Rheumatology Flashcards
Features of Reiter’s syndrome
Triad of:
Urethritis
Conjunctivitis
Arthralgia
Antibodies most commonly seen in SLE
Anti-dsDNA
Features of ankylosing spondylitis
Young male
Buttock / sacroiliac pain
Worse in the morning
Relieved by exercise
X-ray Features of ankylosing spondylitis
Syndesmophytes
Bamboo spine
Associated conditions of ankylosing spondylitis
Arthritis
Anterior uveitis
Apical lung fibrosis
Aortic regurgitation
What is meant by ‘seronegative arthritis’
Arthritis not associated with rheumatoid factor production.
E.g. Reiter’s syndrome, ankylosing spondylitis, psoriatic arthritis, enteropathic arthropathy
Features of Raynaud’s phenomenon
Usually F
cold, cyanosed fingers
Normal –> white –> blue –> pink
Features of systemic sclerosis
Calcinosis Raynaud's is common Oesophageal dysmotillity Sclerodactly Telengiectasia
Features of Bechets disease
More common in Turkish/Iranian patients Oro-genital ulceration Uveitis Arthritis Pathergy reaction = pathognomonic
Features of polymyositis
Proximal muscle weakness
Pain and tenderness
Raised CK
Features of dematomyositis
Proximal muscle weakness
Pain and tenderness
Raised CK
Heliotrope (purple) rash
Features of Sjögren’s syndrome
Dry eyes
Dry mouth
Positive schirmers test
Corneal ulcers Oral candida Vaginal dryness Dyspareunia Respiratory hoarseness
What is anti-double stranded DNA antibody most commonly s associated with?
SLE
What are anti-Jo antibodies most commonly associated with?
Polymyositis
What are anti-centromere antibodies most commonly associated with?
Limited systemic sclerosis
What are anti-topoisomerase antibodies most commonly associated with?
Diffuse systemic scerosis
What are cANCA and anti-PR3 antibodies most commonly associated with?
Wergener’s granulomatosis
What is alpha-endomysial antibody most commonly associated with?
Coeliac
What are anti-cyclic citrunillated peptide antibodies most commonly associated with?
Rheumatoid arthritis
What is feltys syndrome
Splenomegally
Neutropenia
In a pt with RA
Clinical features of pseudogout
acute monoarticular or oligoarticular arthritis.
Commonly knees - or wrists, shoulders, ankles, hands and feet.
Acute joint pain and swelling.
Effusion, warmth, tenderness and pain on movement.
Positively birefringent crystals occur when….
Pseudogout
Rhomboid shaped crystals
Negatively birefringent crystals occur in….
Gout
Needle shaped crystals
Features of psoriatic arthritis
DIPJ involvement
Dactylitis
(Arthritis mutilans = severe form)
Features of a septic arthritis
Hot swollen tender joint Unwell patient restricted range of movement
Most common cause of a septic arthritis
Staph aureus
Risk factors for septic arthritis
Old very young IVDU diabetes Pre-existing joint condition
Management of septic arthritis
Surgical washout
IV flucloxacillin and benzylpenicillin
Few weeks oral antibiotics
Complications of septic arthritis
Joint destruction
osteomyelitis
bony fusion across to joint (ankylosis)
Features of Reiter’s syndrome
Arthritis
urethritis
iritis
What causes osteoarthritis
Wear and tear of articular surfaces of the joint
Risk factors osteoarthritis
Female obesity Hyper mobility trauma Repetitive use
Clinical presentation of osteoarthritis
Joint pain worse with movement relieved by rest stiffness joint instability deformity
Examination findings in osteoarthritis
Bony swellings
Joint effusion
crepitus
Where do heberdens nodes occur
DIPJ
Where do Bouchards nodes occur
PIPJ
Management of osteoarthritis
Weight loss physiotherapy NSAID intra-articular steroid injection arthrodesis joint replacement
What is tennis elbow
Inflammation of the insertion of the tendon into the lateral epicondyle of the elbow
Usually due to repetitive strain
Exacerbated by wrist extension
What is golfers elbow
Inflammation of the insertion of the tendon into the medial epicondyle of the elbow
Usually due to repetitive strain
Exacerbated by wrist flexion
Typical patient with gout
Male Older Obese Drinks alcohol Hypertension Ischaemic heart disease Diabetes
Presentation of acute gout
Sudden pain, swelling and redness of joint (commonly 1st metatarso-phalangeal)
Management of acute gout
NSAIDS - indometacin or diclofenac
Prophylaxis for gout
Allopurinol (xanthine oxidase inhibitor)
Do not prescribe during or within 1 month of an acute attack.
It can precipitate and acute attack initially
What is chronic tophaceous gout
Where the urate crystals accumulate in cartilage - often in the ear and Achilles’ tendon
What is gout nephropathy
Urate deposition in the kidney causing acute renal failure and urate stones
Symptoms of ankylosing spondylitis
Insidious onset low back pain
Stiffness worse in morning - better with exercise
Poor spinal flexion
Question mark posture
+ extra articular features = apical lung fibrosis, anterior uveitis, Achilles tendinitis, plantar fasciitis, aortic regurgitation, amyloidosis
Management of ankylosing spondylitis
Physiotherapy
Exercise
Slow release NSAIDs
Presentation of enteropathic arthritis
Asymmetrical oligoarthrits
Mostly affects large joints of lower limb
Occurs with IBD
Management = treat IBD
Classical presentation of RA
Symmetrical arthritis of small joints of the hand
Worse in the morning
Boggy swelling
Common deformities in RA
Swan neck Boutonnières deformity Z thumb Atlanto-axial subluxation Spindling of fingers Ulnar deviation
Features of juvenile idiopathic arthritis
Joint inflammation >6 weeks
Onset <16yo
Types of juvenile idiopathic arthritis
Mono articular = single joint
Pauciartiular = 4 or less joints
Polyarticular = > 4 joints
Complications of juvenile idiopathic arthritis
Chronic anterior uveitis
Flexion contraction of joints
Amyloidosis
Management of juvenile idiopathic arthritis
Physiotherapy
NSAIDs
Intra-articular steroids
DMARDs
What is stills disease
A systemic form of juvenile idiopathic arthritis - autoimmune.
Intermittent high pyrexia Salmon pink rash Arthralgia Myalgia Hepatosplenomegally Lymphadenopathy Pericarditis
Diagnosis of Polymyositis
Serum raised creatinine kinase
Muscle biopsy demonstrates information and necrosis
What is polymyositis
Rare
inflammatory disorder of skeletal muscle
Associated with underlying malignancy
What is the name given to features of dermatomyositis without muscle weakness
Amyopathic Dermatomyositis
Symptoms of antiphospholipid syndrome
Recurrent arterial venous thrombosis PE DVT stroke Recurrent miscarriage thrombocytopenia
Antibodies in antiphospholipid syndrome
Anti-cardiolipin antibodies
Management of antiphospholipid syndrome
Avoid smoking / COCP
Treat hypertension
treat hyperlipidaemia
treat diabetes
After thrombosis a lifelong warfarin - INR 2.5
Substitute s/c heparin if planning pregnancy
Features of limited cutaneous scleroderma
Scleroderma limited to distal limbs
Beaked nose
small furrowed mouth (Microstomia)
CREST Syndrome
Features of diffuse cutaneous scleroderma
Involved skin of whole-body
Involvement of internal organs (Renal impairment, lung fibrosis)
Worse prognosis
Antibodies associated with Sjögren’s syndrome
Anti-Ro
anti-La
Treatment of Sjögren’s syndrome
Artificial tears
artificial saliva
Diagnosis of SLE
Four or more of: Arthralgia renal disease - Nephrotic syndrome antinuclear Ab Serostitis - Pleurisy, pleural effusion, pericarditis Haematological disorder - Pancytopenia photosensitivity Oral ulcer immunology - Anti-dsDNA, Anti-Smith Neurological problems- depression, psychosis Malar rash Discoid rash
Management of SLE
Analgesia, steroids, immuno-suppression
What are overlap syndromes
Cases in which patient have more than one connective-tissue disease simultaneously
What drugs can induce lupus
Isoniazid
penicillamine
What is the 1st line DMARD in the UK
Sulfasalazine
Why should patients with rheumatoid arthritis with rheumatoid nodules NOT receive methotrexate
Causes accelerated nodule growth
Management of anti phospholipid syndrome
Not suffered thrombosis yet - daily low dose aspirin
Previous thromboses - warfarin
Previous thromboses + pregnancy - enoxaparin
Diagnostic test for dematomyositis
Muscle biopsy
Demonstrates inflammation and necrosis
Osteoporosis prophylaxis for patients on steroids
Lifestyle - Stop smoking, limit alcohol and exercise
Calcium and vitamin D supplements
Oral bisphosphonates
