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nicks phase 2a flaschards > rheumatology > Flashcards

rheumatology Flashcards

1
Q

what is osteoarthritis?

A

osteoarthritis is an age-related, dynamic reaction pattern of a joint in response to injury

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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
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3
Q

what is the main differential diagnosis of osteoarthritis?

A

rheumatoid arthritis

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4
Q

how is osteoarthritis diagnosed?

A 
Radiography shows LOSS:
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts
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5
Q

how would you treat a patient with osteoarthritis?

A

exercise for local muscle strength, analgesia, intra-articular steroid injections

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6
Q

what is rheumatoid arthritis?

A

autoimmune

Chronic systemic inflammatory disease with a symmetrical, deforming, peripheral polyarthritis

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7
Q

what can cause rheumatoid arthritis?

A
  • pre-menopausal women
  • FH
  • genetic factors- HLA-DR4 and HLA-DR1
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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

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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,
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10
Q

what are the differential diagnoses of RA?

A
  • psoriatic arthritis
  • SLE
  • actue viral polyarthritis
  • osteoarthritis
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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
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12
Q

what is the treatment of rheumatoid arthritis?

A
  • DMARDS- methotrexate
  • TNF alpha inhibitors
  • IL-3 and IL-6 inhibition via tocilizumab
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13
Q

what is osteoporosis?

A

a reduction in the total bone mass

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14
Q

what can cause osteoporosis?

A

an inadequate peak bone mass- genetics, nutrition, physical activity
age-related bone loss

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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

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16
Q

what is the key symptom of osteoporosis?

A

increased fractures

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17
Q

how is osteoporosis diagnosed?

A

x-ray
bone densitometry- DEXA scan
bloods- all normal (Ca2+, phosphate and alkaline phosphatase)

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18
Q

how is osteoporosis treated?

A

lifestyle- quit smoking, weight-bearing exercise, balance exercises
pharmacological- bisphosphsates, calcium and vitamin D, HRT

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19
Q

what is systemic lupus erythematous?

A

a multisystem autoimmune disease in which autoantibodies are made against auto antigens

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20
Q

what is the aetiology of SLE?

A 
heredity
premenopasual women
drugs- hydralazine and penicillamine
UV light
EBV
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21
Q

How does SLE present clinically?

A 
malar rash on face
photosensitivity
oral ulcers
serositis
renal disorders
seizures 
haemolytic anaemia
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22
Q

how is SLE treated?

A

IV cyclophosphamide

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23
Q

what conditions is secondary Sjorgens syndrome associated with?

A

RA, SLE, systemic sclerosis

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24
Q

how does Sjorgens syndrome present clinically?

A

decreased tear production
xerostomia
parotid swelling
systemic signs- poly arthritis, Raynaud’s, vasculitis

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25
Q

how is Sjorgens syndrome treated?

A

NSAIDs and saliva replacement

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26
Q

what is Raynaud’s phenomenon?

A

intermittent spasms in the arteries supplying the fingers and toes

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27
Q

how is Raynaud’s treated?

A

keep hands and feet warm
stop smoking
stop beta blockers
oral nifedipine

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28
Q

what is ankylosing spondylitis?

A

a chronic inflammatory disease fo the spine and sacroiliac joints of unknown aetiology

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29
Q

what are 90% of patients with ankylosing spondylitis positive for?

A

HLA. B27

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30
Q

What are the clinical features of ankylosing spondylitis?

A
  • pain radiates from sacroiliac joints to hips
  • worse at night and improves towards end of day
  • fatigue, costochondritis
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31
Q

how is ankylosing spondylitis diagnosed?

A

MRI
sacroillitis, erosions and sclerosis seen on XR
normocytic anaemia
HLA B27 positive

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32
Q

how can ankylosing spondylitis be treated?

A

exercise, NSAIDs, TNF alpha blockers, local steroid injections

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33
Q

what are the pattens of psoriatic arthritis?

A

symmetrical polyarthritis
asymmetrical oligoarthritis
spinal
DIP joints

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34
Q

what does radiology of psoriatic arthritis show?

A

erosive changes, ‘pencil in cup’ deformity

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35
Q

how is psoriatic arthritis treated?

A

NSAIDs, sulfasalazine, methotrexate, anti TNF agents

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36
Q

what type of arthritis is sterile?

A

reactive arthritis

37
Q

when does reactive arthritis occur?

A

1-4 weeks after urethritis or dysentery

38
Q

how does reactive arthritis present clinically?

A
  • 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
Q

how would you treat reactive arthritis?

A

NSAIDs, local steroid injections, methotrexate

40
Q

what is vasculitis?

A

inflammatory disorders of the blood vessel walls- resulting in destruction (aneurysm/ rupture) or stenosis

41
Q

how is vasculitis categorised?

A

on size of artery affected
- large- GCA, Takayasu’s

  • medium- polyarteritis nodosa, Kawasaki disease
  • small- Wegener’s granulomatosis
42
Q

how is vasculitis managed?

A

steroids and cyclophosphamide

43
Q

what is polyarteritis nodosa?

A
  • A necrotizing vaculitis

* Causes aneurysms and thrombosis in medium-sized organs, infarcting affected organs

44
Q

what is crystal arthritis?

A

arthritis caused by crystal deposition in joint lining

45
Q

what is gout?

A

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
Q

what are risk factors of pseudo gout?

A

old age
hyperparathyroidism
haemochromatosis
hypophosphataemia

47
Q

what are risk factors if fibromyalgia?

A
  • 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
Q

how does fibromyalgia present clinically?

A

chronic widespread pain for over 3 months with no inflammation
pain on palpation of 11/18 ‘tender’ points

49
Q

how do you treat a patient with fibromyalgia?

A

education, explain, reassure, CBT, exercise programmes

50
Q

what are the clinical features of mechanical back pain?

A

stiff back, scoliosis, muscular spasm, pain relieved by sitting or lying down

51
Q

what are the risk factors of septic arthritis?

A
  • Pre-existing joint disease – esp. RA
  • Diabetes mellitus
  • Immunosuppression
  • Chronic renal failure
  • Recent joint surgery
  • Prosthetic joints
  • IVDU
  • > 80yo
52
Q

what investigations would you do in a patient with septic arthritis?

A

joint aspiration for synovial fluid, blood cultures

53
Q

how would you treat septic arthritis?

A

empirical IV abx- flucloxacillin

54
Q

what organisms can cause osteomyelitis?

A

staph aureus

salmonella

55
Q

what are the symptoms of osteomyelitis?

A

fever, local pain, erythema, sinus formation

56
Q

how would you treat osteomyelitis?

A

flucloxacillin for 4-6 weeks

57
Q

what are the risk factors of osteoarthritis?

A
  • age-cumulative effect
  • female gender
  • genetics
  • obesity
  • inflammatory- IL-1, IL-6, TNF
  • manual labour
58
Q

what are the complications of osteoarthritis?

A
  • skeletal deformity
  • bone pain due to compression fractures
  • fractures
59
Q

what is osteomalacia?

A

inadequate mineralisation of the organic bone matrix- there is a normal amount of bone but the mineralisation of that bone is low

60
Q

what is the aetiology of osteomalacia?

A
  • vitamin D deficiency- poor dietary intake or malabsorption
  • renal osteodystrophy
  • liver failure
61
Q

what symptoms does a patient with osteomalacia present with clinically?

A
  • bone pain
  • tendenress
  • proximal myopathy
  • fractures
62
Q

how can osteomalacia be diagnosed?

A
  • biopsy- incomplete mineralisation
  • x-ray- loss of cortical bone
  • plasma- decreased calcium and phosphate levels
  • bowing of the long bones of the leg
63
Q

how is osteomalacia treated?

A

vitamin D treatment

64
Q

what is osteomyelitis?

A

infection localised to the bone

65
Q

how can infection spread to the bone and cause osteomyelitis?

A
  • direct inoculation of infection into bone
  • contiguous spread from soft tissues and joints
  • haematogenous seeding
66
Q

how can osteomyelitis be diagnosed?

A
  • high WCC, ESR and CRP
  • MRI- marrow oedema and abscesses
  • X-ray- cortical erosion and sequestra
67
Q

what is Paget’s disease?

A

increased bone turnover associated with increased numbers of osteoclasts and osteoblasts

68
Q

how do patients with Paget’s disease present clinically?

A

bone pain
deformities
fractures

69
Q

how can Paget’s disease be diagnosed?

A

elevated alkaline phosphate

x-ray-lytic lesions

70
Q 
what are some extra-articular features of:
- eyes
- neurological
- haematological
- lungs
- heart 
- kidneys
- skin
associated with rheumatoid arthritis?
A
  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
Q

what are the symptoms of psoriatic arthritis?

A

pain, swelling, warmth and stiffness in the affected joints

72
Q

what are the symptoms of septic arthritis?

A

pain, tenderness, swelling, erythema, mono arthritic, fever, decreased function of affected joint

73
Q

what organisms can be responsible for septic arthritis?

A

S.aureus, S. pyogenes, Dip. Pneumonia, mycobacterium tuberculosis

74
Q

how can gout be diagnosed?

A

Diagnosis based on history, pattern, aspiration of joint to look for crystals and blood tests/ XR’s

75
Q

what is the aetiology of gout?

A
  • hereditary
  • high dietary purines
  • alcohol excess
  • diuretics
  • leukaemia
76
Q

how is gout treated?

A
  • high dose NSAID
  • colchicine
  • steroids
77
Q

how can pseudo gout be diagnosed?

A

polarised light microscopy of synovial fluid shows calcium pyrophosphate crystals

78
Q

how is pseudo gout treated?

A

NSAIDs and colchicine

79
Q

what are the symptoms of polyarteritis nodosa?

A
  • systemic- fever, malaise, weight loss, myalgia
  • skin rash
  • haematuria
  • proteinuria
  • angina
  • testicular pain
80
Q

how is polyarteritis nodosa treated?

A

corticosteroids and cyclophosphamide

81
Q

how would polymyalgia rheumatic be treated?

A

oral prednisolone

82
Q

what is the commonest type of bone tumour?

A

metastatic carcinoma

83
Q

where do metastatic carcinomas of the bone arise from?

A

breast, kidney, lung or thyroid

84
Q

what are the red flag signs of a bone tumour?

A

rest pain
tender tumour present
loss of function
neurological symptoms

85
Q

how can a bone tumour be investigated?

A
  • bloods
  • x-ray
  • CT
    MRI- T1= anatomy, T2= pathology
  • bone scan- skeletal metastases
86
Q

what system is used to grade rheumatological tumours?

A

Enneking system:
G0= histologically benign
G1= low grade malignant
G2= high grade malignant

87
Q

what can an osteosarcoma occur secondary to?

A

Paget’s disease

88
Q

how can the clinical symptoms of vertebral disc generation be exacerbated?

A

heavy straining when lifting and poor posture

89
Q

what is Schmorl’s node?

A

softened nucleus pulposus can herniate vertically into an adjacent vertebral body

nicks phase 2a flaschards (15 decks)

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