Rheumatology pastest Flashcards
What marker of bone turner is raised in Paget’s disease?
Alkaline Phosphatase
Normal Calcium , phosphate, PTH
What is used to treat Pagets?
Bisphosphonates
What are the features of reactive arthritis?
“Can’t Pee, Can’t see, Can’t climb a tree”
Urethritis
Arthritis- Pain in knees, ankles or feet
Conjunctivitis
HLA-B27 positive
Other complications:
Circinate balanitis
Keratoderma Blennorrhagicum
How is the diagnosis of osteoporosis confirmed?
T score < -2.5 on DEXA Scan
Fragility fracture
What is a T score
The number of standard deviations from the mean bone mass of a 30 yr old.
> 1.0 = normal
-1 to -2.5 = osteopenia
<-2.5 = osteoporosis
Treatment for osteoporosis is initiated if T score <-2.5
what complication is associated with Anti-Scl-70 antibodies in systemic sclerosis?
Pulmonary Fibrosis
what complication is associated with Anti-RNA polymerase III antibodies in systemic sclerosis?
rapidly progressive skin involvement and scleroderma renal crisis
what complication is associated with Anti-centromere antibodies in systemic sclerosis?
associated with limited cutaneous systemic sclerosis, pulmonary hypertension and GI involvement
What are the features of cryoglobulinaemia?
- purpuric rash
- raynauds
-polyarthralgia
-positive RF in 90%
-low C4
What are the features of osteomalacia?
- Vitamin D deficiency leads to hypocalcaemia, lower end of normal phospjate and raised ALP.
- Proximal muscle weakness
- low density bands extending from the cortex
What crystals are seen in gout vs pseudogout?
Gout - needle shaped negative birefringence
pseudogout - calcium pyrophosphate crystals appear rhomboidal
What is the characteristic finding of ankylosing spondylitis on Xray
Sacroiliitis
Subchondral erosiion
Loss of lumbar lordosis
Bamboo spine
What HLA is associated with Ankylosing Spondylitis?
HLA B27
How does Ankylosing Spondylitis present?
Age of onset between 15 and 40.
higher incidence in men
Lower back pain and stiffness.
Pain better worse in morning and improves with movement
Associated with anterior uveitis and aortic incompetence.
How is ankylosing spondylitis treated?
- NSAIDs and Physio
- Anti-TNF-a therapy effective in high disease activity.
What are the typical features of dermatomyositis?
- Proximal muscle weakness
- heloptrope rash around eyes
- Gottron’s papules over knuckles
- nail fold dilated capillaries
- shawl sign - upper back and neck redness.
What antibodies are specific for dermatomyositis?
Anti-Mi-2 antibodies are found in 30%
What are the features of Adult onset juvenile chronic arthritis (JCA)?
- fevers for more than 2 weeks
- Oligoarthritis
- erythematous rash
- pericarditis
First line treatement - NSAIDs and short course systemic corticosteroids
Second line treatment - methotrexate and anti-tnf based therapies.
What is the main agent for neutralising the immediate toxic effects of methotrexate?
Calcium Folinate
(Calcium Leucovorin)
What is the intial treatment of choice in patients presenting with Gout on background of CKD?
Colchicine
(allopurinol should not be started during an acute attack but at least 4 weeks after the attack has settled)
How does Discoid lupus typically present?
- well demarcated macular rash with erythema
- scales, plaques, atrophy,
-scarring alopecia of scalp - Photosensitivity
- Afro-caribbean women
What is lupus pernio?
Lupus pernio us a cutaneous form of sarcoidosis with dusky-purple infiltration of the nose.
What is Buerger’s disease?
- Affects smokers
- disease of small and medium sized vessels leading to inflammation and ulceration
- digital ischaemia / gangrene
- Arteriorgram will show occlusion of distal arteries of hands and feet.
What drugs cause lung fibrosis?
Methotrexate
bleomycin
amiodarone
nitrofurantoin
cyclophosphamide
