Rheumatology

Question 1

Osteoarthritis

1. Key X-ray changes
2. Presentation
3. Commonly affected joints
4. Hand signs
5. Management of OA

Answer 1

1. Loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts
2. Joint pain and stiffness, worsened by activity
3. Hips, knees, sacro-iliac joints, DIPs, MCP joint at base of thumb, wrist, cervical spine
4. Heberden’s nodes, Bouchard’s nodes, squaring at the base of the thumb at the CMC joint
5. Patient education, weight loss, physio, occupational therapy and orthotics, stepwise analgesia, intra-articular steroid injections, joint replacement

Question 2

Rheumatoid Arthritis

1. Genetic associations
2. Antibodies
3. Presentation
4. Common Joints Affected
5. Signs in the hands
6. Extra-articular manifestations
7. Investigations
8. X-ray changes
9. Diagnostic criteria- what are patients scored on?
10. DAS28- what is involved in this?
11. Management of RA
12. SE of methotrexate
13. SE of leflunomide
14. SE of sulfasalazine
15. SE of hydroxychloroquine
16. SE of anti-TNF drugs
17. MoA of rituximab
18. SE of rituximab

Answer 2

1. HLA DR4, HLA DR1
2. RF, anti-CCP
3. Symmetrical distal polyarthropathy, pain, swelling, stiffness, worse in the morning, improves with activity, systemic symptoms
4. PIP, MCP, wrist and ankle, MTP joints, cervical space
5. Z shaped deformity to the thumb, swan-neck deformity, boutonnieres, ulnar deviation
6. Pulmonary fibrosis, bronchiolitis obliterans, Felty’s syndrome, Sjogren’s, anaemia of chronic disease, episcleritis and scleritis, CTS, cardiovascular disease
7. Clinical. RF. Anti-CCP. Inflammatory markers. X-ray of hands and feet
8. Joint destruction and deformity, erosions, soft tissue swelling, periarticular osteopenia
9. The joints that are involved, serology, inflammatory markers, duration of symptoms
10. Swollen joints, tender joints, ESR/CRP joints
11. MDT, steroids/NSAIDs for flares, DMARDs -> dual therapy -> methotrexate + biological therapy -> methotrexate + rituximab
12. Pulmonary fibrosis, pneumonitis, bone marrow suppression, teratogenic
13. peripheral neuropathy, rashes, hepatotoxicity, teratogenic
14. Reduced sperm count
15. Nightmares, reduced visual acuity
16. Immunosuppression, reactivation of TB and hep B
17. Monoclonal antibody against CD20 protein on B cell surface
18. Immunosuppression, low platelets, thrombocytopenia, night sweats