rheumatology cases! Flashcards
how many joints involved in oligoarthritis?
2-4
how many joints involved in polyarthritis?
5
is this acute or chronic?
chronic due to being >6 weeks
is this inflammatory or non inflammatory?
inflammatory, shown by:
- morning stiffness
- swelling in joints
- smaller joints
- younger age (less likely to be degenerative)
- shorter duration of symptoms
general exam shows inflammation of 1st MCP joint and PIP joints- what would some differentials be?
RA
psoriatic arthritis
connective tissue disease
why would it not be psoriatic arthritis?
- psoriatic arthritis usually asymetrical oligoarthritis
- usually enthesis
- no skin or nail involvement
- DIP joints usually involved
why is the DIP not involved in RA?
RA affects synovial joints, DIP is a really small joint so it doesn’t have much synovium
do all RA patients have auto antibodies?
no
what auto antibody do patients with RA usually have?
anti- CCP
RF
what is the sensitivity of anti-CCP?
> 70%
what is the specificity of anti-CCP?
> 90%
what tests would be done for this case?
- bloods (FBC, ESR, CRP, PV, autoantibodies)
- MRI could detect erosion in early RA
what is seen on Xray of someone with psoriatic arthritis?
pencil in cup appearance
this patient has been diagnosed with RA- how do you manage?
methotrexate
4-6 weeks of steroids!! -prdnisolone
when is hydroxychloroquine used?
in addition to stronger DMARDs
what should a patient be told when given methotrexate?
- if female talk about contraception (can’t have methotrexate when pregnant/ trying to conceive)
- she will get ill more easily (recommend vaccines such as flu and pneumococcal)
- regular blood tests
- can cause pneumonitis
- an cause bone marrow suppression
- likely to become folate insufficient (should give folic acid)
what can happen to RA during pregnancy?
it can improve
how is the severity of RA measured?
using DAS28
what is DAS28 measuring?
how many joints are inflammed (28 joints are looked at)
what DAS28 score suggests active disease?
> 5.1
a patient on methotrexate wants to get pregnant- what to you tell her?
- continue taking contraceptive for 3 months after she first stops taking methotrexate
- switch to sulfalazine
- maybe wait until disease is less active to try conceive as higher chance of having successful pregnancy when disease is less active
if a patient with RA takes methotrexate + steroids- RA is no longer controlled, what should be done next?
-give second DMARD, either + sulfalazine or hydroxxychloroquine
if a patient with RA takes 2 DMARDs + steroids- RA is no longer controlled, what should be done next?
biologics (anti TNF, tocilizumab, rituximab, abatacept)
is this mono, oligo or poly arthritis?
oligoarthritis
is this acute or chronic?
chronic (>6 weeks)
is this inflammatory?
probably not
- no morning stiffness
- worse on exercise instead of rest
- chronic
they tested positive for serum ANA with a titre of 1:80 and got diagnosed with SLE- is this the right duiagnosis?
NO
- no clinical symptoms of SLE
- ANA is non specific
what does a higher titre of ANA mean?
-higher titre of ANA the more significant it can be
is this acute or chronic?
chronic
what is the diagnosis?
SLE
what is the rash on someone with SLE called?
-butterfly rash
why is there a rash on her face?
Has SLE:
-may be butterfly rash or photosensitivity
what does a 1/640 ANA titre mean?
it means the titre containing the ANA was diluted 640 times
