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Year 4 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is the presentation of rheumatoid arthritis

A
  • symmetrical swollen, stiff painful joints, typically starting with small joints eg of the hand
  • worse on the morning
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2
Q

What deformities of the fingers might be seen in rheumatoid arthritis

A
  • boutonniere deformity

* swan neck deformity

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3
Q

What blood tests could you order for RA

A
  • anti-CCP

* rheumatoid factor

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4
Q

Which blood test is most specific for rheumatoid arthritis

A

anti CCP

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5
Q

What might you see on x-ray of a joint affected by rheumatoid arthritis

A
  • loss of joint space
  • bony erosion
  • juxta-articular osteopenia
  • soft tissue swelling
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6
Q

What is the treatment for rheumatoid arthritis

A
  • NSAIDs
  • steroids (oral or steroid injections)
  • DMARDs (methotrexate, hydroxycloroquine, sulfasalazine)
  • anti-TNFalpha biologics (infliximab, etanercept)
  • anti-b cell biologics (rituximab)
  • physio
  • surgery
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7
Q

What is the typical presentation of osteoarthritis

A
  • pain and stiffness of one (usually large) joint, typically the knee or hip
  • pain on movement
  • crepitus
  • worse at end of day
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8
Q

Osteoarthritis and rheumatoid arthritis differ on which time of the day the pain is worse - which is which?

A
  • osteoarthritis pain worse at end of day

* rheumatoid pain worse in morning

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9
Q

What will you see on x ray of an osteoarthritic joint

A

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

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10
Q

What is treatment for osteoarthritis

A
  • physio
  • NSAIDs
  • steroid injections
  • surgery
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11
Q

What is psoriatic arthritis highly associated with

A

psoriatic nail disease

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12
Q

What is the presentation of psoriatic arthritis

A
  • symmetrical polyarthritis similar to RA

* spondylarthropathy

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13
Q

What is treatment of psoriatic arthritis

A

NSAIDs and DMARD if necessary

most commonly used medication is methotrexate

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14
Q

What treatment should be avoided in psoriatic arthritis

A

oral and IM steroids

intra-articular steroids may be used

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15
Q

What are the two ways a joint may become septic

A
  • contiguous spread

* haematogenous spread

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16
Q

What are the common causative pathogens in septic arthritis

A

contiguous spread

  • straph A
  • strep

haematogenous spread
* neisseria gonococcus

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17
Q

What are risk factors for septic arthritis

A
  • immobility
  • recent surgery
  • recent injury
  • immunosuppression
  • IVDU
  • prosthetic joint
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18
Q

When should you suspect septic arthritis

A
  • red, hot swollen joint acute onset
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19
Q

What investigation must be done for septic arthritis

A
  • joint aspiration - MCS (microscopy, culture and sensitivity)
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20
Q

What treatment should be done for septic arthritis

A
  • start empirical antibiotics after joint aspirate and fine tune treatment when sensitivity results get back
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21
Q

Where is the most common site for gout

A

first MTP joint (podagra)

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22
Q

what causes inflammation in gout

A

monosodium urate crystals accumulating at the joint capsule causing inflammation

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23
Q

What might increase risk of gout

A
  • alcohol intake
  • diet high in purines
  • stress eg surgery
  • low water intake
  • starvation
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24
Q

How is gout diagnosed

A

joint aspiration with light microscopy

- will show urate crystals

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25
How is gout treated
* high dose NSAID * colchicine * 3 weeks after flare up prescribe allopurinol to prevent future flare ups
26
Why wouldn't you prescribe allopurinol during a gouty attack?
allopurinol should be given three weeks after attack because it can cause a flare up
27
What causes temporal arteritis?
giant cell arteritis - vasculitis of the temporal artery - fibrosis and wall weakening of this artery
28
What are the symptoms of temporal arteritis
* headache * scalp tenderness * unilaterall blindness * jaw claudication
29
What should you do if you suspect temporal arteritis?
* do ESR | * start prednisolone immediately
30
What blood result would you expect in GCA
* VERY elevated ESR * platelets elevated * alk phos elevated
31
What investigation should you do in GCA? When should you order it?
temporal artery biopsy - within 7 days
32
What is the main cause of death and morbidity in GCA?
long-term steroid use - so titrate when appropriate
33
What is polymyalgia rheumatica
a condition that causes neck, shoulder and hip stiffness and pain
34
Which condition does polymyalgia rheumatica commonly occur with
giant cell arteritis
35
What is the treatment of polymyalgia rheumatica
prednisolone
36
What is the creatinine kinase level like in polymyalgia rheumatica?
Normal
37
What is osteoporosis
decreased bone density
38
What is the DEXA score that diagnoses osteopenia?
T score between -1 and -2.5
39
What is the DEXA score for osteoporosis
-2.5
40
What are risk factors for osteoporosis
* early menopause * steroid use * smoking * increased age * low BMI * low calcium intake * low vitamin D
41
Where are the three most common sites of frailty fracture
* radius * vertebrae * neck of femur
42
What pharmacological treatment can be given for osteoporosis
* bisphosphonates (eg alendronate) * calcium and vitamin D * HRT
43
What non-pharmacological treatment can be given for osteoporosis
* physiotherapy | * exercise
44
What advice must be given to patients about bisphosphonates
they must be taken sitting upright and after meals - causes oesophagitis
45
What is ankylosing spondylitis
chronic inflammation of the IV discs of the spine and the sacroiliac joints
46
How does ankylosing spondylitis present
* gradual onset of stiff, painful back and buttock pain | * progressive loss of spinal movement
47
How is ankylosing spondylitis diagnosed
it is a clinical diagnosis supported by MRI
48
How is ankylosing spondylitis treated
* exercise * TNF-alpha blockers * local steroid injections
49
What virus might trigger SLE
epstein barr virus
50
What is SLE
an autoimmune condition that causes production of anti-nuclear antibodies that can deposit in tissue and cause inflammation
51
What is the presentation of SLE
remitting and relapsin illness presenting with noon-specific constitutional symptoms (malaise, fatigue, fever) * possibly also lymphadenopathy, erythematous skin, weight loss
52
What is the diagnostic test for SLE
ANA (anti-nuclear antibody) (95% +ve)
53
What inflammatory marker will be raised in SLE
ESR
54
What is Sjogren's syndrome
inflammatory autoimmune disorder that causes lymphocytic infiltration and fibrosis of exocrine glands, particularly the salivery and lacrimal glands
55
What does Sjogren's syndrome cause
* reduced tear production * reduced saliva * parotid gland swelling
56
What is polymyositis
autoimmune inflammation of (typically large) muscle groups
57
How does polymyositis present
With weakness and wasting typically of large muscle groups
58
What is vasculitis
Inflammation of blood vessels (usually arteries) causing weakness (and aneurysms) and fibrosis, which can cause organ ischaemia
59
What is the most common type of vasculitis
Kawasaki disease
60
What are the large vessel vasculitides
* GCA | * Takayasu's arteritis
61
When should you consider vasculitis?
In any unidentified multisystem disorder
62
What tests should you consider in vasculitis
* ESR/CRP may be raised | * may be ANCA-positive
63
What are the main causes of reactive arthritis
* STIs | * gastroenteritis
64
What is reactive arthritis
* sterile arthritis
65
What is the investigation of reactive arthritis
must joint aspirate to rule out septic arthritis
66
What is treatment of reactive arthritis
* NSAIDs * consider local steroid injection * consider DMARDs if chronic
67
When does reactive arthritis usually occur after an infection
1-2 weeks
68
What causes Paget's disease of bone
excessive bone remodelling
69
What are the symptoms of Paget's
* may be asymptomatic * deep, boring bone pain * bony deformity and enlargement may cause * deafness/blindness * leonitis of facial features * fractures
70
Which bones are typically affected in Paget's
* skull * lumbar spine * pelvis * femur * tibia
71
What is the investigations of Paget's
* X-ray for deformities and sclerotic lesions * bone scan may reveal 'hot spots' * alk phos will be raised
72
What is treatment for Paget's
* analgesia | * bisphosphonates
73
What malignancies commonly metastasise to bone
* breast * thyroid * prostate * lung * renal * lymphoma
74
What are the primary cancers of the bone
* osteosarcoma * chrondrosarcoma * Ewing's sarcoma

Year 4 (13 decks)

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