Rheumatology Flashcards
What is rheumatoid arthritis?
Autoimmune disease resulting in symmetrical polyarthritis, Antibodies to Fc portion of IgG (RF) and anti-CCP
How does RA typically present?
Usually middle aged women with progressive, peripheral and symmetrical polyarthritis, Worse in the morning, gets better with use ~30 mins
Can affect any joint, but most often MCP, PIP, MTP
What are some extra-articular manifestations of RA?
ILD, Anaemia, Pulmonary disease eg bronchiectasis, Inc CVS risk
What are x-ray features of RA?
Loss of joint space, Periarticular erosions, Soft tissue swelling, Subluxation
What investigations are done in RA?
Bloods: FBC - microcytic anaemia, raised inflammatory markers
Anti-CCP - more specific to RA
Rheumatoid factor - not specific
What is the management of RA?
DMARD therapy - methotrexate, need to also take folate
Steroids for acute flareups; PO, IM or intra-articular
Symptoms control with NSAIDs
Manage risk factors for cardiovascular disease
What is SLE?
Autoimmune disease with inadequate T cell activity and increased B cell activity
Autoantibodies made against tissues => immune complexes
These can’t be cleared so there is local inflammation and damage
How can SLE present?
Non-specific; fatigue, fever, weight loss, arthralgia
Photosensitivity - malar rash
Renal - glomerulonephritis
Neuro - seizures, psychosis
What investigations are done for SLE?
FBC - anaemia, leukopenia
Raised ESR, normal CRP
Urinalysis - proteinuria
Antibodies: \+ve ANA Anti-Ro, Anti-La Anti-dsDNA inc with disease activity Low complement
How is SLE managed?
Sun protection
Hydroxychloroquine used for rash and arthralgia
Short course of prednisolone for flares
What are spondyloarthropathies?
Group of conditions affecting the spine and peripheral joints
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
How does ankylosing spondylitis present?
Lower back pain, stiffness which improves throughout the day
Progressive loss of spinal movement
What signs are seen in ankylosing spondylitis?
Oft normal
Later stages - loss of lumbar lordosis, exaggerated thoracic kyphosis
Reduced lateral flexion, reduced forward flexion (Schober’s test)
What imaging is done for ankylosing spondylitis?
MRI more sensitive
What is the management of ankylosing spondylitis?
NSAIDs
Physio
TNF inhibitors - infliximab/etanercept
What are extra-articular manifestations of ankylosing spondylitis?
Anterior uveitis
Aortic incompetence
AV block
Apical lung fibrosis
What is reactive arthritis?
Sterile synovitis occurring after a distant infection, eg salmonella, chlamydia
How does reactive arthritis present?
Asymmetrical lower limb arthritis
Conjunctivitis
Can’t see, can’t pee, can’t bend at the knee
What investigations are done in reactive arthritis?
Serology
Raised inflammatory markers
Joint aspirate to rule out septic/crystal arthropathies
management
Treat infection
NSAIDs, joint injection
If it doesn’t resolve in 2 yrs => DMARDs
How does polymylagia rheumatica present?
Pain and stiffness of shoulder, hips and neck
Decreased ROM, lethargy
Normal muscle strength, but limited by pain
What is the management of polymyalgia rheumatica?
15mg prednisolone 1-2 yrs
Should respond fairly quickly
Need to co-prescribe bisphosphonates, vit D, calcium and PPI
What is temporal arteritis?
Vasculitis of large cells
Associated with polymyalgia rheumatica
How does temporal arteritis present?
Headache, localised over temple
Scalp tenderness
Tongue/jaw claudication due to reduced blood supply
Visual disturbances - blindness, diplopia
