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Rheumatology conditions Flashcards

1
Q

Rheumatoid arthritis is HLA____ mediated?

A
  • HLA-DR4
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2
Q

What are potential triggers of rheumatoid arthritis?

A
  • Smoking
  • Infection
  • Stress
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3
Q

What is the main structure involved in rheumatoid arthritis?

A
  • synovium
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4
Q

What classification system is used in rheumatoid arthritis?

A
  • ACR/EULAR

- DAS 28

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5
Q

Clinical features of rheumatoid arthritis?

A
  • morning stiffness lasting greater than 1 hour
  • relieved by exercise
  • involvement of small joints of hands and feet
  • symmetrical
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6
Q

What are the 2 auto-antibodies in rheumatoid arthritis?

A
  • Rheumatoid factor

- Anti-CCP antibodies

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7
Q

What scoring system is used in rheumatoid arthritis?

A
  • DAS 28
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8
Q

What DAS28 score indicates remission?

A
  • DAS less than 2.6
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9
Q

Treatment of rheumatoid arthritis?

A
  • DMARDs
  • NSAIDs
  • steroids
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10
Q

Describe swan-neck deformity in rheumatoid arthritis?

A
  • hyperextension at the PIP joint and flexion of the DIP joint
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11
Q

Describe boutonniere deformity of the thumb in rheumatoid arthritis?

A

-flexion of the PIP joint and hyperextension of the DIP joint)

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12
Q

Define osteoarthritis?

A
  • chronic disease characterised by cartilage loss and accompanying periarticular change
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13
Q

Where are the most commonly affected joints in osteoarthritis?

A
  • knees
  • hands (TMC, PIP, DIP)
  • Hips
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14
Q

What is an osteophyte?

A
  • New bone formation
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15
Q

What are risk factors for osteoarthritis?

A
  • genetic
  • age
  • female
  • obesity
  • joint injury
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16
Q

What are some features of osteoarthritis on x-ray?

A
  • bone erosion

- osteophytes

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17
Q

What is generalised OA?

A
  • At either the spine or the hand joints and in at least 2 other joint regions
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18
Q

Where are heberdens nodes seen?

A
  • DIP joints
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19
Q

Where are Bouchards nodes seen?

A
  • PIP joints
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20
Q

What is the clinical presentation of OA?

A
  • Pain worse with joint use
  • morning stiffness less than 30 mins
  • poor grip
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21
Q

Pain felt at the hip region may be pain originating from where?

A
  • lower back
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22
Q

Where may pain from the hip radiate to?

A
  • the groin or knee
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23
Q

Occipital headaches may be characteristic of what?

A
  • spine involvement of OA
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24
Q

How do you diagnose OA?

A
  • clinical

- x-ray (joint space narrowing, sclerosis, cysts)

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25
Q

Pharmacologic treatment of OA?

A
  • Analgesia

- Local intra-articular steroid injections

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26
Q

What is the definition of a crystal arthropathy?

A
  • deposition of various minerals in joints and soft tissues leading to inflammation
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27
Q

What are the 2 main causes of gout?

A
  • increased urate production

- reduced urate excretion

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28
Q

Hyperuricaemia may be a risk factor for what?

A
  • gout
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29
Q

What are causes of increased urate production?

A
  • increased dietary intake

- alcohol

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30
Q

What are causes of reduced urate excretion?

A
  • chronic renal impairment

- hypothyrodism

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31
Q

What is the most common site of gout?

A
  • 1st MTP
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32
Q

What crystals are associated with gout?

A
  • monosodium urate crystals
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33
Q

What crystals are associated with pseudogout?

A
  • calcium pyrophosphate crystal deposition
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34
Q

What crystals are associated with hydroxyapatite?

A
  • basic calcium phosphate deposition
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35
Q

Chronic tophaceous gout is characterised by what?

A
  • granulomatous inflammation around urate crystals

- tophaceous

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36
Q

What is the single best investigation of gout?

A
  • Polarised microscopy of synovial fluid
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37
Q

What will polarised microscopy of synovial fluid in gout appear like?

A
  • negative birefringent urate crystals.
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38
Q

What test can be done to rule out septic arthritis?

A
  • joint aspiration
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39
Q

What blood test can be performed to investigate gout?

A
  • uric acid levels
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40
Q

What is the treatment of acute gout?

A
  • NSAIDs + PPI
  • Colchicine
  • Steroids
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41
Q

When can preventative treatment of gout be introduced?

A
  • wait 1 week after acute attack
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42
Q

What is the preventative treatment of gout?

A
  • lifestyle modification

- allopurinol

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43
Q

What are some causes of calcium pyrophosphate deposition disease (CPPD)

A
  • Age
  • OA
  • hyperparathryodism
  • haemochromatosis
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44
Q

calcium pyrophosphate deposition disease (CPPD) will have a ___ -ve/+ve___ birefringent

A
  • positive
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45
Q

Treatment of hydroxyapatite?

A
  • NSAIDs

- intra articular steroid injections

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46
Q

What scoring system can be used to diagnose joint hypermobility syndrome

A
  • modified beighton score
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47
Q

What type of hypersensitivity reaction is SLE/

A
  • Type III hypersensitivty
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48
Q

Who is most likely to be effected by SLE?

A
  • Female
  • childbearing ages
  • Afro-caribbean
49
Q

What are some environmental triggers of SLE?

A
  • Silica
  • Smoking
  • UV light
  • Infection
50
Q

What scoring system is used for SLE?

51
Q

What are symptoms of SLE?

A
  • Fever
  • fatigue
  • malar rash
  • discoid rash
  • serositis
52
Q

What is serositis?

A
  • pleural or pericardial inflammation (effusion)

- seen in SLE

53
Q

What are the 3 most common SLE antibodies?

A
  • ANA
  • dsDNA
  • Complement
54
Q

What is an example of a specific antibody in SLE?

55
Q

Treatment of SLE?

A
  • Sun protection

- Hydroxychloroquine

56
Q

Explain sjogrens syndrome?

A
  • Autoimmune condition that affects the exocrine glands

- leads to dry mucous membranes

57
Q

What are the symptoms of sjogrens syndrome?

A
  • dry gritty eyes
  • dry mouth and throat
  • joint pains
58
Q

What antibodies are associated with sjogrens syndrome?

A
  • Anti Ro

- Anti La

59
Q

What test can be performed in sjogrens syndrome?

A
  • Schirmer test
60
Q

What are some complications of sjogrens syndrome?

A
  • increased risk of lymphoma

- eye infections

61
Q

What is systemic sclerosis also called?

A

Scleroderma

62
Q

What is systemic sclerosis?

A
  • multi-systemic autoimmune disease
63
Q

What are symptoms of systemic sclerosis?

A
  • Raynauds
  • skin thickening and tightening
  • dysphagia
  • GORD
64
Q

What antibodies are associated with scleroderma?

A
  • Anticentromere

- Anti-Scl70

65
Q

Small mouth with puckering may be a facial change seen in what condition?

A
  • Scleroderma (systemic sclerosis)
66
Q

What is the classic triad of Raynauds’ phenomenon?

A
  • Blanching (white)
  • acrocyanosis (purple)
  • reactive hyperaemia (redness)
67
Q

Treatment of Raynaud’s phenomenon?

A
  • Calcium Channel Blockers

- Nitrates

68
Q

What are the 4 different types of spondyloarthropathies?

A
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Reactive arthritis
  • Enteropathic arthritis
69
Q

What is the similarities between the spondyloarthropathies?

70
Q

How is mechanical back pain described?

A
  • Worse after activity
  • Worse at end of day
  • Better with rest
71
Q

How is inflammatory back pain described?

A
  • Worse with rest
  • Better with activity
  • significant early morning stiffness
72
Q

Descrive enthesitis

A

-Inflammation at insertion of tendons into bone

73
Q

Describe Dactylitis

A
  • inflammation of an entire digit
74
Q

What are some extra-articular features of spondyloarthropathies

A
  • occular inflammation
  • mucocutaneous lesion
  • rare aortic incompetence or heart block
75
Q

Describe Ankylosing spondylitis

A
  • chronic systemic inflammatory disorder
76
Q

Where does Ankylosing spondylitis primary affect?

77
Q

What classification systems are used in Ankylosing spondylitis?

A
  • ASAS classification
78
Q

Investigations into Ankylosing spondylitis

A
  • bloods (inflammatory, HLA B27)
  • X ray
  • occiput to wall test
  • schobers test
79
Q

Symptoms of Ankylosing spondylitis

A
  • limited lumbar motion
  • lower back pain not relieved by rest
  • reduced chest expansion
  • question mark posture
80
Q

Clinical features of psoriatic arthritis?

A
  • nail involvement
  • dactylitis
  • enthesitis
81
Q

What causes reactive arthritis?

A
  • infection induced systemic illness

- 1-4 weeks post infection

82
Q

What are the most common infections that trigger reactive arthritis?

A
  • urogenital (chlamydia)

- eneterogenic (salmonella)

83
Q

Reiters syndrome is also called?

A
  • Reactive arthritis
84
Q

What is the classical Reiters (Reactive arthritis) triad?

A
  • urethritis
  • conjunctivitis
  • arthritis
85
Q

What should be performed before commencing treatment for reactive arthritis?

A
  • joint aspiration to rule out septic arthritis
86
Q

Symptoms of enteropathic arthritis?

A
  • GI loose, watery stools
  • Weight loss
  • Fever
87
Q

Investigations into enteropathic arthritis

A
  • Upper and lower GI endoscope

- joint aspirate

88
Q

Management of spondyloarthropathy

A
  • NSAIDs
  • corticosteriods
  • physio
  • OT
89
Q

What is a myopathy?

A
  • Disease of the muscle in which the muscle fibres do not function properly
  • results in muscular weakness
90
Q

What are the 2 types of inflammatory myopathies?

A
  • polymyositis

- dermatomyositis

91
Q

Describe the clinical features associated with inflammatory myopathies?

A
  • Muscle weakness
  • Gradual onset
  • Reduced muscle strength
92
Q

What are the most common muscles affected in inflammatory myopathies?

A
  • proximal muscles (shoulders and hips)
93
Q

What investigations would you carry out for inflammatory myopathies?

A
  • CK levels
  • EMG
  • Muscle biopsy
94
Q

What is the treatment of inflammatory myopathies?

A
  • Corticosteroids

- Immunosuppression

95
Q

What is polymyalgia rheumatica characterised by?

A
  • pain and stiffness
96
Q

What are associated effects of polymyalgia rheumatica

A
  • temporal arteritis

- giant cell arteritis

97
Q

What are the symptoms of polymyalgia rheumatica?

A
  • ache in shoulders and hip
  • movement limited
  • muscle strength normal
  • morning stiffness
98
Q

Polymyalgia rheumatica is associated with _____ muscle strength?

A
  • normal muscle strength
99
Q

Inflammatory myopathies is associated with ____ muscle strength?

A
  • reduced muscle strength
100
Q

What is temporal arteritis?

A
  • Granulomatous arteritis of large vessels
101
Q

What are the symptoms of temporal arteritis?

A
  • Headache
  • Scalp tenderness
  • Potential visual loss
102
Q

What is used in the diagnosis of temporal arteritis?

A
  • Raised ESR
  • USS of temporal artery
  • temporal artery biopsy
103
Q

What is the treatment of temporal arteritis/giant cell arteritis?

A
  • steroid
  • Prednisolone 40-60mg
  • higher dose given due to the potential vision loss
104
Q

What is fibromyalgia characterised by?

A
  • Pain and fatigue
105
Q

What are the most common muscles affected in fibromyalgia?

A
  • Proximal muscles
106
Q

What are the symptoms of fibromyalgia?

A
  • Muscle pain (pins and needles)
  • fatigue
  • headaches
  • anxiety
107
Q

What criteria is used in the diagnosis of fibromyalgia?

A
  • ACR diagnostic criteria
108
Q

What is vasculitis?

A
  • inflammation of the blood vessels
109
Q

What are some consequences of vasculitis?

A
  • inflammation
  • ischamia
  • necrosis
110
Q

What is primary vasculitis?

A
  • results from an inflammatory response

- no known cause

111
Q

What is secondary vasculitis?

A
  • triggered by an infection, drug, toxin
112
Q

What should always be checked in vasculitis?

A
  • urinalysis
113
Q

What are the main causes of large vessels vasculitis?

A
  • Takayasu arteritis (TA)

- Giant cell arteritis (GCA)

114
Q

Where is a common site for a bruit in takayasu arteritis?

A
  • carotid artery
115
Q

What are investigations of giant cell arteritis?

A
  • ESR
  • CRP
  • Temporal artery biopsy
  • USS
116
Q

Renal features of Granulomatosis with polyangiitis?

A
  • necrotising glomerulonephritis
117
Q

What is Henoch-Schonlein Purpura (HSP)?

A
  • Acute immunoglobulin IgA mediated disorder

- Pre-ceding URTI (Strep A)

118
Q

HSP management?

A
  • self limiting

- essential to perform urinalysis

119
Q

Localised AAV management

A
  • methotrexate + steroids

MSK (16 decks)

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