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YEAR 2 FCM Revision > Rheumatology Revision > Flashcards

Rheumatology Revision Flashcards

1
Q

chronic pain in specific areas or pain all over

  • worse when stress, with activity or in cold weather
  • associated with morning stiffness

lethargy, cognitive impairment,
sleep disturbance, headaches, dizziness

women in 30-50yrs

A

fibromyalgia

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2
Q

Ix and dx of fibromyalgia?

A

typically clinical diagnosis
blood tests to r/o other ddx = TFTs, ESR/CRP, RF and CCP

11/18 trigger points

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3
Q

Management of fibromyalgia?

A

non-pharm = educate, exercise and CBT

first line pharm tx = amitriptyline

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4
Q 
sudden onset pain (can last 1-2wks)
spontaneous but can also be triggered 
big toe affected 
joint - warm, shiny, swollen and red 
very painful - cannot touch bedsheets
A

gout

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5
Q

what causes gout?

A

uric crystal deposition into joint space

can be mono or oligoarthritis

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6
Q

Ix in gout?

A

GOLD standard = joint aspiration and crystal analysis
= -ve birefringent crystals

serum uric conc may drop in acute attack
- often checkes around 2/52 after attack

leucocytosis, raised ESR/CRP

XR = effusion, punched out erosions, eccentric erosions and soft tissue trophi

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7
Q

Acute management of gout?

A

NSAIDs + colchicine 500mg BD
can give prednisolone

resolves within 2wks
need to exclude septic joint, RICE protocol

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8
Q

Prophylactic management of gout?

A

allopurinol - OD to prevent frequent attacks

  • main S/E is diarrhoea
  • can continue use if already on during acute attack, but cannot be initiated in acute attack
  • indicated if 2+ attacks in 1 yr, renal disseas/uric stones and on diuretics
  • lower dose in reduced eGFR

second-line = febuxostat

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9
Q

commonly knee affected
painful, swollen , warm , erythematous
acute onset

A

pseudogout

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10
Q

Ix for pseudogout?

A

aspirate joint & crystal analysis
- +vely birefringent crystals

XR = chondrocalcinosis - linear calcifications

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11
Q

management of pseudogout?

A

IA steroids

NSAIDs for pain mx

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12
Q

older pt (>60) for the past month has been having…

morning stiffness, achy pain in the shoulders and hips
- can affect proximal limbs
lethargy
depression
low grade fevers, night sweats and anorexia

A

polymyalgia rheumatica

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13
Q

What is PMR associated with?

A

temporal arteritis and GCA

often seen in older pts, and mainly females

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14
Q

Investigations and diagnosis of PMR?

A

raised inflammatory markers - ESR>40
CK normal
EMG normal

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15
Q

Management of polymyalgia rheumatica?

A

prednisolone 15mg OD

usually rapid response to steroids, if any failure to effectively respond - consider alternative dx

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16
Q

stiffness in peripheral joints

hands and fingers commonly affected - joints may be swollen
multiple joints are affected
symmetrical

may have ulnar deviation, swan neck deformity, hyperextended PIP and flexed DIP (Boutonniere) , thumb deformity
hyperextension of interphalangeal joint

A

Rheumatoid arthritis

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17
Q

How is Rheumatoid arthritis investigated?

A

bloods - FBC, ESR/CRP, anti-CCP, RF, ANA

XR = bone erosions

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18
Q

Which blood test is the most specific for Rheumatoid arthritis?

A

anti-CCP

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19
Q

What criterion used for diagnosis of rheumatoid arthritis? What score is needed for a diagnosis?

A

American college of rheumatology criterion

6/10 = diagnosis

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20
Q

Management of Rheumatoid Arthritis?

A

usually initiated in 2° care

  • DMARD = methotrexate (or sulfasalazine)
  • short term bridging steroids on initiation of tx
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21
Q

what is methotrexate regime? What is monitored? How is monitoring assessed?

A

methotrexate is given on a weekly basis
- co-prescribed with folic acid which is given 24hrs after methotrexate dose

monitor LFTs (hepatoxic drug), monitor FBC (WCC), monitor ESR/CRP

monitoring based on DAS28 score

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22
Q

methotrexate - side effects?

A 
mucositis = inflamed mouth and gut 
pulmonary fibrosis 
liver cirrhosis 
myelosuppression 
pneumonitis
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23
Q

Methotrexate - contraindications? things to avoid?

A

contras = pregnancy (tetragenic)

avoid prescribing alongside trimethoprim and co- trimaxazole
avoid prescribing with aspirin

24
Q 
mono/oligoarthritis 
non-symterical joints 
common affecting knee and DIPs 
dactylitis - swollen digit 
enthesitis = swollen tendon 
pitting nails

known to have psoriasis

A

Reactive arthritis

25
Q

What are the investigations for psoriatic arthritis?

A

XR = pencil cup deformity - often later stage sign but very characteristic

Elevated CRP & ESR
often CCP neg

26
Q

Management for psoriatic arthritis

A

mild cases - treated with NSAIDs
DMARDs - methotrxate = helps skin and joint manifestations

if methotrexate provides an inadequate response = TNFa inhibitors (immunosupressant)

27
Q 
male 
Hx of GU/GI infection 
fever 
joint pain - oligoarthritis/asymmetrical
uveitis - red/sore eye 
urethritis = dysuria
A

reactive arthritis / reiter’s syndrome

28
Q

What other features can be seen in reactive arthritis

A

skin lesions
circinate balantis
keratoderma blennorrhagica

29
Q

what is Reactive arthritis associated with

A

HLA-B27

30
Q

what is reactive arthritis triad?

A

uveitis
urethritis
arthritis

can’t see, can’t pee and can’t climb a tree

31
Q

Ix for reactive arthritis?

A

clinical diagnosis - not need for any Ix

can do tests to rule out other causes

32
Q

Management for reactive arthritis

A

NSAIDs
IA steroids for joints

if persistent disease (>6/12) consider DMARD (methotrexate or sulfasalazine)

33
Q

What is Polyarteritis Nodosa?

A 
rare form of vasculitis affecting medium/small arteries 
causing aneurysms (microaneurysms)
34
Q 
men, 40-60yrs 
arthralgia 
malaise, fevers, weight loss 
peripheral painful neuropathy 
ulcers/pupuric rash/mottled skin 
testicular pain/haematuria
A

Polyarteritis nodosa

35
Q

Ix and Dx for Polyarteritis nodosa?

A

elevated CRP/ESR
FBC = normocytic, normochromic anaemia

renal involvement = raised creatinine

affected skin/tissue = necrotizing inflammation

36
Q

Management of Polyarteritis nodosa?

A

steroids

DMARDs if needed

37
Q

what can increase risk/closely associated with Polyarteritis nodosa ?

A

Hep B virus infection

38
Q

proximal muscle weakness

  • common complaint = can’t brush my hair
  • symmetrical

chronic/subacute onset
dysphagia/phonia
resp muscle weakness/dyspnoea
raynaud’s phenomenon

A

Polymyositis

39
Q

What is associated with Polymyositis?

A

associated with malignancy

40
Q

Investigations and diagnosis for Polymyositis ?

A

massively elevated CK
- elevated LDH, adolase, AST/ALT
EMG
antisynthetase/anti-Jo antibodies

Definitive dx = muscle biopsy

41
Q

Management of Polymyositis?

A

steroids

Other options include = immunosuppressants, IVIG and biologics

42
Q

What is scleroderma?

A

multi-system autoimmune disease via production of autoantibodies

structural & functional abnormalities

  • small blood vessels
  • fibrosis of skin/internal organs
43
Q

RFs for scleroderma?

A

family history

autoimmune disease

44
Q

sclerodactyly/claw like hand
skin thickening
swelling of hands and feet
severe raynaud’s phenomenon

esophageal dysmotility/dysphagia
telangiectasia

A

Scleroderma

45
Q

Ix and Dx of Scleroderma?

A

Bloods - ANA usually positive, Scl-70 positive and also anti-topoisomerase I

46
Q

Management of scleroderma?

A

NSAIDs and steroids

47
Q

severe dry eyes
severe dry mouth
- associated poor dentition
Fatigue

Pre-exisiting RA or SLE

A

Sjogren’s syndrome

48
Q

Ix or dx of Sjogren’s syndrome ?

A

bloods - +ANA
diagnostic = +SSA/Ro, +SSB/La antibodies

Gold standard = salivary gland biopsy

49
Q

Management of Sjogren’s syndrome?

A

symptomatic tx - eye drops, sialogues and punctal plugs

50
Q

what is the dry eyes and dry mouth also referred to

A

sicca complex

51
Q 
females, <16yrs 
6weeks + hx of....
joint pain and swelling in knee 
intermittent fever spikes 
uveitis

family hx of autoimmune conditions

A

juvenile RA

52
Q

Investigations and diagnosis for juvenile RA?

A

elevated ESR/CRP
ANA+
RF +

53
Q

Management for juvenile RA?

A

NSAIDs

DMARDs

54
Q 
arthritis
raynaud's phenomenon 
malar rash 
photosensitivity 
fatigue 
weight loss and fevers 
oral ulcers 
alopecia/hair loss
A

Systemic Lupus Erythematous (SLE)

55
Q

Investiagations and diagnosis for SLE?

A 
ANA+
anti-dsDNA/anti-smith antibodies 
low complement C3/4 levels 
raised CRP/ESR 
immunoglobulins

urine/ACR = protineuria = lupus nephritis
- if found then renal biopsy should be done

56
Q

What blood test is specific to SLE?

A

anti-dsDNA and anti-smith

57
Q

Management of SLE?

A

hydroxychloroquinolone
NSAIDs and steroids - pred

in severe/resistant SLE = trial other immunosuppressants or biological therapies

YEAR 2 FCM Revision (8 decks)

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