rheumatology important

Question 1

HLA B27 is associated with

Answer 1

mnemonic PAIR: Psoriasis (and psoriatic arthritis), Ankylosing spondylitis, IBD, Reactive arthritis

Question 2

ankylosing spondylitis symptoms

Answer 2

• BACK PAIN AND SITIFFNESS
• inflammatory arthritis of axial skeleton (new bone formation and fusion of vertebrae)
• Peripheral arthritis

Question 3

most common organisms to cause reactive arthritis

Answer 3

in genitals= chlamydia trochomatis

in bowel= campylobacter, salmonella

Question 4

Reiter’s syndrome

Answer 4

when reactive arthritis is accompanied by urethritis, conjunctivitis or
mucocutaneous lesions.

Question 5

how to differentiate between reactive and septic arthritis

Answer 5

culture synovial fluid to check fluid is aseptic

Question 6

enteropathic arthritis is associated with

Answer 6

IBD

Question 7

features of rheumatoid arthritis

Answer 7

• SYMMETRICAL- affects PIP and MCP joints in hands, MTP in feet and wrists
• early morning stiffness lasting more than 30 mins
• ULNAR DEVIATION, BOUTONNIERE + SWAN NECK deformities
• weakness of joint capsules, causing joint instability/subluxation/deformity
• bursitis, tenosynovitis, muscle wasting + subcutaneous nodules over pressure points at elbow, finger joints and Achilles tendon

Question 8

investigations rheumatoid arthritis

Answer 8

• ACPA antibodies ( anti-citrullinated protein antibodies)
• Rheumatoid factor 70% of time (but RF also present in Lupus, Sjorgens, vasculitis)
• X ray shows soft tissue swelling, joint narrowing, erosions at joint margins and porosis of periarticular joints and cysts

Question 9

management rheumatoid arthritis

Answer 9

• flares are managed with corticosteroids

- methotrexate and/or sulfasalazine (DMARDs)

Question 10

features of osteoarthritis

Answer 10

• joint pain relieved by rest
• stiffness <30 mins in morning
• DIPs, MTP in feet, weight bearing joints (hips, knees, vertebrae)
• crepitus (popping/cracking sound and pain)
• restricted movement
• bony enlargement
• bony instability and muscle wasting
• Herbeden (DIPs) and Bouchard (PIPJs) nodes

Question 11

how to differentiate osteo and RA

Answer 11

• RA has longer early morning stiffness (>30 mins)

- RA has pattern of systemic features because it is autoimmune

Question 12

treatment osteoarthritis

Answer 12

• paracetamol and NSAIDs

- joint replacement

Question 13

atlanto-axial subluxation

Answer 13

medical emergency caused by Rheumatoid arthritis. Pain around back of head, radiating arm pain, numbness/weakness of limbs and vertigo on neck movement. treatment surgical

Question 14

vasculitis treatment

Answer 14

corticosteroids and immunosuppressants

Question 15

granulomatosis with polyangitis

• cause
• treatment

Answer 15

• cANA

- corticosteroids and cyclophosphamide (but relapses are common)

Question 16

pANCA is associated with…

Answer 16

microscopic polyangitis
crohn’s disease
microscopic polyangitis

Question 17

Systemic lupus erythmatous clinical features

Answer 17

malar (butterfly) rash, discoid rash, photosensitivity, mucosal ulcers, arthritis,
serositis, neurological disorder (psychosis, seizure), renal disorder, haematological disorder
(lymphopaenia), immunological disorder & positive antinuclear antibodies

Question 18

lupus investigations

Answer 18

bloods: ANA positive

Question 19

tinnels test

Answer 19

carpal tunnel- tapping nerve elicits pins and needles over distribution of nerve

Question 20

phalens test

Answer 20

carpal tunnel
patient fully flex their wrists by placing dorsal surfaces of both hands together for one minute. A positive test is when symptoms (numbness, tingling, pain) are reproduced.

Question 21

osteoporosis treatment

Answer 21

• bisphosphonates (alendronic acid first line)

- calcium + vit D

Question 22

diagnosis of fibromyalgia

Answer 22

pain in at least 7 areas of the body with a symptom severity score of at least 5/12
- difficultly concentrating/remembering (fibro fog), fatigue,
poor sleep, waking up unrefreshed, headache