rheumatology and bone disease I and II

Question 1

rheumatoid arthritis

Answer 1

disease of synovial joints
autoimmune systemic infalmamtory illness
symmetrical joint inflammation and demfromity

Question 2

pain history of rheumatoid arthritis

Answer 2

inflammatory pain

• early morning stiffness (more than 30 mins), less stiff after lunch but then stiffen in the evening
• better after movement
• stiffness after rest
• ease with use/exercise
• swelling
• may have flue like symptoms, feverish, hot etc

Question 3

clinical features of rheumatoid arthritis

Answer 3

boggy swelling (more soft tissue than expected around the joints)
knuckesl MCP joints, fingers sit lower than the level of the palm due to sub luxation
Z thumb deformity 
ulner deviation of fingers
swan neck deformity

Question 4

what causes swam neck deformity

Answer 4

tendons move anchor points due to arthritis
flexion of distal point
extension of PIP point

Question 5

extra articular features of joints

Answer 5

lungs
- nodules
lung firbosis
pleural effusions
cardio
- pericardial infalmamtion
- myocarditis
- valve inflmamtion
kidneys
- amyloidosis
skin
- rheumatoid nodules
secondary sjogrens syndrome

Question 6

blood tests show what in rheumatoid arthrtis

Answer 6

anaemia
high/low platelts
high inflammatory markers (CRP and ESR)

Question 7

CRP/ESR

Answer 7

measure of inflammation or infection in blood stream
- CRP produced in response to pro inflmamtory cytokines
ESR - found on RBCs

Question 8

X ray rheumatic arthriris

Answer 8

osteopenia around joints
soft tissue swelling

late
- erosions
joint space narrow
subluxation/dislocation
fusion (ankylosis)

Question 9

treatment of rheumatoid arthrosi

Answer 9

immediate relief
NSAIDS
steroids

Control of disease

• DMARDS eg methotrexate
• biological drugs eg anti TNF

Question 10

DMARDS

Answer 10

disease modifying anti rheumatic drugs

e.g. methorexate

Question 11

biologic drugs

Answer 11

anti TNF

B cell depletion

Question 12

side effects of treatments for rheumatic fever

Answer 12

1) infection
- all increase risk
- for biologic drugs: reactivation of TB
2) bone marrow toxicity
- low WBC count/low platlets/pancytopenia
- pts often have lots of blood test
3) hepatotoxic
- abnormal liver tests
4) gastric upset
- nausea, diarrhoea, flatulence
5) skin rashes

Question 13

methotrexate

Answer 13

never prescribe with trimethoprim
really excreted
nauseas
mouth ulcers
lung complications
1x weekly dose

Question 14

rheumatoid neck

Answer 14

erosive change at C1/2
subluxation at atlanto axial level or at sunaxial levels

ligament damaged by inflammation
dens starts to move into the same leading to spinal compression
numbness/tingle of hands etc. ataxic gate

Question 15

juvenila idiopathic arthritis

Answer 15

inflammatory arthritis occurring before 16
jaw underdevelopment, TMJ inflammation leads to alter Md growth
malocclusion
micrognathia

Question 16

spondylarthropathy conditions

Answer 16

ankylosing spondylitis
psoriatic arthritis
enteropathic athritis
reactive arthritis

all closely related condiions

Question 17

ankylosing spondylitis

Answer 17

inflammatory arthritis of spine and sarcophagus iliac joitns
back pain
stooped posture
neck ridge fused

Question 18

common features of spondyloarthropathy

Answer 18

enteritis
dactylitis
skin/nail psoriasis
inflammatory bowl disease

Question 19

osteoarthritis

Answer 19

degenerative process
exaggerated repair responce
cartilage damaged puts
pressure on bones

Question 20

osteophytes

Answer 20

spikes of calcium

Question 21

OA treatment

Answer 21

• physiotherapy/exercises
• weight loss (lower limb joints)
• paracetamol, co codamol
• NSAIDS
• surgery as final result (for uncontrolled pain, joint failure eg knee giving away)

Question 22

what leads the response to gout

Answer 22

neutrophil lead inflammatory responce

Question 23

why does gout occur

Answer 23

patient has high serum urate

c

Question 24

causes of gout

Answer 24

• genetic predisposition (enzyme defects)
• renal impairment (kidneys)
• diuretics
• dehydration
• intercurrent illness
• high alcohol/fructose/red meat/shellfish
• part of metabolic syndrome – central obesity, diabetes, high BP, high cholesterol

Question 25

treatment for gout

Answer 25

Acute
- colchicine (reduces neutrophil activity)
- steroids
- NSAIDS
Prevention of future attacks
- urate lowering drugs eg allopyrinol and febuxostat (both xanthine oxidase inhibitor

Question 26

common connective tissue diseases

Answer 26

1) systemic lupus erythematosus (SLE)
2) scleroderma
3) primary sjogrens
4) polymyositis/dermatomyositis

Question 27

scleroderma/systemic scelroros

Answer 27

progressive skin tightening and thickening

severe raynauds - (can lead to gangrene)

Question 28

types of sclerosis

Answer 28

limited systemic sclerosis LcSSc

diffuse systemic sclerosis DcSSc (widespread)

Question 29

LcSSc

Answer 29

associated with pulmonary hypertension

severe acid efflux

Question 30

DcSSc

Answer 30

associated with pulmonary fibrosis

scleroderma renal crisis

Question 31

telangiectasica

Answer 31

small spots around the mouth

Question 32

sjogrens syndrome

Answer 32

1) primary
- occurring on its own without associated rheumatic illness but with its own systemic manifestations
2) secondary
- occurring with rheumatic illness eg RA
- associated with other auto immune disorders including interstitial lung disease, autoimmune liver disease

Question 33

polymyositis

Answer 33

inflammation of muscles

painless wasting o he muscles

Question 34

dermatomyositis

Answer 34

inflammation of muscles and skin
photosensitivity rash around the eyes
ulceration of muscosa

Question 35

treatment for connective tissue diseases (pyrimid going up in severity)

Answer 35

• NSAIDS/steroids
• DMARDs
• cytotoxic drugs
• biologic drugs