Rheumatology ILOs Flashcards
Which gene is associated strongly with rheumatoid arthritis?
HLA-DR4
Give 4 deformities seen in RA
Swan neck
Boutonnière
Z-thumb
Ulnar deviation
Give 3 symptoms of RA
Pain
Stiffness (morning >1 hour)
Small joint affected
Outline the pathophysiology of RA
Synovial lining becomes hyperplastic, infiltrates synovium causing erosions
Give 2 blood test used specifically to assess RA
Rheumatoid factor (IgM antibody)
Anti CCP antibody
Give 3 signs seen on X-ray in RA
Peri-articular osteopenia
Erosions
Subluxation
Give 3 classes of drug treatment for RA
Analgesia
DMARDs
bDMARDs
Give 3 examples of DMARDs
Methotrexate (folate antagonist)
Hydroxychloroquine
Sulfasalazine
Define the 2 types of OA and give 2 symptoms
Primary and Secondary (due to other cause like Paget’s)
- Pain worse on movement
- Stiffness after inactivity
Give 4 signs seen on an OA X-Ray
Subchondral cysts
Subchondral sclerosis
Joint space narrowing
Osteophytes
Give 2 microscopic changes seen in OA
Fissuring cartilage
Nodules of reactive bone
What will Rheumatoid factor and Anti-CCP antibody show in OA?
Negative
Give 3 management options in OA
Analgesia
Physiotherapy
Surgery
Define psoriatic arthritis and which gene it is associated with
Seronegative inflammatory arthritis with 3 or more swollen joints asymmetrically
HLA-B27
Give 3 symptoms of psoriatic arthritis
- Morning pain >30 mins
- Dactylitis
- Psoriasis
Outline the pathophysiology of psoriatic arthritis
CD8+ cells cause hypervascularity in synovium
How is psoriatic arthritis differentiated from RA?
DIP involvement and dactylics in psoriatic arthritis but not RA
Give 2 X-ray signs seen in psoriatic arthritis
Erosions
Osteolysis (pencil in cup)
Give 3 drug treatments for psoriatic arthritis
NSAIDs
Steroids in flare
DMARDs
Give 3 features of septic arthritis affecting one joint
- Cardinal inflammation features
- Fever
- Leukocytosis/raised CRP
How many joints are usually affected in polyarticular septic arthritis and name 2 common organisms
- 4 joint average
Strep and Staph
Give 3 risks of septic arthritis
- Previous arthritis
- Trauma
- Diabetes
What is gold standard Dx for septic arthritis?
Joint aspirate
Define gout and give common clinical features
Hyperuricaemia and deposition of urate crystals causing attacks of acute inflammatory arthritis
Severe acute pain, commonly feet
Give 3 risks of gout
- Age
- Male
- Obesity
How do gout crystals appear compared to pseudo-gout?
Gout: needle shaped, negatively birefringent
PG: rhomboid crystals, weakly positively birefringent
Give 2 management options for gout
NSAIDs
Allopurinol
Define pseudo-gout and give 2 risks
Calcium pyrophosphate deposition associated with acute and chronic arthritis
- Age
- Hyperparathyroidism
Give 2 management options for pseudo-gout
NSAIDs
Colchicine
Define temporal arteritis
Granulomatous vasculitis of large and medium sized arteries, affecting branches of external carotid artery commonly
Give 3 symptoms of temporal arteritis and which condition it is associated with
- Headache
- Jaw claudication
- Loss of vision
Polymyalgia Rheumatica
Give 2 risks of Temporal arteritis
- Female
- Caucasian
What is gold standard Dx for Temporal arteritis and what is the main form of treatment?
Temporal artery biopsy
Prednisolone
Define Polymyalgia Rheumatica
Inflammatory syndrome causing pain and morning stiffness in neck, shoulder and or pelvic girdle in those over 50, unclear cause
Which Interleukin is thought to be associated with Polymyalgia Rheumatica?
IL-6
Give 3 management options for Polymyalgia Rheumatica
Prednisolone
NSAIDs
Calcium
Define osteoporosis and give 1 risk
Skeletal disorder characterised by compromised bone strength, porous bone, often leads to fragility fractures
Early menopause (<45)
Outline the pathology of osteoporosis
Imbalance of bone formation and resorption leads to decreased bone mass and higher fracture risk
How is osteoporosis diagnosed?
DEXA scan (T < -2.5)
How is 10 year fracture risk assessed for osteoporosis?
FRAX/Qfracture score
Give 2 drug treatments for osteoporosis
Adcal D3
Bisphosphonate
Define Ankylosing Spondylitis and which gene it is commonly associated with
Progressive inflammatory arthropathy affecting sacroiliac joints and axial spine
HLA B27
Give 2 symptoms and 2 risks for Ankylosing Spondylitis
Back pain + Enthesitis
Male + late teens/early 20s
Briefly outline the pathophysiology of Ankylosing Spondylitis
Increased osteoclasts cause inflammation and cartilage erosion
Give 2 signs which may be seen on spinal imaging in Ankylosing Spondylitis
Vertebral body squaring
Peripheral large joint arthritis
Give 2 treatments for Ankylosing Spondylitis
NSAIDs
Sulfasalazine
Give the 5 most common primary cancers to cause secondary bony mets
Prostate Breast Follicular thyroid Renal Bronchi
Name a benign primary bone tumour
Osteoid Osteoma
Define osteosarcoma
Tumour whose cells form bone, commonly in young males
Give an example of a benign and malignant cartilage tumour
B: Enchondroma
M: Chondrosarcoma
Who does Ewing’s sarcoma usually occur in and what chromosome translocation is commonly seen?
5-15 y/o in long flat bones
11/22 translocation
Define SLE and give 3 features
AI chronic multi-system disorder commonly affecting women in reproductive years
- Photosensitive rash
- Malar rash
- Raynaud’s
Give 3 investigations for SLE
- ESR
- ANA
- APTT (prolonged)
Give 3 drug treatments for SLE
Steroids
DMARDs
Rituximab
Define Sjogren syndrome and give 2 risks
AI disease characterised by dry eyes and dry mouth due to lymphocytic invasion of lacrimal and salivary glands
- Female
- SLE
Define Polymyositis
Inflammatory myopathy affecting skeletal muscle affecting adults commonly between 30-60
Give 2 investigations for Polymyositis
CK (elevated)
Muscle biopsy
Define dermatomyositis and give 2 skin features
Idiopathic inflammatory myopathy characterised by skin manifestations
- Gottron’s papules
- Heliotrope rash
Define vasculitis
AI condition causing inflammation of blood vessels in any location e.g. skin, ENT, nerves…
Define Henoch-Schölein Purpura and give 2 symptoms
Small vessel vasculitis common in 2-11y/o
- Purpuric rash
- Ulcers
What are the 3 types of ANCA-associated small vessel vasculitis?
- Microscopic polyangitis
- Granulomatosis with polyangiitis (GPA)
- Eosinophilic granulomatosis with polyangiitis (EGPA)
Which 2 antibody tests can be done in suspected vasculitis?
cANCA
pANCA
Give 3 drugs to induce remission in vasculitis
Prednisolone
Rituximab
Methotrexate
Define reactive arthritis
Bacteria cannot be aspirated from the joint to culture, infection instead occurs due to another infection in the body e.g. Chlamydia
Give 2 risks of reactive arthritis
HLA B27
Male
What is the triad in reactive arthritis?
Arthritis
Conjunctivitis
Urethritis
Give 2 investigations for reactive arthritis
Joint aspirate to exclude sepsis
Urethral/cervical swab
Define Paget’s disease of the bone and give 3 common sites
Chronic bone disorder that is characterised by focal areas of increased bone remodelling, resulting in overgrowth of poorly organised bone
- Pelvis, femur, skull
Which LFT may be elevated in Paget’s and give 2 signs seen on bone scan
ALP
Cortical thickening + sclerosis
Give 2 risks of Paget’s
> 55y/o
Temperate climate
Name 6 things to look for on inspection of hands (DREAMS)
Deformity Rashes Erythema Asymmetry Muscle wasting Swelling/skin changes
What nodes are commonly seen in OA and where do they occur?
Heberden’s nodes in DIPs
Where does a Bouchard node commonly affect?
Proximal interpharyngeal joints
What can be seen on an X-ray of gout and pseudo-gout respectively?
G: Tophi
PG: Chondrocalcinosis
Define the symptoms of scleroderma using CREST
Calcinosis Raynaud's Esophageal dysfunction Sclerodactyly (thick and tight skin on fingers) Telangectasia
