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Year 2 Revision > Rheumatology Investigations and Management > Flashcards

Rheumatology Investigations and Management Flashcards

1
Q

What is the criteria for diagnosing RA?

A

ACR/EULAR classification criteria

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2
Q

RA investigations

A

Blood testing (anaemia, raised platelets)
Inflammatory markers
Autoantibodies (anti-CCP)
Imaging (x-ray, US, MRI)

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3
Q

RA management

A

DMARD (1st methotrexate, 2nd sulfasalazine, 3rd hydroxychloroquine)
Steroids (for exacerbations)
Biologics (if DAS28 greater than 5.1 on 2 occasions 4 weeks apart)

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4
Q

Lupus diagnostic investigations

A 
ANA
Anti-dsDNA
Anti-Sm
Antiphospholipid ab
Low complement
Direct coombs test (haemolytic anaemia)
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5
Q

Lupus organ involvement investigations (depend on symptoms)

A 
CXR
Pulmonary function tests
CT chest
Urine protein quantification
Renal biopsy
Echocardiogram
Nerve conduction studies
MRI brain
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6
Q

SLE management

A

NSAIDs and simple analgesia
Hydroxychloroquine (may reduce systemic complications)
Steroids (varying dose for complications)
DMARDs
Biologics

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7
Q

Raynauds management

A

Calcium channel blockers or PDE5 inhibitors (sildefanil)

If digital ulcers - prostacyclin analogues (iloprost), botox injections, endothelin receptor antagonists (bosentan)

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8
Q

Systemic sclerosis management

A

Yearly ECHO and PFTs
Treat raynauds
Treat reflux (PPI)
Treat pulmonary fibrosis (immunosuppression)
Treat pulmonary hypertension (prostacyclin analogues, endothelin receptor antigonists, PDE5 inhibitors)
Tight blood pressure control (ACEI)

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9
Q

Sjogrens investigations

A 
Antibodies (anti-ro and anti-la, ANA)
Salivary gland ultrasound and biopsy (if antibodies negative)
Inflammatory markers (high ESR/PV)
Raised IgG
Cytopaenia
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10
Q

Sjogrens management

A

Lubricants
Strong fluoride toothpaste
Hydroxychloroquine (if fatigue and arthralgia)
Immunosuppression for major organ involvement

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11
Q

Antiphospholipid investigations

A

Autoantibodies (anti-cardiolipin, lupus anticoagulant, beta 2 glycoprotein)
Thrombocytopenia

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12
Q

Anti-phospholipid management

A

Lifelong anti-coagulation IF THROMBOSIS

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13
Q

General principles of CTD management

A

Assess disease severity
Urinalysis
CXR, PFT, ECHO
Manage cardiovascular risk factors
If major organ involvement - immunosuppression
If not - hydroxychloroquine, symptomatic management

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14
Q

Poly/dermatomyositis investigations

A 
Blood tests (CK, inflammatory markers, U&E, PTH, TSH)
Autoantibodies (ANA, anti-Jo-1)
Electromyography
Muscle biopsy (definitive test)
MRI
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15
Q

Poly/dermatomyositis management

A

Steroids (prednisolone)

Immunosuppressants (steroid sparing)

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16
Q

Temporal arteritis/polymyalgia rheumatica investigations

A 
Inflammatory markers (raised)
Temporal artery biopsy
17
Q

Temporal arteritis/polymyalgia rheumatica management

A

Low dose steroids in just polymyalgia rheumatica
Higher dose in temporal arteritis
Gradual reduction in dose around 18 months to 2 years

18
Q

Fibromyalgia management

A

Supportive/holistic therapy (including graded exercise therapy)
Antidepressants
Analgesia
Gabapentin/pregabalin

19
Q

What is the radiographic grading scale for OA?

A

Kellgren-lawrence

20
Q

OA management

A 
Physiotherapy
Lifestyle advice
Analgesia
NSAIDs
Atypical pain killers
Intra-articular steroids
Surgery
21
Q

Gout investigations

A

Inflammatory markers (raised)
Serum uric acid (may be raised or normal)
Synovial fluid polarised microscopy (diagnostic)
X-rays

22
Q

Gout management

A

Acute: NSAID (colchicine second line)
Steroid

Prophylaxis: allopurinol or febuxostat (2-4 weeks after acute attack)
Need to take NSAID or colchicine as well.

23
Q

Pseudogout management

A

NSAIDs
Colchicine
Steroids
Rehydration

24
Q

Milkwaukee shoulder management

A

NSAIDs
Intra-articular steroid
Physiotherapy
Partial or total arthroplasty

25
Q

Score for hypermobility name

A

Modified beighton score

26
Q

Criteria for ank spon name

A

ASAS classification criteria

27
Q

Ank spon investigations

A

Inflammatory markers
HLA B27
X-ray

28
Q

Ank spon management

A

Physio/occupational therapy
NSAID
DMARDs if peripheral joint involvement
Anti-TNF/anti-IL17 if severe

29
Q

Psoriatic arthritis investigations

A

Inflammatory markers (raised)
Negative RF
X-rays (pencil in cup, enthesitis)

30
Q

Psoriatic arthritis management

A 
NSAIDs
Steroid IA
DMARDs
Anti-TNF (if unresponsive to DMARDs)
Anti-IL17
31
Q

Reactive arthritis

A

Inflammatory markers
FBC/U&Es
HLA B27 (rarely necessary)
Cultures
Joint fluid analysis (rule out septic arthritis)
X-ray
Ophthalmology opinion (for eye involvement)

32
Q

Reactive arthritis management

A

NSAIDs
Corticosteroids (IA, oral, eye drops)
Antibiotics for underlying infection
DMARDs if resistant or chronic

33
Q

Enteropathic arthritis management

A 
Treat inflammatory bowel disease (controls arthritis)
NO NSAID
Normal analgesia
Steroids
DMARDs
Anti-TNF
34
Q

Small vessel vasculitis investigations

A

ANCA, PR3, MPO (varies with disease activity)

C3/4

35
Q

Anca associated vasculitis management

A

Localised/early systemic - methotrexate and steroids
Generalised/systemic - cyclophosphamide and steroids
Refractory - IV immunoglobulins, rituximab

36
Q

HSP investigation and management

A

Self-limiting

Urinalysis to screen for renal involvement

Year 2 Revision (45 decks)

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