Rheumatology Flashcards
What are classic nail signs in psoriatic arthritis?
Pitting Ridging Onycholysis Hyperkeratosis Discolouration / oil-spots
What are clinical indications of activity in inflammatory arthritis?
- joint line tenderness
- bogginess
- effusion
- erythema and heat may be present, but less likely
What are DDx for rheumatoid nodules?
How to differentiate?
- Gouty tophi
- Calcinosis cutis
- Ganglion
Distribution:
- Rheumatoid nodules are at extensor surfaces/pressure points
- Tophi typically originate at the joint margin, can be in ears
They will be firm, non-tender, subcutaneous lesions Rheumatoid nodules may be fixed or movable, whereas tophi fixed
Appearance of tophi will be whitish with chalk-like texture. They can also leak and ulcerate, become infected
XR changes in OA?
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis
XR changes in rheumatoid arthritis?
Periarticular swelling Periarticular osteopaenia Marginal erosions Joint space narrowing Deformities
XR changes in gout?
Erosions with overhanging edges / punched out
Calcified tophi
Preserved joint space and no osteopenia
XR changes in psoriatic arthritis?
“Rat bite” erosions with periarticular joint erosions, pencil in cup deformity
Soft tissue swelling and sausage digits
Extra-articular manifestations of RA?
Face - anaemia, eyes for scleritis/episcleritis Chest - fibrosis, rubs Abdomen - splenomegaly Legs - pyoderma *screen other joints too
Extra-articular manifestations of spondyloarthropathiess?
Face - anaemia, uveitis
Abdomen - stoma, resection
Back - axial disease
Feet - enthesitis
Extra-articular manifestations of gout?
Tophi in ears / rest of body Underlying cause - metabolic syndrome - BP - ETOH - fluid overload - CKD
What is difference between limited and diffuse systemic sclerosis?
Pattern of skin involvement
- if sclerosis in upper arms/chest then is diffuse
*note limited can involve face
DDx for Raynauds
Primary
Secondary
- Scleroderma
- Systemic lupus erythematosus
- Polymyositis/dermatomyositis
- Sjögren’s syndrome
- MCTD
Cryoglobulinemia
Hypothyroidism
Vasculitis
Drugs (sympathomimetics)
After hands, what to look for in systemic sclerosis?
BLOOD PRESSURE
Body habitus (malnutrition)
Face
- alopecia
- bird-like facies / mouth opening restriction
- anaemia
- telangectasia
Chest
- Pulm HTN
- Rubs
- fibrosis
- heart failure
Dermatomyositis - hand signs?
Gottron's papules Mechanic's hands (rough cracked) Nailfold capillary changes = - abnormal capillary nailbed loops - periungual erythema - cuticular hypertrophy
Dermatomyositis - after hands, what signs will you look for?
Skin
- heliotrope rash
- shawl sign
Neuro
- proximal myopathy
Resp exam
- interstitial fibrosis
DDx for widespread skin thickening?
Systemic sclerosis Nephrogenic systemic fibrosis Endocrine - Diabetes - hypothyroidism Amyloidosis Chronic GVHD Drugs (chemotherapy)
What are the possible patterns of presentation of psoriatic arthritis?
- Distal arthritis, characterized by involvement of the DIP joints
- Asymmetric oligoarthritis, in which less than five small and/or large joints are affected in an asymmetric distribution
- Symmetric polyarthritis, similar to and, at times, indistinguishable from rheumatoid arthritis
- Arthritis mutilans, characterized by deforming and destructive arthritis
- Axial disease
Classic arthropathy of haemachromatosis?
Extra-articular manifestations to look for?
2nd / 3rd MCP predominant involvement
Other manifestations
- bronze skin
- hepatomegaly
- signs of diabetes
- dilated cardiomyopathy
DDx for symmetrical deforming polyarthropathy of hands?
Rheumatoid arthritis
SLE (deformities passively reversible)
Psoriatic arthritis
Manifestations of Cushing’s / evidence of steroid complications on exam?
Body habitus
HTN
Hyperlipidaemia
Diabetes
Bruising / skin atrophy
Proximal myopathy
Oral thrush
Cataracts
What antibodies would you check in suspected systemic sclerosis?
ANA titre and pattern
Limited -> anti-centromere (associated with pulmonary hypertension)
Diffuse
- > RNA-polymerase III (associated with renal manifestations)
- > Scl-70 (associated with ILD)
Can also review U1-RNP for DDx of MCTD
What other investigations (aside from antibodies) would you want to review in SSc?
To look for specific organ involvement
- HRCT to look for ILD
- PFTs to look for ILD
- TTE to explore pulmonary HTN
- Can consider looking for GI involvement with upper endoscopy +/- oesophageal manometry
Where in the lungs is SSc - related ILD most affected?
Bases
