Rheumatology Flashcards
What is vasculitis? How is it classified?
Inflammation of blood vessels, more commonly arteries
Large, Medium, Small vessel
Give 2 example of a large vessel vasculitis
Giant Cell Arteritis
Takayasu’s Arteritis
Give 2 examples of a medium vessel vasculitis
Kawasaki Disease
Polyarteritis Nodosa
Give 5(!) examples of small vessel vasculitis
think of how to classify them
p-ANCA +VE = microscopic polyangitis AND Churg-Strauss
cANCA +VE = Granulomatosis with Polyangitis (wegners)
ANCA -ve = HSP AND Goodpastures
Where can you find info about GCA?
Opthalmology/neuro
What is Takayasu’s Arteritis?
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
What is polyarteritis nodosa?
Necrotising vasculitis leading to fibrotic aneurysm + thrombosis formation
RARE IN UK
location dependent sx e.g. GI = mesenteric ischaemia
What is the pathology of small cell vasculitis?
B cells produce antibodies against the granules from the body’s own neutrophils
SO
ANCA = Anti-Neutrophilic Cytopasmic Antibodies
mad!
Give an example of cANCA +ve small cell vasculitis and how it would present
c = cytoplasmic
Granulomatosis with Polyangitis
Nasopharyngeal (epistaxis, chronic sinusitis and saddle nose)
Lung (haemoptysis)
Kidney (glomerulonephritis)
Give two examples of pANCA +ve small cell vasculitis and how they would present
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
Give two examples of ANCA -ve vasculitides and how they would present
HSP - triad of abdo pain, joint (knee) pain and blanching purpuric rash
Goodpastures = Glomerulonephritis and haemoptysis
Define rheumatoid arthritis
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
Describe the joint problems seen with rhuematoid arthritis
Bilateral, warm, stiff and tender joint swelling
Worse in morning
small joints e.g. MCP, IP affected first
Describe the extra-articular symptoms seen in rheumatoid arthritis
Nodules
Lungs = ILD
Cardiac = IHD, pericarditis, carpal tunnel
Eye = [Epi]Scleritis,
What are the late signs in the hands of rheumatoid arthritis?
Swan neck deformity (flexion of DIP but hyperextension of PIP)
Boutonnieres (flexion of PIP, hyperextension of DIP)
Z thumb deformity
give 3 blood tests that are specific for lupus
ANA
anti-dsdna
anti-smith
How does ankylosing spondylitis normally present?
Young men
Lower back pain - worse in morning but improves with exercise
Reduced lateral and forward flexion
Which gene is ank spond associated with and which other conditions?
HLA-B27 and PAIR
Psoriasis
Ank Spond
IBD
Reactive Arthritis
What are 4 late features of ank spend on X-ray?
Bamboo spine
Sacroililiits - subchondral erosions, sclerosis
squaring of lumbar vertebrae
syndesmophytes (ossification of outer fibers of annulus fibrosus)
What is the management of ank spond?
Conservative - low impact exercise e.g. swimming, physio
Medical - adequate analgesia (NSAIDS). DMARDs if there is small joint involvement
