Rheumatology

Question 1

What is rheumatology?

Answer 1

Dealing w/ inflammatory and usually auto-immune disease of muscoskeletal system

Question 2

What is rheumatoid arthritis?

Answer 2

Auto-immune and systemic inflammatory condition affecting disease of synovial joints

Question 3

Is RA symmetrical or un-symmertrical?

Answer 3

Symmetrical inflammation and deformity

Question 4

Symptoms of RA?

Answer 4

Early morning stiffness/ or after rest - ease with use
Swelling - hot, painful and inflamed
Flu like symptoms

Question 5

Signs of RA?

Answer 5

Z thumb deformity
Swelling and subluxation MCPs
Sparse DIPDs
Boggy swelling
Ulnar deviation of fingers

Question 6

Extra-articular features RA

Answer 6

Lungs - nodules/ fibrosis 
CV- pericardial inflammation/ valve inflammation
Kidney - amyloidosis 
Skin - rheumatoid nodules
Secondary sjogrens 
Neurological - rheumatoid neck

Question 7

Diagnosis RA - what would the test show?

Answer 7

1. Blood test
   Auto-abs - rheumatoid factor
   High inflammatory marks - C reactive protein and erythrocyte sedimentation rate
2. X-ray
   Early - osteopenia around joints and soft tissue swelling
   Late - erosion, joint space narrowing, subluxation and dislocation

Question 8

Tx RA?

Answer 8

Immediate relief: NSAIDs/ steroids
Control of disease: DMARDS - methotrexate
Biologic drugs: Anti TNF, anti IL6

Question 9

Side effects of tx of RA and when would you stop tx?

Answer 9

Infection risk w/ biologics
Gastric upset, skin rash, bone marrow toxicity and hepatotoxicity

DMARDs/ biologics and Ab - for duration of course and 2 weeks after

Question 10

Dosing and contra-indication of methotrexate?

Answer 10

Once weekly dose - 15-25mg

Avoid w/ septrin and trimethoprim - risk bone marrow suppression
Renally excreted - can renal pt
Men and women pre-conception

Question 11

What is rheumatoid neck?

Answer 11

Erosive change C1/C2 - subluxation

Instability can cause peg migrating back into cord = neurological symtpoms

Question 12

Why may dental health be compromised in those w/ RA?

Answer 12

Poor hand/neck/ shoulder function
Immuno-suppressive drug
Many have co-existing osteoporosis - bisphosphonates

Question 13

What is JIA - what are complications?

Answer 13

Juvenile idiopathic arthritis - occur before age of 16

Jaw underdevelopment - TMJ inflam can lead to altered mandibular growth

Question 14

What is ankylosing spondylitis?

Answer 14

Inflammatory spinal pain - progressive bone formation nd calcification of spine (question mark back)

Question 15

Common features spondylitis?

Answer 15

Enthesitis
Dactylitis - sausage fingers
Skin/ nail psoriasis
Inflammatory eye disease

Question 16

What features would you expect to see with psoriatic arthritis?

Answer 16

Nail pitting, swelling at distal joints and often asymmetrical

Question 17

What is gout - what would you expect to see microscopically

Answer 17

Urate crystals due to raised serum uric acid - neutrophil led inflammatory response
Microscopically - needle-shaped urate crystals

Question 18

Name types of connective tissue disease?

Answer 18

Systemic lupus erythematosus, primary sjogrens, scleroderma

Question 19

What is SLE

Answer 19

Non-erosive arthritis

Butterfly rash and photosensitivity

Question 20

What is scelroderma?

Answer 20

Progressive skin thickening and tightening

Question 21

What is primary sjogrens?

Answer 21

Occurs w/o associated rheumatoid illness - associated Ro and La antibodies (+Ve RF)
Atrophic shrunken parotid

Question 22

What is secondary sjogrens?

Answer 22

Occur w/ rheumatic illness?