Rheumatology & Autoimmune

Question 1

Ulcerative colitis histology

Answer 1

o Superficial inflammation
o Chronic inflammatory cell infiltrate in the lamina propria
o Crypt abscesses
o Goblet cell depletion

Question 2

Crohn’s disease histology

Answer 2

o Inflammation through all layers of the bowel (Transmural)
o Increase in chronic inflammatory cells
o Lymphoid hyperplasia
o Granulomas (TH1 Response)

Question 3

Ulcerative colitis extra intestinal problems

Answer 3

Eyes: anterior uveitis
Gut: Ascending cholangitis
Joint: Polyarticular, symmetrical arthritis
Derm: Erythema nodosum, pyoderma gangrenous

Question 4

Chron’s disease extra intestinal problems

Answer 4

Eyes: Episcleritis
Joints: Polyarticular, symmetrical arthritis
Derm: Erythem nodosum, pyoderma gangrnosum

Question 5

UC Management - REMISSION

Answer 5

treatment depends on the extent and severity of disease

1) rectal (topical) aminosalicylates or steroids: for distal colitis rectal mesalazine has been shown to be superior to rectal steroids and oral aminosalicylates
2) oral aminosalicylates
3) oral prednisolone is usually used second-line for patients who fail to respond to aminosalicylates. NICE recommend waiting around 4 weeks before deciding if first-line treatment has failed

Question 6

UC Management - MAINTENANCE

Answer 6

1) oral aminosalicylates e.g. mesalazine

2) azathioprine and mercaptopurine

Question 7

CHRONS Management - REMISSION

Answer 7

patients should be strongly advised to stop smoking
1) glucocorticoids (oral, topical or intravenous) are generally used to induce remission. Budesonide is an alternative in a subgroup of patients
enteral feeding with an elemental diet may be used in addition to or instead of other measures to induce remission, particularly if there is concern regarding the side-effects of steroids (for example in young children)

2) 5-ASA drugs (e.g. mesalazine) are used second-line to glucocorticoids but are not as effective
3) azathioprine or mercaptopurine* may be used as an add-on medication to induce remission but is not used as monotherapy. Methotrexate is an alternative to azathioprine

Question 8

CHRONS MANAGEMENT - MAINTENANCE

Answer 8

Azathioprine or mercaptopurine is used first-line to maintain remission
methotrexate is used second-line

Question 9

Severity of UC

Answer 9

mild: < 4 stools/day, only a small amount of blood
moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

Question 10

Radiological signs UC

Answer 10

Leadpipe deformity
continuous
loss of haustration

Question 11

Barium signs Crohn’s disase

Answer 11

String sign of cantor
rose thorn ulcers
skip lesions