Rheumatology Flashcards
What can cause a monoarthritis?
Septic arthritis
Gout/pseudogout
Oesteoarthritis
Trauma eg. haemarthrosis
What can cause an oligoarthritis?
Psoriatic arthritis Gout/pseudogout Oesteoarthritis Ankylosing spondylitis Reactive arthritis
What can cause a symmetrical polyarthritis?
Rhematoid arthritis
Oesteoarthritis
Hep A/B/C
Systemic disease eg. SLE, sickle cell anaemia, sarcoidosis, leukaemia
What can cause an asymmetrical polyarthritis?
Psoriatic arthritis
Reactive arthritis
Systemic disease
What are the key sign/ symptoms of osteoarthritis?
Pain on movement Worse with prolonged activity Pain relieved on resting Nodes on fingers- Heberdens and Bouchards Varus knees Square hands
What are the key radiological features of osteoarthritis?
Loss of joint spaces
Osteophytes (Bony projections)
Subarticular sclerosis
Subchondral cysts (sacks of fluid)
What are the risk factors for septic arthritis?
Diabetes CKD Joint disease Recent joint surgery Immunocompromised
What is the investigation for septic arthritis?
Joint aspiration-> Synovial fluid culture and microscopy.
What is the treatment for septic arthritis?
IV antibiotics eg Flucloxacillin
What are the risk factors for rhematoid arthritis?
Female
Smoking
HLA DR41
CCP Autoantibodies
What are the features indicative of RA on investigation?
CCP Autoantibodies
Raised CRP, C3, C4 and ESR
RF
What treatments are available for RA?
NSAIDS
Steroids
Anti TNFalpha eg. Infliximab
Surgery
What are the risk factors for gout?
Increased urate production eg. alcohol, red meat, sea food, psoriasis
Decreased urate excretion eg. CKD, diuretics, hypertension, metabolic syndrome
What are the features indicative of gout on investigation?
Negative bifringent urate crystals
Increased serum urate
Punched out erosions on bone
What plasma autoantibodies are found in RA?
RF, CCP autoantibodies
What plasma autoantibodies are found in coealiac?
Anti TTG
What plasma autoantibodies are found in SLE?
ANA, Anti dsDNA
What plasma autoantibodies are found in antiphospholipid syndrome?
Anti cardiolipin
What plasma autoantibodies are found in PBC?
Antimitochondrial
What plasma autoantibodies are found in vasculitis?
cANCA, pANCA
What are osteophytes?
Bony projections associated with cartilage degeneration at joints
What would be found on a blood culture in a patient with septic arthritis?
Usually strep, S. Aureus, N. Gonorrhoea or gram negative bacilli
What are the features of rheumatoid arthritis on X ray?
Loss of joint space, soft tissue swelling and joint deformity
How should synovial fluid normally appear?
Clear, colourless, no neutrophils
How does synovial fluid appear in osteoarthritis?
Clear, straw coloured, viscous
WBC <1000mm
How does synovial fluid appear in an acutely inflamed joint (crystal or Rheumatoid)?
Turbid, yellow, decreased viscosity, high number of neutrophils
How does synovial fluid appear in septic arthritis?
Turbid, yellow, decreased viscosity, high number of neutrophils
How does gout appear on Xray?
Soft tissue swelling
Bony erosion
Normal joint space
What are the most likely causes of back pain in patients aged >50years?
Degenerative changes Vertebral collapse (due to osteoporosis) Paget's disease Malignancy Myeloma Spinal stenosis
What is the most likely cause of back pain in patients aged 15-30years?
Prolapsed disc Trauma Fracture Ankylosing spondylitis Pregnancy
What are the key signs that cauda equina is present?
- Leg pain (alternating/ bilateral)
- Saddle anaesthesia (perianal)
- Loss of anal tone
- Bladder and bowel incontinence
What is ankylosing sponylitis?
Chronic inflammatory disease of spine
Unknown cause
What is the typical patient that suffers anykylosing spondylitis and what are their symptoms?
Typical patient is male <30yrs with gradual onset lower back pain
Pain worse at night
Spinal morning stiffness
Relieved by exercise
Radiates from sacro-iliac joints to hips/buttocks
Which diseases are associated with HLA B27?
Ankylosing spondylitis
Uveitis
Reactive arthritis
Psoriatic arthritis
What are the key clinical features of SLE?
Malar rash Discoid rash Synovitis Serositis Alopecia Oral/nasal ulcers Haemolytic anaemia, leucopenia, neutropenia
Erythema nodosum is painful red/blue raised lesions on shins, caused by _______________
Sarcoidosis
Drugs
Strep infection
Erythema marginatum is pink rings on the trunk which come and go, seen in _________________
Rheumatic fever
Dermatitis herpetiformis is itchy blisters in groups on the knees, elbow and scalp, usually seen in ____________
Coeliac disease
