Rheumatology Investigations

Question 1

What investigations would you do for RA? (5 things)

Answer 1

1. FBC (Possibly have anaemia of chronic disease)
2. ESR+CRP
3. Anti- CCP (MOST SPECIFIC FOR RA)
4. RF
5. X-ray (erosions of bones)

Question 2

Diagnostic test for RA?

Answer 2

Anti- CCP

• A positive RF alone is not diagnostic for RA
• Patients may also have a positive ANA

Question 3

What’s the difference in X-ray findings of RA and OA?

Answer 3

RA:
Bony erosions

OA:
Joint space narrowing

Question 4

How would you investigate for Sjrogens disease?

Answer 4

1. Antibody testing
   - SSA (Ro)
   - SSB (La)

• usually +ANA (but this test is not specific)

Question 5

How would you investigate reactive arthritis? How is it treated?

Answer 5

• Clinical diagnosis
  Tx:
• NSAID’s (1st line)
• Steroids (2nd line)

Most people will have symptom resolution in 6 months

(Common in: HLA-B27)

Question 6

What tests are done for PMR?

Answer 6

The only diagnostic test is ESR and CRP which will be elevated

Question 7

Gold standard test for GCA? & treatment?

Answer 7

• Temporal artery biopsy **
• USS and ESR+CRP may also be done

Treat with high dose IV Glucocorticoid
if not possible then oral prednisolone 60-100mg for 3/7

Question 8

What is juvenile arthritis? and what investigations would you do for it ? What is the treatment?

Answer 8

Ix:
Bloods (CRP+ESR INCREASED. +ANA+ & RF possibly increased)

Tx:
1st line - NSAID’s
2nd line- DMARD’s

Question 9

What investigations would you do for What is juvenile arthritis? What is the treatment?

Answer 9

Ix:
Bloods (CRP+ESR INCREASED. +ANA+ & RF possibly increased)

Tx:
1st line - NSAID’s
2nd line- DMARD’s

Most people achieve remission by adulthood

Question 10

What antibodies are specific for SLE? (2 things)

Answer 10

1. dsDNA (Diagnostic for lupus)
2. Anti-smith antibodies

^ both these are not typically seen in other disease other than Lupus!

Note:
Lupus patients will also have a positive ANA

Question 11

What is ANA ?

Answer 11

A marker for rheumatological disease. It’s not specific and so many patients will have a positive ANA.

Question 12

What is RF ?

Answer 12

Non- specific for autoimmune disease. Again its not diagnostic for rheum disease

Question 13

What is SCL70 diagnostic for?

Answer 13

Scleroderma

Question 14

What is dsDNA diagnostic for?

Answer 14

SLE

Question 15

What is Anti- CCP diagnostic for?

Answer 15

RA

Question 16

What is SSA and SSB diagnostic for?

Answer 16

Sjogrens

Question 17

What diseases is the genotype HLA-B27 found in ? (Give 3 examples)

Answer 17

• Reiters syndrome (reactive arthritis)
• IBD
• Ankylosing spondylitis

Question 18

If a patient’s ANA is negative, is it likely that they have Lupus?

Answer 18

No

Question 19

What test is used to monitor disease activity in RA?

Answer 19

ESR +CRP

Question 20

Could you still have RA with negative serologies?

Answer 20

Yes

Question 21

How is a slipped disc diagnosed and managed?

Answer 21

Diagnosis:
MRI

Management:

1. Rest the body - recovery in 6/52 SELF LIMITING
   - No lifting
   - No extensive exercise
2. Steroids (not mandatory)
   - for pain