rheumatology Flashcards
1
Q
what is osteoarthritis?
A
osteoarthritis is an age-related, dynamic reaction pattern of a joint in response to injury
2
Q
what is the clinical presentation of osteoarthritis?
A
Localized disease (usually knee/hip)
- Pain on movement
- Worse at end of day
- Background pain at rest
- Joint stiffness after 30min rest
- Joint instability
•Generalised disease
- Heberden’s nodes
- Joint tenderness and derangement
- Decreased range of movement
- Mild synovitis
3
Q
what is the main differential diagnosis of osteoarthritis?
A
rheumatoid arthritis
4
Q
how is osteoarthritis diagnosed?
A
Radiography shows LOSS: Loss of joint space Osteophytes Subarticular sclerosis Subchondral cysts
5
Q
how would you treat a patient with osteoarthritis?
A
exercise for local muscle strength, analgesia, intra-articular steroid injections
6
Q
what is rheumatoid arthritis?
A
autoimmune
Chronic systemic inflammatory disease with a symmetrical, deforming, peripheral polyarthritis
7
Q
what can cause rheumatoid arthritis?
A
- pre-menopausal women
- FH
- genetic factors- HLA-DR4 and HLA-DR1
8
Q
what is the pathophysiology of rheumatoid arthritis?
A
local production of rheumatoid factor and formation of immune complexes contribute to inflammation- synovial lining thickens and grows out the surface of the cartilage- a pannus.
the pannus destroys the articular cartilage and subchondral bone
9
Q
how does rheumatoid arthritis present clinically?
A
- symmetrical swollen, painfull stiff small joints of the hands and feet worse in the morning
- extra-articular- nodules in elbows and lungs, lymphadenopathy, vasculitis,
10
Q
what are the differential diagnoses of RA?
A
- psoriatic arthritis
- SLE
- actue viral polyarthritis
- osteoarthritis
11
Q
how can rheumatoid arthritis be diagnosed?
A
- positive for rheumatoid factor
- anaemia of chronic disease
- x-ray- soft tissue swelling, loss of joint space
12
Q
what is the treatment of rheumatoid arthritis?
A
- DMARDS- methotrexate
- TNF alpha inhibitors
- IL-3 and IL-6 inhibition via tocilizumab
13
Q
what is osteoporosis?
A
a reduction in the total bone mass
14
Q
what can cause osteoporosis?
A
an inadequate peak bone mass- genetics, nutrition, physical activity
age-related bone loss
15
Q
what are the risk factors of osteoporosis?
A
age, FH, rheumatoid arthritis, BMI less than 22, menopause, steroid use, low testosterone, renal failure
16
Q
what is the key symptom of osteoporosis?
A
increased fractures
17
Q
how is osteoporosis diagnosed?
A
x-ray
bone densitometry- DEXA scan
bloods- all normal (Ca2+, phosphate and alkaline phosphatase)
18
Q
how is osteoporosis treated?
A
lifestyle- quit smoking, weight-bearing exercise, balance exercises
pharmacological- bisphosphsates, calcium and vitamin D, HRT
19
Q
what is systemic lupus erythematous?
A
a multisystem autoimmune disease in which autoantibodies are made against auto antigens
20
Q
what is the aetiology of SLE?
A
heredity premenopasual women drugs- hydralazine and penicillamine UV light EBV
21
Q
How does SLE present clinically?
A
malar rash on face photosensitivity oral ulcers serositis renal disorders seizures haemolytic anaemia
22
Q
how is SLE treated?
A
IV cyclophosphamide
23
Q
what conditions is secondary Sjorgens syndrome associated with?
A
RA, SLE, systemic sclerosis
24
Q
how does Sjorgens syndrome present clinically?
A
decreased tear production
xerostomia
parotid swelling
systemic signs- poly arthritis, Raynaud’s, vasculitis
25
how is Sjorgens syndrome treated?
NSAIDs and saliva replacement
26
what is Raynaud's phenomenon?
intermittent spasms in the arteries supplying the fingers and toes
27
how is Raynaud's treated?
keep hands and feet warm
stop smoking
stop beta blockers
oral nifedipine
28
what is ankylosing spondylitis?
a chronic inflammatory disease fo the spine and sacroiliac joints of unknown aetiology
29
what are 90% of patients with ankylosing spondylitis positive for?
HLA. B27
30
What are the clinical features of ankylosing spondylitis?
- pain radiates from sacroiliac joints to hips
- worse at night and improves towards end of day
- fatigue, costochondritis
31
how is ankylosing spondylitis diagnosed?
MRI
sacroillitis, erosions and sclerosis seen on XR
normocytic anaemia
HLA B27 positive
32
how can ankylosing spondylitis be treated?
exercise, NSAIDs, TNF alpha blockers, local steroid injections
33
what are the pattens of psoriatic arthritis?
symmetrical polyarthritis
asymmetrical oligoarthritis
spinal
DIP joints
34
what does radiology of psoriatic arthritis show?
erosive changes, 'pencil in cup' deformity
35
how is psoriatic arthritis treated?
NSAIDs, sulfasalazine, methotrexate, anti TNF agents
36
what type of arthritis is sterile?
reactive arthritis
37
when does reactive arthritis occur?
1-4 weeks after urethritis or dysentery
38
how does reactive arthritis present clinically?
- young man with acute arthritis shortly after infection
- affects joints of lower limbs in an asymmetrical pattern
- skin lesions reassembling psoriasis
CANT SEE, CANT PEE, CANT CLIMB A TREE:
- conjunctivitis
- dysuria
- arthritis
39
how would you treat reactive arthritis?
NSAIDs, local steroid injections, methotrexate
40
what is vasculitis?
inflammatory disorders of the blood vessel walls- resulting in destruction (aneurysm/ rupture) or stenosis
41
how is vasculitis categorised?
on size of artery affected
- large- GCA, Takayasu's
- medium- polyarteritis nodosa, Kawasaki disease
- small- Wegener's granulomatosis
42
how is vasculitis managed?
steroids and cyclophosphamide
43
what is polyarteritis nodosa?
* A necrotizing vaculitis
| * Causes aneurysms and thrombosis in medium-sized organs, infarcting affected organs
44
what is crystal arthritis?
arthritis caused by crystal deposition in joint lining
45
what is gout?
Monosodium urate crystals deposited in joint
- Uric acid synthesised from xanthine oxidase pathway
- Can be caused by hyperuricaemia
- Deposition of crystals results in local inflammatory response and tissue damage
oPresents acutely with hot & swollen joints
46
what are risk factors of pseudo gout?
old age
hyperparathyroidism
haemochromatosis
hypophosphataemia
47
what are risk factors if fibromyalgia?
* Belief that pain and activity are harmful
* Sickness behaviours e.g. extended rest
* Social withdrawal
* Emotional problems e.g. low mood, anxiety or stress
* Problems at work
* Problems claiming compensation/time off from work
* Overprotective family or lack of support
* Inappropriate expectations of treatment
48
how does fibromyalgia present clinically?
chronic widespread pain for over 3 months with no inflammation
pain on palpation of 11/18 'tender' points
49
how do you treat a patient with fibromyalgia?
education, explain, reassure, CBT, exercise programmes
50
what are the clinical features of mechanical back pain?
stiff back, scoliosis, muscular spasm, pain relieved by sitting or lying down
51
what are the risk factors of septic arthritis?
* Pre-existing joint disease – esp. RA
* Diabetes mellitus
* Immunosuppression
* Chronic renal failure
* Recent joint surgery
* Prosthetic joints
* IVDU
* >80yo
52
what investigations would you do in a patient with septic arthritis?
joint aspiration for synovial fluid, blood cultures
53
how would you treat septic arthritis?
empirical IV abx- flucloxacillin
54
what organisms can cause osteomyelitis?
staph aureus
| salmonella
55
what are the symptoms of osteomyelitis?
fever, local pain, erythema, sinus formation
56
how would you treat osteomyelitis?
flucloxacillin for 4-6 weeks
57
what are the risk factors of osteoarthritis?
- age-cumulative effect
- female gender
- genetics
- obesity
- inflammatory- IL-1, IL-6, TNF
- manual labour
58
what are the complications of osteoarthritis?
- skeletal deformity
- bone pain due to compression fractures
- fractures
59
what is osteomalacia?
inadequate mineralisation of the organic bone matrix- there is a normal amount of bone but the mineralisation of that bone is low
60
what is the aetiology of osteomalacia?
- vitamin D deficiency- poor dietary intake or malabsorption
- renal osteodystrophy
- liver failure
61
what symptoms does a patient with osteomalacia present with clinically?
- bone pain
- tendenress
- proximal myopathy
- fractures
62
how can osteomalacia be diagnosed?
- biopsy- incomplete mineralisation
- x-ray- loss of cortical bone
- plasma- decreased calcium and phosphate levels
- bowing of the long bones of the leg
63
how is osteomalacia treated?
vitamin D treatment
64
what is osteomyelitis?
infection localised to the bone
65
how can infection spread to the bone and cause osteomyelitis?
- direct inoculation of infection into bone
- contiguous spread from soft tissues and joints
- haematogenous seeding
66
how can osteomyelitis be diagnosed?
- high WCC, ESR and CRP
- MRI- marrow oedema and abscesses
- X-ray- cortical erosion and sequestra
67
what is Paget's disease?
increased bone turnover associated with increased numbers of osteoclasts and osteoblasts
68
how do patients with Paget's disease present clinically?
bone pain
deformities
fractures
69
how can Paget's disease be diagnosed?
elevated alkaline phosphate
| x-ray-lytic lesions
70
```
what are some extra-articular features of:
- eyes
- neurological
- haematological
- lungs
- heart
- kidneys
- skin
associated with rheumatoid arthritis?
```
1. Eyes- sicca, episcleritis, scleritis
2. Neurological- peripheral neuropathy
3. Haematological- palpable lymph nodes, splenomegaly
4. Lungs- pleural effusion
5. Heart- pericardial rub, pericarditis, pericardial effusion
6. Kidneys- amyloidosis
7. Skin- vasculitis
71
what are the symptoms of psoriatic arthritis?
pain, swelling, warmth and stiffness in the affected joints
72
what are the symptoms of septic arthritis?
pain, tenderness, swelling, erythema, mono arthritic, fever, decreased function of affected joint
73
what organisms can be responsible for septic arthritis?
S.aureus, S. pyogenes, Dip. Pneumonia, mycobacterium tuberculosis
74
how can gout be diagnosed?
Diagnosis based on history, pattern, aspiration of joint to look for crystals and blood tests/ XR’s
75
what is the aetiology of gout?
- hereditary
- high dietary purines
- alcohol excess
- diuretics
- leukaemia
76
how is gout treated?
- high dose NSAID
- colchicine
- steroids
77
how can pseudo gout be diagnosed?
polarised light microscopy of synovial fluid shows calcium pyrophosphate crystals
78
how is pseudo gout treated?
NSAIDs and colchicine
79
what are the symptoms of polyarteritis nodosa?
- systemic- fever, malaise, weight loss, myalgia
- skin rash
- haematuria
- proteinuria
- angina
- testicular pain
80
how is polyarteritis nodosa treated?
corticosteroids and cyclophosphamide
81
how would polymyalgia rheumatic be treated?
oral prednisolone
82
what is the commonest type of bone tumour?
metastatic carcinoma
83
where do metastatic carcinomas of the bone arise from?
breast, kidney, lung or thyroid
84
what are the red flag signs of a bone tumour?
rest pain
tender tumour present
loss of function
neurological symptoms
85
how can a bone tumour be investigated?
- bloods
- x-ray
- CT
MRI- T1= anatomy, T2= pathology
- bone scan- skeletal metastases
86
what system is used to grade rheumatological tumours?
Enneking system:
G0= histologically benign
G1= low grade malignant
G2= high grade malignant
87
what can an osteosarcoma occur secondary to?
Paget's disease
88
how can the clinical symptoms of vertebral disc generation be exacerbated?
heavy straining when lifting and poor posture
89
what is Schmorl's node?
softened nucleus pulposus can herniate vertically into an adjacent vertebral body
