Systemic sclerosis Systemic lupus erythematosus Vasculitis Sjogren's disease ```
59
What is systemic sclerosis?
Fibrosis of skin and subcutaneous tissue but can get organ involvement.
60
What organs can be involved in systemic sclerosis?
Vasomotor- Gives Raynaud's Syndrome Renal Lungs GI
61
What are the two forms of systemic sclerosis?
Limited- Peripheral skin and little organ involvement | Diffuse- Central skin problems and lots of organ involvement
62
What auto antibody is associated with limited systemic sclerosis?
Anti-centromere AB
63
What auto antibody is associated with diffuse systemic sclerosis?
Anti-Scl-70 AB
64
What is important to check when systemic sclerosis presents?
Renal function | Renal failure kills!!!!!
65
How do you treat systemic sclerosis?
``` Depends on symptoms: Raynaud's syndrome- CaC Blockers Renal involvement- ACEI GI involvement- PPI Lung disease- Immunosuppression ```
66
What is Sjogren's Syndrome?
Autoimmune condition where lymphocytes infiltrate exocrine organs. Associated with anti-RO and anti-LA AB Can be primary or secondary to RA or SLE
67
How does Sjogren's syndrome present?
``` Dry eyes and mouth Arthralgia Fatigue Parotid gland swelling Lung involvement ```
68
How do you diagnose Sjogren's syndrome?
``` Need 4 of the following: Dry mouth for >3 months Dry mouth for >3 months Positive Schirmer's test (blotting paper on eyes) Abnormal salivary glands Positive salivary gland biopsy Positive RO and LA antibodies ```
69
How do you manage Sjogren's syndrome?
Eye drops Good dental care Hydroxychloroquine for arthralgia and fatigue Immunosuppres for lung involvement
70
What is Systemic Lupus Erythematosus?
Autoimmune condition what has a variable presentation
71
What systems can be involved in SLE?
``` Skin Joints Kidneys Blood cells Nervous system Vasculature Lungs GI ```
72
What causes SLE?
Inadequate clearing of apoptosed cell material leads to the development of antibodies against it.
73
What type of hypersensitivity reaction is SLE?
Type 3 as mediated by immune complexes
74
How does SLE present?
Variable
75
Give the systemic presentations of SLE
Fatigue Fever Weight loss
76
Give the MSK presentations of SLE
Arthralgia/myalgia Arthritis AVN
77
Give the dermatological presentations of SLE
``` Malar rash- Butterfly rash Photosensitivity DIscoid lupus Subcutaneous lupus Oral/nasal ulceration Raynaud's syndrome Alopecia ```
78
Give the renal presentation of SLE
Lupus nephritis
79
Give the respiratory presentations of SLE
``` Pleurisy Pleural effusion Pneumonitis PE Pulmonary hypertension Interstitial lung disease ```
80
Give the hematological presentations of SLE
Leukopenia Lymphopenia Anaemia
81
Give the neurological presentations of SLE
Seizures Psychosis Headaches Meningitis
82
Give the CV presentations of SLE
``` Pericarditis pericardial effusion Pulmonary hypertension Sterile endocarditis IDH ```
83
Give the GI presentations of SLE
Hepatitis Pancreatitis Mesenteric vasculitis
84
How do you test for SLE?
FBC for anaemia leukopenia and thrombocytopenia Urianalisis for glomerulonephritis Image for organ involvement Test antibodies
85
What auto antibodies are associated with SLE?
Anti-nuclear- Sensitive but not specific Anti-dsDNA- SPecific but varies w/ disease activity Anti-Sm- Specific but low sensitivity C3/4- Decrease in diseased state
86
How do you treat SLE?
Variable Skin- Hydroxychloroquine, steroids and NSAIDs Arthritis/organ involvement- Azathioprine + steroids If unresponsive use biological agents
87
How do you know if a drug is a biological agent?
Ends in '-mab'
88
How do you monitor SLE?
Check anti-dsDNA and C3/4 Urine for blood and protein BP and cholesterol
89
What is vasculitis?
Inflammation of blood vessels | Leads to thickening, stenosis and occlusion
90
What are the two main categories of vasculitis?
Large vessel | Small/medium vessel
91
What does large vessel vasculitis affect?
Aorta and major branches
92
How does large vessel vasculitis present?
Low grade fever, malaise, night sweats, weight loss, arthralgia, fatigue Claudications Decrease pulse and bruits
93
How do you diagnose large vessel vasculitis?
Raised ESR, CRP and PV | MR angiogram
94
How do you treat large vessel vasculitis?
Decreasing course of steroids form 40-60mg at start
95
What are the two categories of small/medium vessel vasculitis?
ANCA positive | ANCA negative
96
How does small/medium vessel vasculitis present?
Fever, weight loss, purpuric rash, arthralgia, glomerulonephritis, lung opacity on XR
97
What is the most common form for ANCA positive small/medium vessel vasculitis?
Granulomatosis w/ polyangiitis (GPA or Wegener's)
98
What addition features do Granulomatosis w/ polyangiitis (GPA or Wegener's) have?
Nose bleeds Deafness Collapse of nose
99
How do you detect small/medium vessel vasculitis?
``` Raised ESR, PV and CRP U+E for renal involvement ANCA antibody Urinalysis for renal vasculitis CXR Biopsy affected area ```
100
How do you treat small/medium vessel vasculitis?
IV steroids | Cyclophosphamide
101
What is mixed connective tissue disease?
Mix of symptoms seen in other connective tissue diseases
102
What symptoms can be seen in mixed connective tissue disease?
``` Raynaud's Myositis Sclerodactyly Pulmonary hypertension Interstitial lung disease ```
103
What auto antibody is associated with mixed connective tissue disease?
Anti-RNP AB
104
Why do patients with mixed connective tissue disease need checked regularly?
To look for pulmonary hypertension
105
What is Antiphospholipid syndrome?
Leads to recurrent arterial/venous thrombosis | Get fetal loss
106
What is a defining feature of antiphospholipid syndrome?
Livedo reticularis- Mottled skin
107
How do you diagnose antiphospholipid syndrome?
Thrombocytopenia and prolonged APTT | Positive for: lupus anticoagulant, anticardiolipin and anti-beta 2 glycoprotein
108
How do you treat antiphospholipid syndrome?
Anticoagulate- Warfarin (LMWH is pregnant)
109
What are the three muscle conditions we need to know?
FIbromyalgia Polymyalgia rheumatica and giant cell arteritis Polymyositis and dermatomyositis
110
What is fibromyalgia?
Unexplained muscle pain and fatigue. DIsease of central pain processing
111
How does fibromyalgia present?
``` Persistent (>3m) widespread pain Fatigue/disrupted sleep Cognitive difficulties Anxiety/depression Got to rule out everything else ```
112
How do you treat fibromyalgia?
Self-management Sympathy Psych help
113
What is polymyalgia rheumatica?
Chronic inflammation and pain of hip and shoulder girdles in >50YO Get morning stiffness lasting over 1 hour
114
How do you diagnose polymyalgia rheumatica?
No real diagnosis but have raised CRP, PV and ESR
115
How do you treat polymyalgia rheumatica?
Low dose steroids tapering off over 18 months
116
What does polymyalgia rheumatica predispose you to?
Giant Cell Arteritis
117
What is Giant Cell Arteritis?
Most common systemic vasculitis in older patients
118
How does Giant Cell Arteritis present?
``` Visual disturbances Headache Jaw claudications Scalp tenderness Fatigue Fever ```
119
How do you diagnose Giant Cell Arteritis?
``` Raised inflammatory markers Arterial biopsy (Specific but not sensitive) ```
120
How do you treat Giant Cell Arteritis?
Steroids (40-60mg) tapered over 24 months
121
What is polymyositis?
Symmetrical proximal muscle weakness in limbs leading to difficulties with activities
122
What causes polymyositis?
Potentially T-cell mediated cytotoxic process against muscle antigens
123
What complications can occur from polymyositis?
Dysphagia and interstitial lung disease
124
How do you diagnose polymyositis?
Raised inflammatory markers and CK | Need muscle biopsy- must show varying degrees of inflammation, necrosis and regeneration
125
What antibodies are associated with polymyositis?
Anti-ANA Anti-Jo-1 ANti-SRP
126
How do you treat polymyositis?
Prednisolone and immunosuppression
127
What is dermatomyositis?
Same as polymyositis but with dermal features too
128
What additional features are seen in dermatomyositis?
V shaped rash on chest Heliotrope rash Gottron's papules
129
How do you diagnose dermatomyositis?
Same as polymyositis
130
How do you treat dermatomyositis?
Same as polymyositis

MSK (17 decks)

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