Rheumatology Flashcards
cANCA and pANCA - name the diseases associated with each anti-neutrophil cytoplasmic antibody
cANCA - granulomatosis with polyangiitis (Wegener’s granulomatosis)
pANCA - Chrug-Strauss syndrome + others (microscopic polyangiitis, primary sclerosing polyangiitis, etc.)
Complications in RA - what composes Felty’s syndrome?
RA + splenomegaly + low WCC
Secondary prevention of osteoporotic fractures in post-menopausal women
- Rx is indicated following osteoporotic fragility fractures in post-menopausal women who are confirmed to have osteoporosis (T score of -2.5 SD or below)
- In women 75 y/o or older - DEXA scan may not be needed before Rx
- Vitamin D and calcium supplementation should be offered to ALL women
- Alendronate first line
Antibodies associated with:
- Limited cutaneous systemic sclerosis (CREST)
- Diffuse cutaneous systemic sclerosis
- Anti-centromere antibodies
- scl-70 (topoisomerase) antibodies
In both cases, ANA positive in 90%; RF positive in 30%
‘Plantar spur’ and ‘pencil and cup’ deformity are features in what condition?
Psoriatic arthritis
- What is Paget’s disease of the bone?
- Clinical features (incl. blood results)
- Management
- Increased but uncontrolled bone turnover (primarily thought to be disorder of osteoclasts)
- Features:
- Older male with bone pain and ISOLATED raised ALP
- Bone pain distribution: usually in pelvis (asymmetrical), lumbars spine, femur
- Skull XR: thickening of calvarium, osteoporosis circumscripta - Mx - indications for Rx include bone pain, skull or long bone deformity, fracture, periarticular Paget’s = give bisphosphonates or calcitonin (less commonly used)
Drug-induced lupus (e.g. in isoniazid, phenytoin, procainamide, hydralazine) - which antibody is associated with this?
Anti-histone antibodies
Disease associated with the following antibodies:
- RF
- Anti Jo-1
- Anti scl70
- Anticentromere
- RA
- Polymyositis
- Diffuse systemic sclerosis
- Limited cutaneous SS
Blood test values in osteoarthritis (calcium, phosphate, ALP and PTH)
NORMAL!
Asymptomatic patient with raised uric acid - what is your next management?
Do commence any treatment for asymptomatic hyperuricaemia to prevent gout!
Lifestyle changes (less red meat, alcohol and sugar) can reduce uric acid levels without drug treatment and so can be advised
Three features of reactive arthritis
Urethritis + arthritis and conjunctivitis (Reiter’s syndrome)
‘Can’t see, pee or climb a tree’
Osteoarthritis - management
- 1st line - paracetamol and topical NSAIDs
- 2nd line - NSAIDs (oral - co-prescribe PPI), intra-articular corticosteroid injections, COX-2 inhibitors, opiates
- Non-pharmacological - braces, supports, insoles, etc
- Joint replacement (ortho referral) if all other measures fail
Rheumatoid arthritis - extra-articular features
- Anaemia of chronic disease (normocytic, normochromic)
- Constitutional: fever, weight loss, fatigue
- Raynaud’s
- Abdo: splenomegaly (Felty’s = arthritis, splenomegaly, neutropenia (plus anaemia and lymphadenopathy)
- Resp: pulmonary fibrosis, pleural effusions (exudate)
Cardiac: pericardial effusions - Ocular: keratoconjunctivitis sicca (most common), scleritis/episcleritis, corneal ulceration, keratitis
What is Felty’s syndrome?
RA + splenomegaly + low WCC (neutropenia)
New management guidlines (NICE 2018) for rheumatoid arthritis
See flashcards
Joint aspirate on reactive arthritis
Cloudy yellow in colour, culture negative, WCC raised
Pattern of pyrexia in Still’s disease
Typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash
Ankylosing spondylitis - NSAIDs have been ineffective, which drug would you recommend next?
TNF-alpha blockers such as infliximab and etanercept.
NB DMARDs like methotrexate have not shown any benefit to Ank Spond
Spot diagnosis - isolated rise in ALP
Which bones are usually affected by this disease?
Paget’s disease of the bone
Skull, spine/pelvis, and long bones of the lower extremities
Chemotherapy is a known risk factor for the development of which rheumatological condition?
Gout (increased breakdown of cells lead to hyperuricaemia)
Pharmacological treatment for reynaud’s
Nifedipine
Anti-phospholipid syndrome
- APTT and PT levels
- Platelet levels
Raised APTT and normal PT
Thrombocytopenia
Advice to patients who would like to conceive and are currently taking methotrexate
Patients using methotrexate require effective contraception during and for at least 3 months after treatment in men or women
