Rheumatology Flashcards
What type of symptoms can you have in SLE?
- Mucocutaneous
- Musculoskeletal
- Cardiorespiratory
- Renal
- Neuropsychiatric
- Haematology
- Immunology
- Obstetric
- Oral ulcers, photosensitive rash
- Arthralgia, myalgia
- Pleuritis, pericarditis
- Proteinuria, cellular casts
- Seizures, psychosis
- Haemolytic anaemia, lymphopenia, leukopenia, thrombocytopenia
- Anti DNA, Anti Sm
- Recurrent miscarriage, IUGR, neonatal lupus, prematurity, stillbirth
What are the first-line management options for SLE? (3)
Avoid sunexposure and wear suncream
Hydroxychloroquine
NSAIDs for pain
What antibodies are present in:
- Sjogren’s
- Polymyositis/dermatomyositis
- Systemic sclerosis
- Limited sclerosis
- Antiphospholipid
- Anti Ro and Anti La
- Anti Jo-1
- Anti Scl 70
- Anti centromere
- Anti cardiolipin
What is the general presentation for:
- Granulomatosis with polyangiitis
- Eosinophilic granulomatosis with polyangiitis
- Microscopic polyangiitis
- Nasal crusting and deformity, conductive deafness, haemoptysis, cough, dysnpnoea, glomerulonephritis
- Severe asthma which worsens with Monelukast, haemoptysis, skin nodules and papules, eosinophilia
- Haematuria, proteinuria, RBC casts, alveolar haemorrhage
What is polyarteritis nodosa?
What infection is commonly associated?
Necrotising arteritis involving visceral arteries
Hepatitis B
Which cardiovascular symptoms are associated with Takayasu’s arteritis?
Aortic regurgitation
BP difference >10mmHg in both arms
Jaw and arm claudication
What is the differential diagnosis for vasculitis? (5)
Subactuve bacterial endocarditis Cocaine abuse (nasal deformity) Atrial myxoma Antiphospholipid antibody syndrome (livedo reticularis) Cholesterol embolism (livedo reticularis in digits)
What intial tests should be ordered when investigating vasculitis?
FBC, LFTs, antibodies (RF, anti-CCP, ANA, ANCA, PR3 (pANCA))
Urine dip and ACR
What symptoms are most common in fibromyalgia? (4)
Widespread muscular pain
Generalised stiffness
Persistent fatigue
Non-refreshing sleep
What are some conditions that are associated with fibromyalgia? (8)
Rheumatoid arthritis SLE IBS and irritable bladder TPJ dysfunction Dysmennorhoea Raynaud's phenomenon Restless legs
What are the differentials for fibromyalgia? (6 categories)
Inflammatory: PMR, SLE, connective tissue disorder Endocrine: hypothyroidism Metabolic: vitamin deficiencies, anaemia Malignancy Infection: Lyme disease Myopathy
What are the management options for fibromyalgia?
- Pharmacological
- Non-pharmacological
- Pain killers, antidepressants (amitryptiline, SSRIs, duloxetine)
- Exercise programmes, CBT, relaxation therapies and hydrotherapy, mindfulness, acupuncture
What are some systemic manifestations of rheumatoid arthritis?
What is Felty’s syndrome?
Sjogren's, scleritis and episcleritis Ulcers, rashes, nail fold infarcts Nodules Polyneuropathy Cardiac and respiratory involvement Hepatomegaly and abnormal LFTs
RA with anaemia, leukopenia and splenomegaly
What is the general management of RA?
Involvement of the MDT
NSAIDs
Steroids and DMARDs
Which medication is used for an acute flare of RA?
Intra-articular methylprednisolone
What are some risk factors for gout?
- Medication
- Medical conditions
- Lifestyle
Medication e.g. diuretics, chemotherapy
Obesity, CHD, diabetes, CKD
Meat, seafood, alcohol
What are the differentials for acute gout? (5)
Septic arthritis Reactive arthritis Psoriatic arthritis Pseudogout Haemarthrosis
What microscopy tests should you order for a red, hot and swollen joint?
Joint aspiration and synovial fluid analysis (culture and polarising microscopy)
What is the treatment for acute gout? (3)
NSAID + PPI or colcichine
Intra-articular steroids if above not effective
Oral steroids
What is the prophylactic treatment for gout?
What is second line?
What blood tests are required before starting/during treatment?
Allopurinol after acute attack has resolved - measure uric acid and U&Es every 4 weeks until <300; given lifelong
Febuxostat - must measure LFTs before starting
What are the risk factors for pseudogout? (6)
Haemochromatosis Wilson's disease Hypothyroidism Hyperparathyroidism Acromegaly Low magnesium and phosphate
What will you see in joint aspiration for pseudogout?
What will you see on joint x-ray?
Weakly positive birefringent rhomboid shaped crystals
Chondrocalcinosis
What x-ray changes will you see in OA?
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis
When should you suspect secondary OA? (2)
What are some of the causes?
<40, atypical distribution
Gout, Wilson's, acromegaly, haemochromatosis Collagen disorders Trauma Congenital disorders e.g. SUPE Diabetes
What are the management options for OA?
- Conservative
- Surgical
- Pain relief, weight loss, strengthening exercise, psychological support, OT assessment
- Arhtroscopy, joint replacement
