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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
Q

How does septic arthritis present?

A

Severe pain
Redness
Swelling
Limited movement

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26
Q

How do you diagnose septic arthritis?

A

Look for bacteria in synovial fluid and exclude crystal arthropathies

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27
Q

How do you treat septic arthritis?

A

Presume S. Aureus so start high does flucloxacillin then switch to appropriate when diagnosed
If <5YO Ceftriaxone

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28
Q

What is rheumatoid arthritis?

A

Production of autoantibodies against synovial lining which can also attach articular cartilage and tendons

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29
Q

What antibodies are seen in RA?

A

Anti-CCP

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30
Q

How does RA present?

A

Mainly affects small joints- PIP not DIP
Symmetrical synovitis
Pain
Morning stiffness that takes >30 mins to ease

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31
Q

How can RA progress?

A

To large joints

C1/2 very problamatic

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32
Q

How do you diagnose RA?

A

Anti-CCP (prefered) or Rheumatoid factor
Raised CRP, ESR and plasma viscosity
Periarticular osteopenia and soft tissue swelling
US for inflammation

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33
Q

How do you treat RA?

A

DMARDs w/in 3 months of symptoms
Short term analgesia, NSAIDs and steroids
Biological therapy if resistant
Physio and OT etc

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34
Q

Give some examples of DMARDs

A

Methotrexate- 1st line but do NOT give in pregnancy

Sulfasalazine

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35
Q

Give some examples of biological agents

A

Anti-TNF alpha

Drugs ending in ‘-mab’

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36
Q

What does the DAS28 score measure?

A

RA disease state

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37
Q

What are the categories in DAS28?

A

<2.6- remision
2.7-5.1- Active
>5.1- Highly active

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38
Q

What is the DAS28 cut off score for receiving biological therapies?

A

> 5.1

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39
Q

What are the four seronegative arthropathies?

A

Ankylosing Spondylitis
Enteropathic Arthritis
Reactive Arthritis
Psoriatic Arthritis

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40
Q

Which antigen is often elevated in seronegative arthropathies?

A

HLA‐B27

CRP and ESR also elevated

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41
Q

What is Ankylosing Spondylitis?

A

Chronic inflammation of spine and SI joints

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42
Q

How does Ankylosing Spondylitis present?

A

Spine pain and stiffness
Morning stiffness which eases with exercise
Knee/hip arthritis
‘?’ spine- loss of lumbar lordosis and increased thoracic kyphosis

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43
Q

How do you diagnose Ankylosing Spondylitis?

A

HLA‐B27 test
Bamboo spine on XR
Spinal movement with Schober’s test (line 5cm below and 10cm above PSIC)

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44
Q

What complications can accompany ankylosing spondylitis?

A

Uvitis
Aoritis
Pulmonary fibrosis
Amyloidosis

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45
Q

How do you treat ankylosing spondylitis?

A

Physio, exercise, NSAIDs, anti-TNF inhibitors

Surgery for knee/hip

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46
Q

What is enteropathic arthritis?

A

Inflammatory arthritis of peripheral joints in patients with IBD

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47
Q

How does enteropathic arthritis present?

A

Asymmetrical large joint oligoarthritis

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48
Q

How do you treat enteropathic arthritis?

A

Manage underlying condition

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49
Q

What is reactive arthritis?

A

Arthritis in response to infection in other part of body- usually STI or GI

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50
Q

How does reactive arthritis present?

A

Large joint inflammation 1-3 weeks after infection

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51
Q

What is Reiter’s syndrome?

A

Uveitis, urethritis and arthritis combo associated with reactive arthritis.

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52
Q

What triad of complications is associated with reactive arthritis?

A

Uveitis, urethritis and arthritis- Reiter’s syndrome

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53
Q

How do you treat reactive arthritis?

A

Usually self limiting but can relapse.

Treat underlying infection and relieve symptoms.

54
Q

What is psoriatic arthritis?

A

Can occur w/ or w/o skin psoriasis

55
Q

How does psoriatic arthritis present?

A

Usually asymmetrical but can mimic RA in hands

Nail pitting and lifting (onycholysis)

56
Q

What complications are associated with psoriatic arthritis?

A

Spondylitis
Dactylitis
Enthesitis

57
Q

How do you treat psoriatic arthritis?

A

DMARDs
Anti-TNF alpha
Joint replacement

58
Q

What are the five seropositive arthropathies we need to know?

A 
Rheumatoid Arthritis
Systemic sclerosis
Systemic lupus erythematosus
Vasculitis 
Sjogren's disease
59
Q

What is systemic sclerosis?

A

Fibrosis of skin and subcutaneous tissue but can get organ involvement.

60
Q

What organs can be involved in systemic sclerosis?

A

Vasomotor- Gives Raynaud’s Syndrome
Renal
Lungs
GI

61
Q

What are the two forms of systemic sclerosis?

A

Limited- Peripheral skin and little organ involvement

Diffuse- Central skin problems and lots of organ involvement

62
Q

What auto antibody is associated with limited systemic sclerosis?

A

Anti-centromere AB

63
Q

What auto antibody is associated with diffuse systemic sclerosis?

A

Anti-Scl-70 AB

64
Q

What is important to check when systemic sclerosis presents?

A

Renal function

Renal failure kills!!!!!

65
Q

How do you treat systemic sclerosis?

A 
Depends on symptoms:
Raynaud's syndrome- CaC Blockers
Renal involvement- ACEI
GI involvement- PPI
Lung disease- Immunosuppression
66
Q

What is Sjogren’s Syndrome?

A

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
Q

How does Sjogren’s syndrome present?

A 
Dry eyes and mouth
Arthralgia
Fatigue
Parotid gland swelling
Lung involvement
68
Q

How do you diagnose Sjogren’s syndrome?

A 
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
Q

How do you manage Sjogren’s syndrome?

A

Eye drops
Good dental care
Hydroxychloroquine for arthralgia and fatigue
Immunosuppres for lung involvement

70
Q

What is Systemic Lupus Erythematosus?

A

Autoimmune condition what has a variable presentation

71
Q

What systems can be involved in SLE?

A 
Skin
Joints
Kidneys
Blood cells
Nervous system
Vasculature
Lungs
GI
72
Q

What causes SLE?

A

Inadequate clearing of apoptosed cell material leads to the development of antibodies against it.

73
Q

What type of hypersensitivity reaction is SLE?

A

Type 3 as mediated by immune complexes

74
Q

How does SLE present?

75
Q

Give the systemic presentations of SLE

A

Fatigue
Fever
Weight loss

76
Q

Give the MSK presentations of SLE

A

Arthralgia/myalgia
Arthritis
AVN

77
Q

Give the dermatological presentations of SLE

A 
Malar rash- Butterfly rash
Photosensitivity
DIscoid lupus 
Subcutaneous lupus
Oral/nasal ulceration
Raynaud's syndrome 
Alopecia
78
Q

Give the renal presentation of SLE

A

Lupus nephritis

79
Q

Give the respiratory presentations of SLE

A 
Pleurisy 
Pleural effusion 
Pneumonitis 
PE
Pulmonary hypertension
Interstitial lung disease
80
Q

Give the hematological presentations of SLE

A

Leukopenia
Lymphopenia
Anaemia

81
Q

Give the neurological presentations of SLE

A

Seizures
Psychosis
Headaches
Meningitis

82
Q

Give the CV presentations of SLE

A 
Pericarditis
pericardial effusion
Pulmonary hypertension
Sterile endocarditis 
IDH
83
Q

Give the GI presentations of SLE

A

Hepatitis
Pancreatitis
Mesenteric vasculitis

84
Q

How do you test for SLE?

A

FBC for anaemia leukopenia and thrombocytopenia
Urianalisis for glomerulonephritis
Image for organ involvement
Test antibodies

85
Q

What auto antibodies are associated with SLE?

A

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
Q

How do you treat SLE?

A

Variable
Skin- Hydroxychloroquine, steroids and NSAIDs
Arthritis/organ involvement- Azathioprine + steroids
If unresponsive use biological agents

87
Q

How do you know if a drug is a biological agent?

A

Ends in ‘-mab’

88
Q

How do you monitor SLE?

A

Check anti-dsDNA and C3/4
Urine for blood and protein
BP and cholesterol

89
Q

What is vasculitis?

A

Inflammation of blood vessels

Leads to thickening, stenosis and occlusion

90
Q

What are the two main categories of vasculitis?

A

Large vessel

Small/medium vessel

91
Q

What does large vessel vasculitis affect?

A

Aorta and major branches

92
Q

How does large vessel vasculitis present?

A

Low grade fever, malaise, night sweats, weight loss, arthralgia, fatigue
Claudications
Decrease pulse and bruits

93
Q

How do you diagnose large vessel vasculitis?

A

Raised ESR, CRP and PV

MR angiogram

94
Q

How do you treat large vessel vasculitis?

A

Decreasing course of steroids form 40-60mg at start

95
Q

What are the two categories of small/medium vessel vasculitis?

A

ANCA positive

ANCA negative

96
Q

How does small/medium vessel vasculitis present?

A

Fever, weight loss, purpuric rash, arthralgia, glomerulonephritis, lung opacity on XR

97
Q

What is the most common form for ANCA positive small/medium vessel vasculitis?

A

Granulomatosis w/ polyangiitis (GPA or Wegener’s)

98
Q

What addition features do Granulomatosis w/ polyangiitis (GPA or Wegener’s) have?

A

Nose bleeds
Deafness
Collapse of nose

99
Q

How do you detect small/medium vessel vasculitis?

A 
Raised ESR, PV and CRP
U+E for renal involvement
ANCA antibody
Urinalysis for renal vasculitis 
CXR
Biopsy affected area
100
Q

How do you treat small/medium vessel vasculitis?

A

IV steroids

Cyclophosphamide

101
Q

What is mixed connective tissue disease?

A

Mix of symptoms seen in other connective tissue diseases

102
Q

What symptoms can be seen in mixed connective tissue disease?

A 
Raynaud's 
Myositis
Sclerodactyly
Pulmonary hypertension
Interstitial lung disease
103
Q

What auto antibody is associated with mixed connective tissue disease?

A

Anti-RNP AB

104
Q

Why do patients with mixed connective tissue disease need checked regularly?

A

To look for pulmonary hypertension

105
Q

What is Antiphospholipid syndrome?

A

Leads to recurrent arterial/venous thrombosis

Get fetal loss

106
Q

What is a defining feature of antiphospholipid syndrome?

A

Livedo reticularis- Mottled skin

107
Q

How do you diagnose antiphospholipid syndrome?

A

Thrombocytopenia and prolonged APTT

Positive for: lupus anticoagulant, anticardiolipin and anti-beta 2 glycoprotein

108
Q

How do you treat antiphospholipid syndrome?

A

Anticoagulate- Warfarin (LMWH is pregnant)

109
Q

What are the three muscle conditions we need to know?

A

FIbromyalgia
Polymyalgia rheumatica and giant cell arteritis
Polymyositis and dermatomyositis

110
Q

What is fibromyalgia?

A

Unexplained muscle pain and fatigue. DIsease of central pain processing

111
Q

How does fibromyalgia present?

A 
Persistent (>3m) widespread pain
Fatigue/disrupted sleep
Cognitive difficulties
Anxiety/depression
Got to rule out everything else
112
Q

How do you treat fibromyalgia?

A

Self-management
Sympathy
Psych help

113
Q

What is polymyalgia rheumatica?

A

Chronic inflammation and pain of hip and shoulder girdles in >50YO
Get morning stiffness lasting over 1 hour

114
Q

How do you diagnose polymyalgia rheumatica?

A

No real diagnosis but have raised CRP, PV and ESR

115
Q

How do you treat polymyalgia rheumatica?

A

Low dose steroids tapering off over 18 months

116
Q

What does polymyalgia rheumatica predispose you to?

A

Giant Cell Arteritis

117
Q

What is Giant Cell Arteritis?

A

Most common systemic vasculitis in older patients

118
Q

How does Giant Cell Arteritis present?

A 
Visual disturbances
Headache
Jaw claudications
Scalp tenderness
Fatigue
Fever
119
Q

How do you diagnose Giant Cell Arteritis?

A 
Raised inflammatory markers
Arterial biopsy (Specific but not sensitive)
120
Q

How do you treat Giant Cell Arteritis?

A

Steroids (40-60mg) tapered over 24 months

121
Q

What is polymyositis?

A

Symmetrical proximal muscle weakness in limbs leading to difficulties with activities

122
Q

What causes polymyositis?

A

Potentially T-cell mediated cytotoxic process against muscle antigens

123
Q

What complications can occur from polymyositis?

A

Dysphagia and interstitial lung disease

124
Q

How do you diagnose polymyositis?

A

Raised inflammatory markers and CK

Need muscle biopsy- must show varying degrees of inflammation, necrosis and regeneration

125
Q

What antibodies are associated with polymyositis?

A

Anti-ANA
Anti-Jo-1
ANti-SRP

126
Q

How do you treat polymyositis?

A

Prednisolone and immunosuppression

127
Q

What is dermatomyositis?

A

Same as polymyositis but with dermal features too

128
Q

What additional features are seen in dermatomyositis?

A

V shaped rash on chest
Heliotrope rash
Gottron’s papules

129
Q

How do you diagnose dermatomyositis?

A

Same as polymyositis

130
Q

How do you treat dermatomyositis?

A

Same as polymyositis

MSK (17 decks)

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