Rheumatology

Question 1

What is vasculitis? How is it classified?

Answer 1

Inflammation of blood vessels, more commonly arteries

Large, Medium, Small vessel

Question 2

Give 2 example of a large vessel vasculitis

Answer 2

Giant Cell Arteritis

Takayasu’s Arteritis

Question 3

Give 2 examples of a medium vessel vasculitis

Answer 3

Kawasaki Disease

Polyarteritis Nodosa

Question 4

Give 5(!) examples of small vessel vasculitis

think of how to classify them

Answer 4

p-ANCA +VE = microscopic polyangitis AND Churg-Strauss

cANCA +VE = Granulomatosis with Polyangitis (wegners)

ANCA -ve = HSP AND Goodpastures

Question 5

Where can you find info about GCA?

Answer 5

Opthalmology/neuro

Question 6

What is Takayasu’s Arteritis?

Answer 6

Similar to GCA but affects the branches of the aorta

More common in asian women <40

Limb ischaemia + lack of peripheral pulses
Renovascular involvement = HTN

Question 7

What is polyarteritis nodosa?

Answer 7

Necrotising vasculitis leading to fibrotic aneurysm + thrombosis formation

RARE IN UK

location dependent sx e.g. GI = mesenteric ischaemia

Question 8

What is the pathology of small cell vasculitis?

Answer 8

B cells produce antibodies against the granules from the body’s own neutrophils

SO

ANCA = Anti-Neutrophilic Cytopasmic Antibodies

mad!

Question 9

Give an example of cANCA +ve small cell vasculitis and how it would present

Answer 9

c = cytoplasmic
Granulomatosis with Polyangitis

Nasopharyngeal (epistaxis, chronic sinusitis and saddle nose)
Lung (haemoptysis)
Kidney (glomerulonephritis)

Question 10

Give two examples of pANCA +ve small cell vasculitis and how they would present

Answer 10

p = perinuclear
Churgg-Strauss - “eosinophilic Granulomatosis with Polyangitis”

Like asthma/allergy but with skin, GI, cardiac and nerve presentations

Microscopic polyangitis = like GPA but no nasopharyngeal involvement

Question 11

Give two examples of ANCA -ve vasculitides and how they would present

Answer 11

HSP - triad of abdo pain, joint (knee) pain and blanching purpuric rash

Goodpastures = Glomerulonephritis and haemoptysis

Question 12

Define rheumatoid arthritis

Answer 12

An autoimmune reaction in the joint space that causes thickening of the synovium as the synovial cells proliferate to form a pannus

HLA-DR4 associated

Question 13

Describe the joint problems seen with rhuematoid arthritis

Answer 13

Bilateral, warm, stiff and tender joint swelling

Worse in morning

small joints e.g. MCP, IP affected first

Question 14

Describe the extra-articular symptoms seen in rheumatoid arthritis

Answer 14

Nodules

Lungs = ILD

Cardiac = IHD, pericarditis, carpal tunnel

Eye = [Epi]Scleritis,

Question 15

What are the late signs in the hands of rheumatoid arthritis?

Answer 15

Swan neck deformity (flexion of DIP but hyperextension of PIP)

Boutonnieres (flexion of PIP, hyperextension of DIP)

Z thumb deformity

Question 16

give 3 blood tests that are specific for lupus

Answer 16

ANA
anti-dsdna
anti-smith

Question 17

How does ankylosing spondylitis normally present?

Answer 17

Young men
Lower back pain - worse in morning but improves with exercise
Reduced lateral and forward flexion

Question 18

Which gene is ank spond associated with and which other conditions?

Answer 18

HLA-B27 and PAIR

Psoriasis
Ank Spond
IBD
Reactive Arthritis

Question 19

What are 4 late features of ank spend on X-ray?

Answer 19

Bamboo spine
Sacroililiits - subchondral erosions, sclerosis
squaring of lumbar vertebrae
syndesmophytes (ossification of outer fibers of annulus fibrosus)

Question 20

What is the management of ank spond?

Answer 20

Conservative - low impact exercise e.g. swimming, physio

Medical - adequate analgesia (NSAIDS). DMARDs if there is small joint involvement