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FRACP Shuyu > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Antibody associated with drug induced SLE

A

anti-histone antibody

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2
Q

What drug should everyone with SLE be on

A

hydroxychloroquine

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3
Q

Biggest cause of mortality is well-controlled lupus

A

Cardiovascular disease (but uncontrolled lupus is still the biggest killer)

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4
Q

Adverse effect of hydroxychloroquine

A

retinopathy

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5
Q

1st line for lupus nephritis

A

mycophenolate

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6
Q

antiphospholipid syndromes venous vs arterial INR target range

A

target INR 2.0 to 2.5 for venous 3.0 to 3.5 for arterial clots esp CNS

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7
Q

Most likely cardiopumonary manifestation of SLE

A

Pleurisy, pericarditis, effusions (30-50%)

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8
Q

What ANA is associated with pericarditis in SLE

A

Anti-Sm

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9
Q

Antihypertensive for gout

A

Losartan

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10
Q

Gout synovial fluid findings

A

Monosodium urate crystals = needle shaped crystals which are STRONGLY NEGATIVELY birefringent on polarised light microscopy

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11
Q

Uric acid treatment aims (no tophi vs tophi)

A

No tophi 0.36; tophi 0.3

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12
Q

After allopurinol what other drugs are available for management of gout?

A

Febuxostat - newer xanthine oxidase inhibitor (not a purine analogue) Probenecid - inhibits URAT1 to block retention of urate in kidneys → weak uricosuric agent

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13
Q

Risk factors for avascular necrosis

A

HIV, steroids, excessive ETOH use, sickle cell, transplantation (likely secondary to corticosteroids)

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14
Q

Most common chronic inflammatory arthritis

A

rheumatoid arthritis

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15
Q

What allele in the MHC confers the greatest risk of RA

A

HLA-DRB1

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16
Q

Most reproducible environmental risk factor for rheumatoid arthritis

A

smoking (antibody positive)

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17
Q

Most common cervical spine joint affected in RA

A

Atlantoaxial joint

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18
Q

Felty’s syndrome

A

triad of neutropenia, splenomegaly and nodular RA

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19
Q

Specific immunological marker for rheumatoid arthritis

A

Anti-CCP (associated with erosive disease)

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20
Q

Infliximab

A

Anti-TNF

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21
Q

Anakinra

A

IL-1 receptor antagonist

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22
Q

Rituximab

A

CD20 monoclonal antibody

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23
Q

Tocilizumab

A

mAb agains IL-6

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24
Q

Tofacitinib

A

Inhibits JAK1 and JAK3

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25
Q

DMARDS for RA in pregnancy

A

Hydroxychloroquine and sulfasalazine

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26
Q

What renal disease is associated with poor disease control in rheumatoid arthritis

A

Secondary amyloidosis

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27
Q

What is HLA27 most commonly associated with

A

Ank spond

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28
Q

What features would inflammatory back pain have

A

4 out of 5 of the following: -Age <40 years -Lack of improvement at rest -Pain at night -Improve with exercise -Insidious onset

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29
Q

What is enthesis

A

Inflammatory at the insertion of the tendon to the bone

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30
Q

Ank spond extra articular abnormalities

A

Uveitis (30%) Aortic valve disease Cardiac conduction abnormalities Restrictive lung disease Also atherosclerotic cardiovascular disease

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31
Q

Bug most commonly assocaited with reactive arthritis

A

Yersinia But also Chlamydia Ureaplasma urealyticum Campylobacter E coli Salmonella Shigella

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32
Q

ANA pattern associated with limited sclerosis

A

Centromere - indicates anti-centromere antibody

33
Q

Treatment for scleroderma renal crisis

A

ACE-I

34
Q

What inflammasome and interleukin are involved in the initiation of acute gout flares?

A

NLRP3 inflammasome and interleukin 1beta. Monosodium urate crystals interact with resident macrophages to form and activate the NLRP3 inflammasome. Caspase 1 processes pro-interleukin 1beta into mature interleukin 1-beta

35
Q

What is the dominant cause of hyperuricaemia

A

Underexcretion

36
Q

What are the most common comorbidities associated with gout?

A

Hypertension - 74% CKD - 71% Obesity - 53% Diabetes - 26%

37
Q

When is urate lowering therapy indicated?

A

recurrent gout flares >1 flare a year tophi stage 2 or worse CKD or kidney stones Not recommended for people with asymptomatic hyperuricaemia

38
Q

What HLA is associated with allopurinol hypersensitivity syndrome

A

HLA-B*5801

39
Q

What gout drugs can lead to myelosuppression with azathioprine?

A

Xanthine oxidase inhibitors - allopurinol, febuxostat Due to azathioprine increasing 6-mercaptopurnie concentrations

40
Q

6 ddx of acute knee monoarthritis

A

septic arthritis crystal arthritis other inflammatory monoarthritis traumatic arthritis osteoarthritis avascular necrosis

41
Q

benefit of uric acid

A

antioxidant if someone if profoundly hypouricaemic, it is thought that the rate of neurodegenerative diseases can increase

42
Q

what temperature causes precipitation of uric acid

A

lower temperatures

43
Q

Why does premenopausal women rarely have gout

A

estrogenic is uricosuric

44
Q

What skin condition is associated with gout

A

psoriasis due to high skin turnover

45
Q

What drives elevated ESR in inflammation

A

Fibrinogen

46
Q

Ultrasound of uric acid deposition

A

Double contour sign

47
Q

Ultrasound of gout joint effusion

A

“Snowstorm appearance”

48
Q

What diet for gout

A

DASH diet (dietary approaches to stop hypertension)

49
Q

adverse effect of febuxostat

A

all cause mortality and cardiovascular mortality were higher with febuxostat - do not use in patients with IHD or congestive heart failure

50
Q

What statins don’t interact with colchicine

A

Atorvastatin, simvastatin Ok to use pravastatin and rosuvastatin CYP3A4 inhibitor and P-glycoprotein inhibitors Also interacts with ritonavir

51
Q

Mean time of allopurinol rash onset after starting drug

A

30 days (90% within 6 months)

52
Q

RIsk factors for allopurinol hypersensitivity syndrome

A

Female Age Renal impairement Diuretic use HLA B*58:01

53
Q

How is activity in RA defined by

A

1) joint activity 2) how many active joints 3) CRP and ESR

54
Q

When should DMARDS be commenced in RA

A

at diagnosis

55
Q

Poor prognostic factors in RA

A

RF positivity, anti-CCP positivity Functional limitation Number of joints (synovitis) Early erosions High ESR or CRP

56
Q

Biggest cause of mortality in RA

A

Cardiovascular disease (RA has same independent risk to diabetes)

57
Q

How early can erosions be detected on MRI in RA

A

4 months

58
Q

What cell causes bony erosions in RA

A

osteoclast relevant for bone scans

59
Q

At what doses does prednisolone increase osteoporosis

A

>7.5mg

60
Q

Which TNF inhibitor does not work in inflammatory bowel disease

A

etanercept

61
Q

What infection does JAK inhibitors predispose you to more than the other DMARDS

A

shingles cannot have vaccine because it’s a live vaccine

62
Q

What infection does IL-17 inhibitors predispose you to more than the other DMARDS

A

candidasis

63
Q

What DMARD should not be used in demyelination

A

TNF inhibitors

64
Q

Which DMARD should not be given in heart failure

A

anti-TNF

65
Q

What vaccinations are live

A

shingles, MMR, yellow fever, BCG

66
Q

What organisms in septic arthritis is associated with drug abuse?

A

pseudomonas aeruginosa, serratia percescens

67
Q

What organisms in septic arthritis is associated with haemoglobinopathies

A

streptococcus pneumonia, salmonella

68
Q

diagnostic test of reflex sympathetic dystrophy

A

bone scintigraphy

69
Q

which area of the foot does diabetic arthropathy most commonly affect

A

mid foot

70
Q

patient on dialysis XR diagnosis

A

dialysis related amyloidosis

71
Q

differences between HD related amyloidosis and other amyloidosis

A

less visceral invovlement

mainly joints

increases with duration of HD

72
Q

where are syndesmophytes most commonly seen in ank spond

A

thoraco-lumbar

73
Q

what condition is assos with non-marginal syndesmophytes

A

psoriatic spondylitis

74
Q

which side of the sacroiliac joint does ank spond affect more

A

iliac side

75
Q

what arthritis is most associated with enthesitis

A

reactive arthritis

76
Q

gout erosions vs rheumatoid erosions vs infective

A

gout has bigger erosions - if you few a circle with the erosion the circle woud mainly be outside the bone but in gout more of the erosion is in the bone

in infective, the border of the erosion isn’t as smooth

77
Q

what joint is most suggestive of haemochromatosis

A

MCP (next test ferritin)

78
Q
A

FRACP Shuyu (65 decks)

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