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Finals > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is the pathology of RA?

A

synovitis, thickened synovial lining, infiltration by inflammatory cells and generation of new blood vessels

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2
Q

RF for RA?

A

women, family history, HLA-DR4 (genetics)

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3
Q

X ray features for RA?

A 
LESS - 
LOSS of joint space
EROSIONS
SOFT tissue swelling
SOFT bones (osteopenia)
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4
Q

Hand signs of RA?

A

ulnar deviation, swan neck deformity, boutonierre deformity

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5
Q

Features of RA?

A

symettrical polyarthritis (typically affects the small joints of hands and feet.)

  • morning stiffness >30 minutes
  • as deteriorates, larger joints get involved
  • positive MCP squeeze test
  • weakened joint capsules - deformities, unstable joints, subluxation
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6
Q

Name some non articular manifestations of RA?

A

SYSTEMIC - fever, fatigue, weight loss
EYES - sjogrens, scleritis, episcleritis
NEURO - carpel tunnel, cord compression, polyneuropathy
HAEM - lymphadenopathy, splenomegaly, anaemia
PULM - effusion, fibrosis, nodules
HEART - pericarditis, effusion

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7
Q

Ix for RA?

A

Bloods - FBC/UE/CRP/ESR
ABs - anti CCP/RF antibodies
Xray the affected joints
synovial fluid sample

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8
Q

Which antibodies are positive in RA?

A

RF, anti-CCP

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9
Q

Name some poor prognostic RA factors?

A 
rheumatoid factor positive
poor functional status at presentation
HLA DR4
X-ray: early erosions (e.g. after < 2 years)
extra articular features e.g. nodules
insidious onset
anti-CCP antibodies
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10
Q

How do you manage RA? give a few treatments?

A

NSAIDS - reduce pain and stiffness
Paracetamol - pain
Steroids - reduce disease activity. Systemic vs injection
DMARDS - inhibit inflammatory cytokines e.g. synlfasalazine Methotrexate
Biological DMARD - TNFa inhibitor e.g. Infliximab

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11
Q

List some side effects of commonly used RA drugs

NSAIDS/prednisolone/methotrexate

A

NSAIDS - bronchospasm in asthmatics, peptic ulcers, dyspepsia
Prednisolone - cushingoid, osteoporosis, HTN, impaired glucose tolerance
Methotrexate - myelosuppression, liver cirrhosis, pneumonitis

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12
Q

Features of ankylosing spondylitis? who is the patient group most commonly affected?

A

pain and stiffnesss in lower back/buttocks. Pain improves with exercise and there is progressive reduced spinal movement

Commonly affects young men (early 20s)

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13
Q

What do you find on examination with a patient with ankylosing spondylitis?

A

reduced lordosis and increased kyphosis, reduced L spine mobility and reduced spine flexion, chest does not expand as well

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14
Q

Ix for ankylosing spondylitis?

A

Increased ESR/CRP levels
X ray - erosions and sclerosis
MRI - sacroilitis
HLAB27 testing

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15
Q

Mx for ankylosing spondylitis?

A

exercises in the morning for mobility and posture
NSAIDs
TNFa blocking drugs/methotrexate

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16
Q

Name some seronegative spondyloarthropathies?

A

ankylosing sponydilitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis (Chrons/UC)

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17
Q

Features of psoriatic arthritis?

A

asymetrical affect on small DIP hand joints
arthritis mutilans
sacroiliitis
dactylitis

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18
Q

Ix for psoriatic arthritis?

A

routine bloods/ESR

X-ray - pencil cup deformity

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19
Q

Mx of psoriatic arthritis

A

analgesia, NSAIDS, IA corticosteroids, methotrexate

20
Q

What infections can cause reactive arthritis?

A

GI - shigella, salmonella, campylobacter

STI - chlamydia

21
Q

Features of reactive arthritis?

A

typically affects knees/ankles/feet
CIRCINATE BALANITIS RASH
acute anterior uveitis
plantar fasciitis

22
Q

What is reiters syndrome?

A

urethritis, reactive arthritis, conjunctivitis

23
Q

Ix of reactive arthritis?

A

clinical diagnosis

synovial fluid aspirate - sterile, high neutrophils

24
Q

Mx of reactive arthritis?

A

NSAIDS, local corticosteroid injections

25
Q

What is enteropathic arthritis?

A

large joint asymmetrical oligoarthritis occuring in patients with UC/CD. parrallels the activity of the IBD.

26
Q

What sort of crystals are in joints with gout?

A

intra-articular sodiium urate crystals (due to hyperuricaemia)

27
Q

Causes of hyperuricaemia?

A

reduced excretion - CKD/thiazide diuretics/HTN

increased production - high purine turnover/polycythemia/leukaemia

28
Q

Features of gout?

A

commonly affects MTP joint in big toe. Significant pain, swelling, erythema.

29
Q

Precipitating factors for an attack of gout?

A

diet/alcohol/thiazide diuretic/dehydration

30
Q

Ix for gout?

A

joint fluid microscopy - long needle shaped crystals (-ve bifringent under polarised light)
X ray - joint effusion, punched out erosions
Serum uric acid raised

31
Q

Acute management of gout?

A

NSAIDS, colchicine (SE = diarrhoea), IA corticosteroids

32
Q

Chronic management of gout?

A 
allopurinol (xanthine oxidase inhibitor)
low purine diet
stop thiazide diuretics
reduce alcohol
reduce weight
33
Q

What antibodies are positive in SLE?

A

ANA, dsDNA

34
Q

Blood results in SLE?

A

FBC (anaemia), UE, Cr, raised ESR, normal SLE, low C3 and C4. Positive ANA and dsDNA antibodies
IgG deposition in kidneys

35
Q

Multisystem features of SLE

A

MSK - arthralgia/myalgia
GENERAL - tired, fever, depressed, weight loss
SKIN - butterfly rash, vasculitis, alopocia, UV sensitivity
BLOOD - anaemia, leucopenia, thrombocytopenia
LUNGS - pleural effusions
HEART - pericarditis, myocarditis
KIDNEYS - glomerulonephritis

36
Q

Mx of SLE?

A 
NSAIDS, 
chloriquine/hydroxychloroquine
corticosteroids
immunosuppressant - azathioprine
rituximab (anti - CD20)
37
Q

Features of antiphospholipid syndrome?

A

thrombosis, recurrent miscarriages
Arteries - TIA/stroke/MI
Placenta - recurrent miscarriages
Other - migraine, thrombocytopenia, renal impairment, accelerated atheroma

38
Q

Mx of antiphospholipid syndrome?

A

lifelong anti-coagulation

39
Q

What causes systemic sclerosis?

A

autoimmune activation, proliferation of fibroblasts and production of connective tissue = thickened vascular walls

40
Q

Features of systemic sclerosis?

A

CREST SYNDROME

calcinosis, raynauds, oesophagus, sclerodactyl, telangiectasia

41
Q

What is polymyositis?

A

inflammation and necrosis of skeletal muscle fibres

42
Q

Features of polymyositis?

A

symmetrical progressive weakness, muscle wasting of proximal muscles, difficulty squatting, NO pain

43
Q

Ix for polymyoisitis?

A

muscle biopsy = shows muscle inflammation and necrosis
increased CK, ESR normal
Positive anti JO abs
MRI

44
Q

Mx of polymyositis?

A

prednisolone

45
Q

Features of polymyalgia rheumatica?

A

Pt with GCA. Abrupt stiffness and pain in the neck and shoulder muscles. malaise/fever/weight loss. AION

Finals (21 decks)

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