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Pass Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What drugs cause drug induced lupus?

A 
Hydralazine
Procainamide
Phenytoin
Isoniazid
Minocycline
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2
Q

What are the symptoms of drug induced lupus?

A

Arthralgia
Myalgia
Malar rash
Pleurisy/other chest problems

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3
Q

What tests can we do for drug induced lupus?

A

ANA positive in 100%, dsDNA negative

Anti-histone antibodies positive in 90%

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4
Q

How do we manage drug induced lupus?

A

Stop the drug

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5
Q

What is Felty’s syndrome?

A 
Rare complication of rheumatoid arthritis
Triad of:
Splenomegaly
Neutropenia
Rheumatoid arthritiis
Can use SANTA acronym
Splenomegaly
Arthritis
Neutropenia
Thrombocytopenia
Anaemia
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6
Q

What type of hypersensitivity reaction is SLE?

A

Type 3 hypersensitivity reaction (remember 3 letters in SLE = Type 3 hypersensitivity)

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7
Q

Risk factors for SLE?

A

Female gender (9:1)
Black/Asian ethnicity
Age 20-40

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8
Q

What genes are involved in SLE?

A

HLA B8, DR2 and DR3

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9
Q

What is dactylitis?

A

Inflammation of a digit (finger or toe)

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10
Q

Causes of dactylitis?

A

Spondyloarthropathies

Sickle-cell disease

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11
Q

What is Sjogren’s syndrome?

A

An autoimmune disorder affecting exocrine glands, thus resulting in dry mucosal surfaces.
It is often secondary to RA

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12
Q

What investigations can you do for Sjogren’s?

A

RF +ve
ANA positive (70%)
Anti-Ro antibodies (70%) - remember sjROgren’s
Schirmer’s test - filter paper near conjunctival sac to measure tear formation

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13
Q

How do we manage Sjogren’s?

A

Artificial saliva and tears

Pilocarpine (may stimulate saliva production)

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14
Q

What antibodies are seen in rheumatoid arthritis?

A

Anti-cyclic citrullinated peptide antibodies

Rheumatoid factor

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15
Q

What condition is temporal arteritis associated with?

A

Polymyalgia rheumatica

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16
Q

What do you see histologically with temporal arteritis?

A

Skip lesions

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17
Q

How do we diagnose ankylosing spondylitis?

A

Ankylosing spondylitis needs a radiological feature AND a clinical feature for definitive diagnosis
Key radiological feature is sacroilitis on x-ray

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18
Q

What features would you see on an x-ray in ankylosing spondylitis?

A

Sacroilitis (subchondral erosions, sclerosis)
Squaring of vertebrae
‘Bamboo’ spine
Syndesmophytes: due to ossification of outer fibers of annulus fibrosus

Chest x-ray:
Apical fibrosis

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19
Q

What gene is ankylosing spondylitis associated with?

A

HLA-B27

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20
Q

Is ankylosing spondylitis more common in males or females?

A

3:1 M:F

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21
Q

How do we manage ankylosing spondylitis?

A

Encourage regular exercise (e.g. swimming)
NSAIDs
Physio
DMARDs are only useful if there is peripheral joint involvement
Anti-TNF (in later stages)

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22
Q

What conditions is ankylosing spondylitis associated with?

A 
The A's:
Anterior uveitis
Apical fibrosis
Achilles tendonitis
Aortic regurg.
AV node block
Amyloidosis
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23
Q

What are the features of ankylosing spondylitis?

A 
Back pain/stiffness (reduced lat. flexion of lumbar spine is one of the first signs)
Stiffness usually worse in the morning
Pain and swelling in other parts of body
Extreme tiredness
Anterior uveitis
Loss of lumbar lordosis
Increase in thoracic kyphosis
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24
Q

What is systemic sclerosis?

A

A condition of unknown aetiology in which you get hardened, sclerotic skin and other connective tissues.

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25
What is scleroderma?
A tightening and fibrosis of the skin that is autoimmune in nature
26
What are the 2 types of scleroderma?
Localised scleroderma - only affects the skin | Systemic sclerosis - may affect blood circulation and internal organs as well as the skin
27
What are the 2 types of localised scleroderma?
Morphoea: Discoloured oval patches (plaques) on the skin Usually itchy Patches may be hairless and shiny Improve after a few years and treatment may not be needed Linear: Thickened skin occurs in lines along the face, scalp, legs or arms Occasionally affects underlying bone/muscle May improve after a few years Can cause permanent growth problems (e.g. short limbs)
28
What are the 3 patterns of disease in scleroderma
Limited cutaneous systemic sclerosis Diffuse systemic sclerosis Localised Scleroderma
29
What are the features of limited cutaneous systemic sclerosis?
Raynaud's often the first sign Scleroderma affecting face/distal limbs CREST syndrome (a subtype)
30
What is CREST syndrome?
``` Calcinosis Raynaud's phenomenon oEsophageal dysmotility Sclerodactyly (tightness of skin on fingers/toes) Telangiectasia ```
31
Which antibodies are limited cutaneous systemic sclerosis associated with?
Anti-centromere antibodies
32
What are the features of diffuse cutaneous systemic sclerosis?
``` Scleroderma affecting trunk and PROXIMAL limbs predominantly Interstitial lung disease Pulmonary arterial hypertension Renal disease HTN ```
33
Which antibodies are diffuse cutaneous systemic sclerosis associated with?
Anti-scl-70 antibodies
34
How do we manage rheumatoid arthritis?
DMARD montherapy +/- short course of bridging prednisolone Methotrexate is the most widely used DMARD Sulfasalazine, leflunomide and hydroxychloroquine are others TNF-inhibitors - given after an inadequate response to 2+ DMARDs, including methotrexate Examples include: Etanbercept/infliximab
35
How do we monitor response to treatment in rheumatoid arthritis?
CRP and disease activity (DAS28)
36
How do we manage rheumatoid arthritis flares?
Corticosteroids - oral or IM
37
What is Schober's test?
A way of testing lumbar spine flexion (for ankylosing spondylitis): Line 5cm below and 10cm above iliac crests (15cm distance between them) Patient then flexes (as if reaching for feet) as much as possible and distance is remeasured: >4cm difference - mild 2-4cm difference - moderate <2cm difference - severe
38
What causes are there of polyarthritis?
``` RA SLE Seronegative spondylarthropathies HSP Sarcoidosis TB Pseudogout Viral infection ```
39
Rheumatoid arthritis x-ray changes
Early: Loss of joint space Juxta-articular osteoporosis Soft-tissue swelling Late: Periarticular erosions Subluxation
40
Paget's disease of the bone features
Only 5% symptomatic ``` Bone pain (skull, spine, pelvis, long bones) Isolated raised ALP Bowing of tibia, bossing of skull ```
41
What is Paget's disease of the bone?
An increased but uncontrolled bone turnover (primarily a disorder of osteoclasti resorption)
42
How do we treat Paget's disease of the bone?
Bisphosphonates | Calcitonin (less common)
43
What are complications of Paget's disease?
``` Deafness Bone sarcoma Fractures Skull thickening High output cardiac failure ```
44
What causes Marfan's?
Marfan's is an autosomal domiinant connective tissue disorder It is caused by a defect in the FBN1 gene that codes for the protein fibrillin
45
Features of Marfan's?
``` Tall statue (arm span to height ratio >1.05) High arched palate Arachnodactyly (long slender fingers) Pectus excavatum Pes planus Scoliosis Dilation of aortic sinuses (seen in 90%) Repeated pneumothoraces ```
46
What is the treatment for Marfan's?
Beta-blocker/ACE-inhibitor therapy to reduce risk of aortic aneurysm/dissection/regurgitation
47
What monitoring occurs in Marfan's?
Regular (yearly) echocardiography to monitor for aortic aneurysm, dissection, regurgitation and mitral valve prolapse
48
How do we treat acute reactive arthritis?
NSAIDs | Sulfasalazine/methotrexate if symptoms persistent
49
What is reactive arthritis?
A HLA-B27 associated seronegative spondyloarthropathy
50
What does Reiter's syndrome encompass?
Urethritis Conjunctivitis Arthritis
51
In what condition do you see Reiter's syndrome?
Reactive arthritis
52
What are the most common causes of reactive arthritis?
Chlamydia trachomatis is very common in men | Post dysenteric form - e.g. shigella, salmonella, campylobacter etc.
53
What is Behcet's syndrome?
A complex multisystem disorder with presumed autoimmune-mediated inflammation of the arteries/veins
54
What are the features of Behcet's syndrome?
``` Oral ulcers Genital ulcers Anterior uveitis Thrombophlebitis Arthritis Erythema nodosum ``` Associated with HLA B51
55
Which rheumatological condition is antiphospholipid syndrome associated with?
SLE
56
What are the risk factors for pseudogout?
``` Haemochromatosis Hyperparathyroidism Acromegaly Low magnesium/phosphate Wilson's disease ```
57
What do you see on joint aspiration in pseudogout?
Weakly-positively birefringent rhomboid-shaped crystals | Calcium pyrophosphate dihydrate crystals
58
How do we treat pseudogout?
Aspiration of joint fluid (to exclude septic arthritis) | NSAIDs (or oral steroids)
59
Which condition are patients more likely to get whilst undergoing chemotherapy?
Gout (increased urate production)
60
What class of drugs increase the risk of TB reactivation?
TNF alpha | And I guess any other immunosuppressive drugs
61
What are the features of Still's disease?
Arthralgia Salmon-pink maculopapular rash Pyrexia (rises in the later afternoon/early evening - with worsening joint symptoms/rash)
62
How do we treat Still's disease?
``` NSAIDs Steroids (if NSAIDs don't adequately manage) ```
63
What on x-ray will distinguish pseudogout from gout?
Chondrocalcinosis (present in pseudogout)
64
Which types of complement are low in SLE?
C3 and C4
65
What is osteogenesis imperfecta?
A group of disorders of collagen metabolism
66
What are some features of osteogenesis imperfecta?
``` Presents in childhood Fractures following minor trauma Blue sclera Deafness secondary to otosclerosis Dental imperfections ```
67
What is polymyalgia rheumatica?
Polymyalgia overlaps with temporal arteritis. There is a vasculitis with giant cells which characteristically 'skip' certain sections of affected artery whilst damaging others. In polymalgia rheumatica it is the muscle bed arteries which are affected most
68
What are the features of polymyalgia rheumatica?
Typically older patients >60 Usually rapid onset (<1 month) Aching Morning stiffness in proximal limb muscles (NOT weakness) Mild polyarthralgia, lethargy, depression, anorexia, night sweats, low-grade fever
69
How do we treat polymyalgia rheumatica?
Prednisolone
70
What investigation findings would you see in polymyalgia rheumatica?
ESR >40 | CK and EMG normal
71
What is Takiyasu's arteritis?
A vasculitis that primarily affects the aorta and its branches
72
What are the features of Takayasu's arteritis?
F>M Symptoms include upper limb claudication Diminished/absent pulses ESR affected in the acute phase
73
What is Buergers disease?
A vasculitis with thrombotic occlusions of the small/medium sized lower limb vessels
74
Features of Buergers disease
Proximal pulses usually present but pedal pulses lost Common in young male smokers Causes pain in the lower limb (e.g. feet)
75
What is polyarteritis nodosa?
A systemic necrotising vasculitis affectiing small and medium sized muscular arteries
76
What organs are often affected in polyarteritis nodosa?
Kidneys (70% of cases)
77
What is Wegener's granulomatosis?
A vasculitis affecting small/medium sized arteries
78
How do we tend to treat vasculitides?
Smoking cessation | Immunosuppression
79
How do we assess hypermobility?
Beighton score (5/9 is +ve in adults, 6/9 for children)
80
What is Ehler-Danlos syndrome?
An autosomal dominant connective tissue disorder that mostly affects type III collagen
81
What are the features of Ehler-Danlos syndrome?
``` Elastic, fragile skin Joint hypermobility Easy bruising Aortic regurgitation, dissection and mitral valve prolapse Subarachnoid haemorrhage ```
82
How do we treat psoriatic arthritis?
Same as rheumatoid arthritis (methotrexate, bridging prednisolone, anti-tnf etc.)
83
Is rheumatoid factor positive in psoriatic arthritis?
No, it's negative
84
How do we treat Raynaud's syndrome?
Nifedipine (a calcium channel blocker)
85
Churg-strauss (eosinophilic granulomatosis with polyangiitis [EPGA])
pANCA associated small vessel vasculitis
86
Features of Churg-strauss
``` Asthma Eosinophilia Paranasal sinusitis (nasal polyps too) Mononeuritis multiplex Petechial rash pANCA positive ```

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