Rheumatology and Dermatology

Question 1

What is rheumatoid factor?

Answer 1

It is an autoAb IgM against own IgG

Relatively sensitive for RA, but low specificity.

High titres correlate with progressive RA so useful in prognosis.

Question 2

What is atlanto-axial subluxation?

Answer 2

Rheumatoid tenosynovitis can weaken the tendons holding the atlas and axial portions of the cervical spine together.

A slow subluxation of the odontoid peg can occur, which compresses the cervical cord causing a progressive spastic tetraparesis.

A rapid compression can occur for example in airway manoeuvres. This can result in rapid output from the vagus resulting in cardiac arrest.

It is therefore important to do a lateral upper cervical spine radiograph in gentle flexion for patients with RA.

Question 3

What are the 4 main forms of seronegative arthritis and what are the common features?

Answer 3

Psoriatic, Reiter’s, Ank Spond and Enteropathic arthritis.

Asymmetrical oligoarthritides with sacroiliac involvement and uveitis.

Question 4

What is erysipelas and what is the most common causative organism?

Answer 4

Acute infection of the superficial dermis, a superficial form of cellulitis. Leads to erythematous, raised, demarcated lesions.

Strep pyogenes

Question 5

Extra-articular manifestations of RA

Answer 5

aNTI CCP OR RF

Nodules
Tenosynovitis
Immune - vasculitis, amyloidosis, Sjogren’s

Cardiac - pericarditis
Carpal Tunnel Syndrome
Pulmonary - fibrosis, nodules

Opthalmic - Scleritis, episcleritis, sicca
Renal : nephrosis due to amyloid

Raynaud’s
Felty - RA + splenomegaly + neutropenia

Question 6

3 main causes of a monoarthritis

Answer 6

Septic arthritis
OA
Crystal-induced (gout / pseudogout)

Question 7

Causes of an oligoarthritis

Answer 7

Crystal induced

OA

Seronegatives: Psoriatic, Reactive, Ank Spond, Enteropathic

Question 8

Causes of symmetrical polyarthritis

Answer 8

RA
OA
Viral: Hep A, B, C; Mumps

Question 9

Causes of a symmetrical oligoarthritis

Answer 9

Reactive

Psoriatic

Question 10

Complications of Ank Spond

Answer 10

Anterior Uveitis
Apical lung fibrosis + amyloidosis
Aortic regurg + AVN heart block
Arthritis + Achilles tendonitis

Question 11

7 American College of Rheum criteria for RA

Answer 11

4/7 = RA

1) Morning stiffness >1h
2) Arthritis in 3+ joints
3) Arthritis in hands
4) Symmetrical
5) Rheumatoid nodules
6) RF +ve
7) Radiographic changes

Question 12

Initial management of a new diagnosis if active RA

Answer 12

Methotrexate + 1 other DMARD + short course of steroids

Question 13

Seborrhoeic dermatitis cause?

Answer 13

Chronic dermatitis caused by an inflammatory reaction associated with Malassezia furfur proliferation