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MSK > rheumatology cases! > Flashcards

rheumatology cases! Flashcards

1
Q

how many joints involved in oligoarthritis?

A

2-4

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2
Q

how many joints involved in polyarthritis?

A

5

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3
Q

is this acute or chronic?

A

chronic due to being >6 weeks

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4
Q

is this inflammatory or non inflammatory?

A

inflammatory, shown by:

  • morning stiffness
  • swelling in joints
  • smaller joints
  • younger age (less likely to be degenerative)
  • shorter duration of symptoms
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5
Q

general exam shows inflammation of 1st MCP joint and PIP joints- what would some differentials be?

A

RA
psoriatic arthritis
connective tissue disease

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6
Q

why would it not be psoriatic arthritis?

A
  • psoriatic arthritis usually asymetrical oligoarthritis
  • usually enthesis
  • no skin or nail involvement
  • DIP joints usually involved
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7
Q

why is the DIP not involved in RA?

A

RA affects synovial joints, DIP is a really small joint so it doesn’t have much synovium

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8
Q

do all RA patients have auto antibodies?

A

no

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9
Q

what auto antibody do patients with RA usually have?

A

anti- CCP

RF

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10
Q

what is the sensitivity of anti-CCP?

A

> 70%

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11
Q

what is the specificity of anti-CCP?

A

> 90%

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12
Q

what tests would be done for this case?

A
  • bloods (FBC, ESR, CRP, PV, autoantibodies)

- MRI could detect erosion in early RA

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13
Q

what is seen on Xray of someone with psoriatic arthritis?

A

pencil in cup appearance

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14
Q

this patient has been diagnosed with RA- how do you manage?

A

methotrexate

4-6 weeks of steroids!! -prdnisolone

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15
Q

when is hydroxychloroquine used?

A

in addition to stronger DMARDs

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16
Q

what should a patient be told when given methotrexate?

A
  • 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)
17
Q

what can happen to RA during pregnancy?

A

it can improve

18
Q

how is the severity of RA measured?

A

using DAS28

19
Q

what is DAS28 measuring?

A

how many joints are inflammed (28 joints are looked at)

20
Q

what DAS28 score suggests active disease?

A

> 5.1

21
Q

a patient on methotrexate wants to get pregnant- what to you tell her?

A
  • 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
22
Q

if a patient with RA takes methotrexate + steroids- RA is no longer controlled, what should be done next?

A

-give second DMARD, either + sulfalazine or hydroxxychloroquine

23
Q

if a patient with RA takes 2 DMARDs + steroids- RA is no longer controlled, what should be done next?

A

biologics (anti TNF, tocilizumab, rituximab, abatacept)

24
Q

is this mono, oligo or poly arthritis?

A

oligoarthritis

25
Q

is this acute or chronic?

A

chronic (>6 weeks)

26
Q

is this inflammatory?

A

probably not

  • no morning stiffness
  • worse on exercise instead of rest
  • chronic
27
Q

they tested positive for serum ANA with a titre of 1:80 and got diagnosed with SLE- is this the right duiagnosis?

A

NO

  • no clinical symptoms of SLE
  • ANA is non specific
28
Q

what does a higher titre of ANA mean?

A

-higher titre of ANA the more significant it can be

29
Q

is this acute or chronic?

A

chronic

30
Q

what is the diagnosis?

A

SLE

31
Q

what is the rash on someone with SLE called?

A

-butterfly rash

32
Q

why is there a rash on her face?

A

Has SLE:

-may be butterfly rash or photosensitivity

33
Q

what does a 1/640 ANA titre mean?

A

it means the titre containing the ANA was diluted 640 times

MSK (64 decks)

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