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Rheumatology Flashcards

1
Q

Why is establishing the travel history for a rheumatology history important?

A

TB arthritis
- rare but important

TB history
- immunosuppressive drugs

G.I infections causing reactive arthritis

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2
Q

Why is it important to establish use of anticoagulation in a rheumatology history?

A

A lot of drugs are given by injection

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3
Q

What does anterior uveitis suggest?

A

Seronegative disease

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4
Q

Where will S.I joint damage/ involvement radiate to? how does this contrast with hip involvement?

A

S.I = buttocks

Hip = groin

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5
Q

Will gout give you a high CRP?

A

Yes very high

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6
Q

How can you differentiate between a pre-patella bursitis and an intra-articular effusion?

A

Often there will be a history of cellulitis
Knee will move
Fluid will not be felt in joint
Large degree of swelling around the knee

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7
Q

What is the standard treatment for septic arthritis?

A

2 weeks IV antibiotics
4 weeks oral
Wash out

*remember to take aspirate prior to antibiotics

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8
Q

Why do you want U&Es in someone suspected with gout?

A

Renal function is one of the biggest predictors of gout

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9
Q

Name 2 main investigations wanted in septic arthritis?

A

Blood cultures

Joint aspiration

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10
Q

What are rheumatoid nodules heavily associated with?

A

Anti - CCP

Smoking

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11
Q

Name two other conditions which are not RA that cause a RH factor increase?

A

Hep C
Lupus
Sjorgens

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12
Q

In suspected septic arthritis, what tests do you want done on a joint aspiration?

A

Gram staining
Culturing
Crystal cytology

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13
Q

What bloods do you want to request in someone with suspected septic arthritis?

A 
FBC 
CRP 
U&Es 
Blood cultures
Lactate
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14
Q

How is methotrexate delivered, and what are some important considerations?

A

Once weekly.
Subcut
With folic acid

CXR should be ordered prior to starting it.

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15
Q

Outline the broad tests done to diagnose a rheumatological arthropathy:

A

Bloods:

  • FBC
  • LFTs (toxicity of drugs)
  • U&Es (Toxicity of drugs)
  • CRP/ ESR
  • Rh factor
  • Anti- CCP
  • Anti-nuclear (further testing if positive)

Imaging:

  • x-rays
  • MRI of joints
  • ultrasound (monitoring)
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16
Q

What are the characteristic findings found on x-ray of RA:

A

Loss of joint space
Bony erosion
Soft tissue swelling
Osteopenia

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17
Q

What substance should people on methotrexate avoid?

A

Alcohol

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18
Q

What DMARD is safe during pregnancy? and list some common/ serious complications of the drug:

A

Sulfasalazine

*caution in use with aspirin as 5-ASA

  • Oligospermia
  • Stevens -Johnson syndrome
  • Pneumonitis
  • Myelosuppression
19
Q

How would you monitor RA?

A

Disease Activity Score of 28 joints (DAS-28)

Ultrasound

CRP

20
Q

How do you monitor psoriatic arthritis? and what score is considered high disease activity?

A

DAPSA-64

A score of >28 is high disease activity

21
Q

What are some important differentials to consider in GCA?

A

Myositis

Malignancy
- lung cancer

Myeloma
- always do a myeloma screen

22
Q

What investigations should be done into GCA?

A

Bloods:

  • FBC
  • CRP/ ESR (ESR >50)
  • TFTs
  • Glucose
  • Bone profile (myeloma)

Orifices:
- Bence jones protein

X-rays:

  • Temporal US
  • CXR (malignancy)

Special tests:
- temporal artery biopsy

23
Q

What is the management for GCA?

A

40-60mg prednisolone

*if visual defects then IV methylprednisolone for 3 days

24
Q

Name two examinations that can be done into ankylosing spondylitis:

A

Schober’s test

  • mark 5cm below L5 and 10cm above.
  • bend over and if less than <5cm increase (20cm in length) then this is positive

Occipital to wall distance

25
Q

List the investigations that should be done into Ankylosing spondylitis:

A

X-ray of lumber spine and S.I joints

MRI of lumber and S.I joints

HLA B27

26
Q

Name the criteria needed for ankylosing spondylitis:

A

Sacrolitis on imaging
+
>1 other seronegative feature

or

HLA B27
+
>2 other seronegative feature

27
Q

What score is used to assess how ankylosing spondylitis is affecting the patient?

A

BASDAI score

28
Q

What is the management of Ankylosing Spondylitis?

A

1st line:

  • NSAIDS
  • Physiotherapy

2nd line:
- Biological therapies (anti- alpha, Anti IL-17)

29
Q

What investigations should be done into Sjogren’s syndrome?

A

Schirmer’s test

Anti- Ro

Anti- La

Salivary gland biopsy (rarely done)

30
Q

What antibody in Sjogren’s syndrome is associated with lymphoma?

A

Anti - Ro antibody

31
Q

List some of the signs and symptoms of polymyositis and dermatomyositis and the investigations:

A

Signs and symptoms:

  • Proximal muscle weakness
  • Symmetrical
  • Groton’s papules (if dermatomyositis)
  • dysphagia
  • fever

Investigations:

  • Creatine kinase (raised)
  • CRP/ ESR
  • Anti - Jo-1
  • Anti- Mi2 antibodies
  • ANA
  • EMG
  • Muscle biopsy (lymphocyte infiltration)
  • malignancy screening
32
Q

What are the radiological findings of sacroiliitis:

A

X-ray:

  • Sclerosis of endplates - especially iliac side
  • Widening of the joint space

MRI:

  • Marrow oedema
  • Synovitis and capsulitis
  • Enthesitis (thickening of ligaments)

Later:

  • subchondral lesions
  • foci erosions
33
Q

What antibodies are associated with systemic sclerosis?

A

ANAs

Anti-centromere: limited cutaneous type

Anti SCL-70: diffuse type

34
Q

What is the general management for SLE?

A

Sun cream
NSAIDs
Hydroxychloroquine
- typically used when NSAIDs is not enough

35
Q

What disease is also known as the pulseless disease - list some other signs and symptoms of it and how is it diagnosed?

A

Takayasu’s disease
- large vessel vasculitis - usually aorta causing aneurysms which swell and compress

  • fever
  • malaise
  • arm claudication
  • CT
    or
  • MRI angiogram
36
Q

How does methotrexate work and List the common side effects of methotrexate and list some parameters which should be monitored throughout the treatment:

A

Inhibits dihydrofolate reductase
- preventing cellular replication

Myelosuppression - anaemia
Lung fibrosis - dry cough
Mucositis - oral ulcers/ G.I upset
Liver fibrosis

  • FBC
  • U&Es
  • LFTs

*1-2 weekly to begin with then 2-3 times monthly there after

**taken with folic acid the day before

37
Q

Highlight some adverse effects of steroids:

A

Mood behaviour

  • insomnia
  • confusion
  • psychosis

Diabetes

Osteoporosis

Skin thinning/ bruising/ ulceration

Immunosuppression

Metabolic changes
- hypokalaemia

38
Q

Name the 4 major DMARDs and side effects for them:

A

Methotrexate

  • lung fibrosis
  • liver hepatiis

Hydroxychloroquine
- Retinopathy

Sulfasalazine

  • Steven’s johnson syndrome
  • myelosuppression
  • pneumonitis

Leflunomide

  • peripheral neuropathy
  • G.I upset
39
Q

Which drug requires a TMPT level prior to administration? and list two autoimmune conditions it is used for and non-autoimmune condition:

A

Azathioprine

  1. Inflammatory bowel disease
  2. Myasthenia gravis
  3. Eczema
40
Q

Name the key skin findings in SLE and highlight key characteristics of them:

A

Mallar rash:
- across cheeks and bridge of nose. Spare nasal labia folds

Discoid rash:
- run exposed area, well demarcated, pigmented and becomes hyperkeratotic

Livedo reticularis
- vessel formation

Raynaud’s

41
Q

List the key antibody tests to conduct into SLE:

A

Anti- Nuclear Antibodies

Anti Double stranded DNA -

Anti - Extractable nuclear Antigens
- anti - smith

Complement studies
- low

42
Q

Which antibody is associated with dermatomyositis?

A

Anti- Jo-1

43
Q

Which two antibodies are associated with Sjogren’s syndrome?

A

Anti Ro
and
Anti- La

44
Q

p-ANCA is also associated with other conditions other than vasculitis, what are they?

A

Ulcerative colitis
PSC
Crohns (rarer)

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