Rheumatology Flashcards
Arthritis is chronic if it lasts for how long?
> 6 weeks
What are the 7 seropositive causes of inflammatory arthritis
Rheumatoid arthritis SLE Scleroderma Sjogrens Vasculitis Polymyositis Dermatomyositis
What are the 4 seronegative causes of inflammatory arthritis
Psoriatic arthritis
Reactive arthritis
Ankylosing spondylitis
Enteropathic arthritis
Generalised features of seropositive arthritis
Affect women more than men
Symmetrical polyarticular small and large joints
DIP spared
+ve RF/CCP
No pelvic/spinal involvement
Nodules, vasculitis, Raynauds, scleritis/episcleritis, photosensitivity, pulmonary involvement
Generalised features of seronegative arthritis
Affect men more than women Asymmetrical oligoarticular large joints -ve RF/CCP DIP affected in psoriatic Pelvic and spinal involvement common Iritis, uveitis, oral ulcers, enthesitis, GI, GU and derm pathology
Hand/wrist examination findings in rheumatoid arthritis
Symmetrical small joint polyarthritis affecting wrists, MCPs, PIPs, ankles, elbows
Swan neck deformity
Boutinniere’s deformity
Ulnar deviation
Rheumatoid nodules on extensor surfaces of tendons
Subluxation
Dorsal muscle wasting/guttering
Extra-articular features of rheumatoid arthritis
Lungs, heart, eyes, blood, hands, spleen
Pleuritis/pleural effusion
Pericarditis/pericardial effusion
Scleritis/episcleritis/scleromalacia perforans/keratoconjunctivitis sicca
Palmar erythema, nail fold infarcts
Caplans syndrome - pulmonary nodules, splenomegaly and low blood count (RBC, WBC, both)
Felty’s syndrome - RA, splenomegaly and neutropenia
Sjogrens syndrome
Carpal tunnel/neuropathies
What is the name of the criteria classification system used to diagnose rheumatoid arthritis
ACR classification criteria
What tool can be used to assess severity of rheumatoid arthritis
DAS-28 score
Management of rheumatoid arthritis
Refer to rheumatology Manage CVD risk factors (at increased risk) NSAIDs Steroids DMARDs/biologics
Typical presentation of reactive arthritis
Young male a few weeks after GU/GI infection
Uveitis/conjunctivitis + Urethritis + Arthritis
What is the pattern of joint involvement for reactive arthritis
Asymmetrical oligoarticular large joints of lower limbs/back
What is the pattern of joint involvement for psoriatic arthritis
Asymmetrical mono/oligoarticular larger joints
5 patterns:
1. DIP arthritis
2. Asymmetrical oligoarticular
3. Symmetrical polyarticular
4. Arthritis mutilans
5. Psoriatic spondylitis + sacroiliitis + spinal involvement
Clinical findings of ankylosing spondylitis
Asymmetrical mono/oligoarticular large joints Sacroiliac tenderness Loss of lumbar lordosis Kyphosis Iritis/uveitis
Clinical feature of SLE
Symmetrical arthritis and chronic arthralgia
Malar butterfly rash, discoid rash, photosensitivity
Fatigue, weight loss, fever, lymphadenopathy
Raynauds
Jacouds arthritis
Pleuritis/ILD
Peri/myo/endocarditis
Hypertension
Oral ulcers, nasal ulcers, alopecia
Nephritic syndrome
VTE (APS)
CNS signs - seizures, psychosis, cognitive defects
Anaemia, lymphopenia, neutropenia, thrombocytopenia
Abdo pain, diarrhoea, vomiting
What is the name of the classification system used to help diagnose SLE
ACR criteria
Which special blood tests are positive in SLE
Double stranded DNA
ANA
Anti-phospholipid antibodies
Management of SLE
Rheumatology referral CVD risk factor management Sun protection NSAIDs Steroids Hydroxychloroquine, MTX Renal assessment/involvement
What is CREST syndrome
Limited scleroderma Calcinosis Raynauds Esophageal dysfunction Sclerodactyly Telangiectasias
Which antibody is associated with scleroderma limited to the skin
Anti-centromere
Secondary causes of Sjogren’s syndrome
SLE
RA
Systemic sclerosis
What is sicca complex
Decreased lacrimal and salivary gland secretion
How can you test for lacrimal secretion
Schirmer’s test
Two antibodies associated with Sjogren’s syndrome
Anti-Ro
Anti-La
Findings associated with dermatomyositis
Heliotrope rash Gottron's papules Symmetrical proximal myopathy V shaped rash on chest/neck Photosensitivity
Diagnosis of fibromyalgia
Pain index score and symptom severity score raised for at least 3 months + no other disorder that wound explain the pain
Clinical features of fibromyalgia
11/18 tender points
Fatigue unrelieved by sleep
Neuropathic pain
How could you explain fibromyalgia to a patient
Its not inflammation it’s chemical changes in pain pathways
Risk factors for developing gout
Male Alcohol Purine diet - steak, oily fish Loop and thiazide diuretics DM HTN Decreased renal function Metabolic syndrome
Two findings that can result from chronic gout
Tophi Renal disease (stones/interstitial nephritis)
Describe the crystals seen in gout
Monosodium urate crystals are needle shape and have strong negative birefringe
Describe the crystals seen in pseudogout
Calcium pyrophosphate rhomboid shape crystals with a weakly positive birefringe
Side effects of steroids
Skin - atrophy, stretch marks, purpura HTN Weight gain, increased appetite Hyperglycaemia Hypocalcaemia (secondary osteoporosis) Mood disorders Dyspepsia Myalgia and proximal muscle weakness
How long do DMARDs take to help symptoms
6-12 months
What life threatening risk associated with DMARDs do you need to tell patients about
Risk of myelosuppression and neutropenia –> sepsis
Large vessel vasculitis
Takayasu
GCA
Medium vessel vasculitis
Polyarteritis nodosa
Kawasaki disease
ANCA positive small vessel vasculitis
Microscopic polyangitis
Granulomatosis with polyangitis
Eosinophilic gransulomatosis with polyangitis
ENT involvement is common in which type of vasculitis
Granulomatosis with polyangitis
Antibody associated with drug-induced SLE
Antihistone
What score measures disease activity in rheumatoid arthritis
DAS-28
Upper limb claudication with diminished/absent reflexes can be due to which vasculitis
Takayasu’s
Segmental thrombotic occlusions of the small and medium sized lower limb vessels
Commonest in young male smokers
Proximal pulses usually present, but pedal pulses are lost
Tortuous corkscrew shaped collateral vessels may be seen on angiography
Buergers disease
First line medication for Raynaud’s phenomenon
Calcium channel blockers e.g. nifedipine
Antibody associated with dermatomyositis
Anti-Jo1
Test for drug-induced lupus
Anti-histone antibodies
