Rheumatology Flashcards
What are some causes of symmetrical polyarthritis?
Rheumatoid
Osteoarthritis
What are some causes of asymmetrical polyarthritis?
Reactive
Psoriatic
What are the x-ray findings of osteoarthritis?
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
What are some risk factors for osteoarthritis?
Age High BMI Female FH Overuse Previous surgery
What should be done for suspected septic arthritis?
Joint aspiration, blood cultures
Ortho referral, IV antibiotics, joint washout
What are the categories for diagnostic criteria in RA?
Number of joints involved Serology Acute phase reactants Duration of 6 weeks Over 6 = diagnostic
What are the serology diagnostic criteria in RA?
RF and anti-CCP
Negative = 0
Low positive = 2
High positive = 3
What are the acute phase reactants diagnostic criteria in RA?
CRP and ESR
Normal = 0
High = 1
What are the joint involvement diagnostic criteria in RA?
1 large = 0 2-10 large = 1 1-3 small = 2 4-10 small = 3 Over 10 = 5
What is the initial management of RA?
- Urgent referral to rheumatology
- High dose NSAID + PPI
- Do DAS28 to measure severity
- 2 x DMARD
- Physio and OT
- Control CVS risk factors
What are some extra-articular features of RA?
Felty's syndrome Atlanto-axial subluxation Caplan's syndrome (pulmonary nodules) Effusions Blood - normocytic anaemia Olecranon bursitis Oral dryness Kidneys - amyloid Sensory neuropathy
What are some risk factors for gout?
Male, alcohol, high purine intake, metabolic syndrome, diuretics, CKD
What investigations should be done for suspected gout?
FBC, CRP, ESR
Joint aspiration and synovial fluid analysis
UEs, LFTs
When should gout prophylaxis be considered?
Over 2 attacks in a year
Tophi
CKD II
Urolithiasis
What are some features of gout prophylaxis?
Introduce 2-4 weeks after acute attack
Cover with NSAIDs for 6 months
Aim urate <300 micromoles/L
Alternative = febuxostat
What is pseudo gout?
Calcium pyrophosphate deposition
Acute monoarthropathy - usually large joints
Rhomboid crystals on light microscopy
What are some features of ankylosing spondylitis?
Disease of spine and SI joints
Typically men under 30
Gradual onset low back pain and stiffness
Neck hyperextension and kyphosis
What are the x-ray findings in ankylosing spondylitis?
SI narrowing
Sclerosis
Erosions
Fusion
What is Reiter’s?
Urethritis
Arthritis
Conjunctivitis
What is the triad of systemic sclerosis?
- Scleroderma - skin fibrosis
- Internal organ fibrosis
- Microvascular abnormalities
What antibodies should be done for systemic sclerosis?
ANA, anti-Scl 70 (diffuse)
Anti-centromere (limited)
What are limited and diffuse systemic sclerosis?
Limited - face, hands and feet, pulmonary hypertension
Diffuse - can involve whole body, control BP, annual echo and spirometry
What is myositis?
Inflammation of muscles
Insidious onset
Progressive symmetrical proximal muscle weakness
Can be secondary to malignancy
What antibodies are associated with myositis?
JO1, anti Mi2
CK
What is Sjogren’s syndrome?
Often secondary to CTD
Dry eyes and dry mouth
Ro and La antibodies
What is SLE?
Multisystemic autoimmune disease
Formation of immune complexes
Inadequate clearance, immune response, tissue inflammation & damage
What are the 11 diagnostic criteria for SLE? (need over 4)
- Malar rash
- Discoid rash
- Photosensitivity
- Oral ulcers
- Arthritis
- Serositis - pleuritis or pericarditis
- Renal disorder
- Neurological disorder
- Haematological disorder
- Immunologic disorder
- ANA
What antibodies are associated with SLE?
Anti-DNA
Anti-Smith
Antiphospholipid
ANA
What is the treatment for SLE?
Avoid sunlight Hydroxychloroquine NSAIDs Lupus nephritis - azathioprine + steroid Pregnancy planning
What is the anatomy of the boutonniere deformity?
Rupture of central slip of extensor expansion
Button hole formed by intact lateral slips
Rheumatoid tenosynovitis
What is rheumatoid factor?
IgM against your own IgG
What signifies active disease in RA?
Active synovitis
Red and swollen joints
What are some side effects of methotrexate?
Bone marrow suppression - neutropenia
Liver and renal toxicity
Pneumonitis/pulmonary fibrosis
FBC, LFTs, UEs every 4-6 weeks
What is the cause of atlanto-axial subluxation?
Weakened cervical spine tendons
Odontoid peg of axis subluxes backwards
Can compress upper cervical cord
What are the x-ray findings in RA?
Soft tissue swelling Peri-articular osteoporosis Absent osteophytes Deformity Erosions Subluxation
What is CREST syndrome?
Calcinosis, Raynaud’s, (o)esophageal involvement, sclerodactyly, telangiectasia
What are the blood findings in osteomalacia?
Raised ALP, raised PTH, low vitamin D, low calcium, low phosphate
