Rheumatology

Question 1

Why do you get stiff joints with inflammatory joint diseases?

Answer 1

Inflammatory synovial fluid which is high in protein which sets, as it is gelatin light + becomes stiff.

Question 2

What is the diagnostic criteria for Behcet’s Disease?

Answer 2

• Oral ulcers recurrding 3 times within 12 months
• AND 2 of the following
  
  • Recurrent genital ulcerations
  • Eye lesions (uveitis / retinal vasculitis)
  • Skin lesions (erythema nodosum, pseudofolliculitis, aceniform nodules)

Question 3

What HLA subtype is associated with Behcet’s?

Answer 3

HLAB51

Question 4

Does ANA correlate with disease activity in SLE?

Answer 4

NO!

Question 5

What marker is associated with disease activity in SLE?

Answer 5

dsDNA

Question 6

Differential diagnosis for monoarthritis (acute)

Answer 6

• Traume
• Septic arthritis / osteomyelitis
• Malignancy; leukaemia, lymphoma, neuroblastoma, bone tumuor
• Early JIA
• Acute rheumatic fever
• Reactive arthritis
• Haemophilia
• Non-inflammatory disorders
  
  • Avascular necrosis / osteochondroses
  • SUFE / transient synovitis
  • Patellofemoral dysfunction

Question 7

What is the most common subtype of JIA?

Answer 7

Oligoarthritis

ANA is positive in 60-80 % of patients

**Oligoarticular JIA with POSITIVE ANA is associated with a higher risk of asymptomtic uveitis**

HIP involvement is uncommon

Question 9

What rheumatological disease do you think of when you have DIP swelling / inflammation?

Answer 9

Psoriatic arthritis

Question 10

“Biologics” with a specific target examples

• Anti TNF
• Anti IL-1
• Anti IL-6
• Against B cells
• Anti co-stimulation molecules
• JAK inhibitors

Answer 10

• Anti TNF
  
  • Etanercept
  • Infliximab
  • Adalimumab
• Anti IL-1
  
  • Anakinra
• Anti IL-6
  
  • Tocilizumab
• Against B cells
  
  • Rituximab
• Anti co-stimulation molecules
  
  • Abatacept
• JAK inhibitors
  
  • Tofacitinib

Question 11

Key features in dermatomyositis

Answer 11

• Symmetrical proximal muscle weakness
• Characteristic skin changes
  
  • Gottron papules (scaly rash over PIP + DIP) on the dorsal surface of the knuckles
  • Heliotrope rash eyelids
  • Photosensitivity
• Nail fold capillary changes
• Arthritis
• Dysphagia
• Elevated muscle enzymes: CK, AST, LDH, aldolase
• Abnormal EMG demonstrating denervation and myopathy
• Abnormal muscle biopsy demonstrating necrosis + inflammation

Question 12

Retinal toxicity is a side effect of what drug used to treat rhematological diseases?

Answer 12

Hydroxychloroquine

Can effect macular vision

Usually affects colour vision first

Question 13

What are the subtypes of JIA?

Answer 13

JIA = inflammatory disorders begins BEFORE 18yrs, persists for at least 6 weeks

• Oligoarticular
  
  • 4 or less joints involved
• Polyarticular RF negative
  
  • 5 + joints involved
• Polyarticular RF positive
  
  • 5 + joints involved
• Systemic
• Psoriatic
  
  • May not have psoriasis prior to diagnosis
• Enthesitis related arthritis
  
  • 80% HLAB27 positive, axial symptoms rare at diagnosis

Question 14

What increases your risk of uveitis in JIA?

Answer 14

• ANA positive, oligoarticular + younger female
• Require regular opthalmology required 3-6 monthly depending on risk (SJIA 12 monthly)
  
  • May not present with redness or eye pain
• Uveitis may present PRIOR to arthritis
• Course is independent of arthritis (e.g. can have well controlled joints but have uveitis)

Question 15

What IL’s are involved in SJIA?

Answer 15

IL1 + IL6

Question 16

10yr old Vietnamese girl presents with 2 months anorexia, weight loss 3-4kg, daily fevers for 1 week,