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Clinical Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Patients with autoimmune CTDs are at an increased risk of what malignancy?

A

Lymphoma - increased B cell activity

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2
Q

Management of SLE

A

Mild - NSAIDs and hydroxychloroquine

Moderate - Corticosteroids, Azathioprine, Methotrexate

Severe - Cytotoxic drugs e.g. cyclophosphamide

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3
Q

Autoantibodies in SLE

A

Anti-dsDNA

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4
Q

Presentation of SLE

A

Women
15-40yrs
Asian & Afro Caribbean
90% arthritis
60% photosensitivity & butterfly rash
CV, Lung, renal, neuro, haem & GI manifestations

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5
Q

Presentation of Sjogren’s

A

Women
20% are RA patients
Dry eyes, mouth, genitalia

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6
Q

Autoantibodies in Sjogren’s

A

Anti RO
Anti La
Rheumatoid Factor
ANA

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7
Q

Management of Sjogren’s

A

Artificial tears and saliva
Dental hygiene support

Hydroxychloroquine & corticosteroids if systemic effects

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8
Q

Presentation of limited scleroderma

A

Skin fibrosis on hands, feet and face

CREST Syndrome 
Calcinosis - white deposits 
Raynaud's 
Esophageal dysmotility 
Sclerodactyly
Telangiectasia

PLUS Pulmonary HTN and arthralgia

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9
Q

Presentation of diffuse scleroderma

A

Skin fibrosis of hands, feet, face and trunk

PLUS Raynaud’s, cardiac abnormality, pulmonary fibrosis, myenteric plexus ischaemia, rapidly progressive renal failure

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10
Q

Management of Scleroderma

A

Monitoring: Lung function tests & echocardiogram

Management of symptoms and systemic illness

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11
Q

Autoantibodies in limited scleroderma

A

Anticentromere

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12
Q

Autoantibodies in diffuse scleroderma

A

Anti Topoisomerase-1 (Scl-70)

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13
Q

Presentation of myositis

A

Symmetrical, proximal muscle weakness
+/- dermatological changes

Raised CK
Myopathic EMG

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14
Q

Autoantibodies in Myositis

A

Anti-Jo-1

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15
Q

Management of Myositis

A

Steroids & Steroid-sparing drugs
IVIg
Rituximab

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16
Q

Features of Marfan’s

A 
Tall
High arched palate
Arachnodactyly
Pectus excavatum
Pes planus
Scoliosis 
Dilatation of aortic sinuses
Repeated pneumothoraces 
Upward lens dislocation, blue sclera and myopia 
Dural ectasia (ballooning of dural sac at lumbosacral level)
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17
Q

Features of Ehler-Danlos Syndrome

A

Elastic, fragile skin
Join hypermobility
Easy bruising

Aortic Regurg
Mitral valve prolapse
Aortic Dissection

SAH

Angioid retinal streaks

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18
Q

Features of Osteogenesis Imperfecta

A 
Childhood
Fractures following minor trauma 
Blue sclera
Otosclerosis
Dental imperfections
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19
Q

Drugs associated with drug-induced lupus

A

Procainamide

Hydralazine

20
Q

Autoantibodies seen in drug-induced lupus

A

Anti-histone (80-90%)

21
Q

Management of Fibromyalgia

A

Education & reassurance
Physiotherapy
CBT
Amitryptiline can improve sleep, fatigue and pain

22
Q

Features of fibromyalgia

A

Females 30-50yrs
Diffuse, chronic pain and fatigue

O/E: Soft tissue tenderness at multiple sites

23
Q

Monitoring in Methotrexate

A

FBC, LFT and U&Es before starting
Every 2 weeks until therapy stabilised
Then every 2-3 months

24
Q

Marker for PMR

25
Features of PMR
Morning stiffness in proximal muscles esp shoulders and hip girdle > 60 yrs Females > Males +/- Systemic symptoms inc B symptoms O/E: Reduced range of movement in affected joints, puffy oedematous hand syndrome, normal neurology ESR > 40 CK and EMGG normal
26
Joints affected in RA
MCP, PIP, wrist, MTP
27
Hand X-ray in late RA
``` Soft tissue swelling Juxta Articular osteopenia Reduced joint space Bony erosion Subluxation Complete carpal destruction ```
28
Tuck sign
Tenosynovitis, fold of skin seen on dorsal aspect of wrist on wrist extension. At rest there is a well-defined swelling on dorsum of wrist
29
Common Extraarticular manifestations of RA
Lung - fibrosing alveolitis Cardiac - IHD Eye - Keratoconjunctivitis Sicca (comorbid Sjogren's) Osteoporosis
30
Autoantibodies in RA
RF positive in 70% | Anticyclic citrullinated peptide antibodies (98% specific, 70-80% sensitive)
31
Management of RA
Physio and OT. Smoking cessation. DMARDs - Methotrexate, Sulfasalazine or Hydroxychloroquine NSAIDs & Steroids for acute exacerbations Surgery
32
Important ADR of Hydroxychloroquine
Retinopathy
33
Marker of Spondyloarthropathy
HLA-B27
34
Features of Ankylosing Spondylitis
LBP Early morning stiffness Pain in sacroiliac joints Question mark posture: Loss of lumbar lordosis & hyperkyphosis of T and C spine + Anorexia, fever, weight loss, fatigue
35
Extra articular features of Ank Spond
Acute Anterior Uveitis - red, painful eye Aortic incompetence + AV block Apical lung fibrosis Amyloidosis
36
Spinal X-ray in Ank Spond
Sclerosis and erosions Lumbar spine: squaring of vertebrae, formation of syndesmophytes (ossification of longitudinal ligaments, bamboo appearance)
37
Management of Ank Spond
Physio NSAIDs DMARDs - Methotrexate or sulfasalazine Anti TNF - Infliximab Surgery
38
Features of Reactive Arthritis
Hx of GI or GU infection Symptoms last 4-6 months Arthritis - weight bearing joints, entheses & dactylitis (sausage digit) Urethritis - urinary symptoms Conjunctivitis/Uveitis +/- Skin lesions (Circinate balanitis, keratoderma blenorrhagica
39
X-ray changes in reactive arthritis
Initially normal Fluffy periostitis in calcaneus, digits or pelvis Plantar spurs
40
Management of Reactive Arthritis
NSAIDs Local steroid injections for enthesitis or synovitis Sulfasalazine, azathioprine or methotrexate for persistent severe disease
41
MSK features of Enteropathic Arthritis
Peripheral arthritis - worse with flare ups of IBD Spondylitis and sacroiliitis - unrelated to disease activity +/- Enthesopathy
42
Features of psoriatic arthritis
``` 5 common patterns of joint disease: DIP joints - pitting and onycholysis of nail Asymmetrical oligoarthritis Symmetrical polyarthritis (indistinguishable from RA) Spondylitis - milder than classic AS Arthritis mutilans - severe inflammation causing deformation. ‘Telescoping’ - reabsorption of bone at metacarpals and phalanges. Pencil-in-cup deformity on X-ray ```
43
Management of psoriatic arthritis
NSAIDs DMARDs AntiTNF
44
Features of temporal arteritis
``` > 60 yrs Headache Jaw claudication Visual blurring Assoc with PMR Raised ESR Normal CK and EMG ```
45
Management of Temporal Arteritis
Urgent ophthalmology review USS & temporal biopsy High-dose prednisolone

Clinical Medicine (9 decks)

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