Rhuem week 2 - joint pain and asthma

Question 1

What are the common symptoms of asthma ?

Answer 1

• cough
• SOB
• wheezing
• chest tightness/pains
• worst in morning/exercise/cold air

Question 2

What is the Samter’s triad ?

Answer 2

• asthma
• nasal polyps
• aspirin allergy/sensitivity

Question 3

What points should you cover when taking a Hx of joint pain ?

Answer 3

• joint distribution ?
• morning stiffness ?
• red, hot, swollen, tender ?
• always same joints affected ?
• movement/ADL restrictions?
• PMHx, Fx, Dx, Sx….

Question 4

What differentials should be considered in joint pain with systemic symptoms ?

Answer 4

• sepsis
• inflammatory arthritis
• connective tissue disorders
• vasculitis
• infection
• malignancy

Question 5

When does a joint aspiration need to be sent for microscopy and culture ?

Answer 5

when septic arthritis is suspected

Question 6

What is the blood test ‘plasma viscosity’ used for in rheumatology ?

Answer 6

check thickness of blood to assess level of inflammation

thicker blood (higher numbers) = more inflammation occurring

similar to ESR

Question 7

What special blood tests would you request in a presentation of joint pain with systemic symptoms ?

Answer 7

• RhF
• anti-CCP
• ANA
• ANCA

checks for inflammatory arthritis/CTDs/vasculitis

Question 8

What are the features seen on XR of osteoarthritis ?

Answer 8

LOSS

L- loss of joint space
O- osteophytes (boney nodules)
S- subchondral cysts
S- subchondral sclerosis

Question 9

What is vasculitis ?

Answer 9

inflammation of the blood vessels

Question 10

Which systems are commonly affected in vasculitis ?

Answer 10

• joints
• kidneys
• lungs
• skin
• nerves

Question 11

How is vasculitis classified ?

Answer 11

by the size of vessels affected

small, medium and large vessel vasculitis

Question 12

Which systemic features are present in most patients with vasculitis ?

Answer 12

• weight loss
• fevers
• sweats

Question 13

What is the ANCA blood test and what is is used for ?

Answer 13

looks for antineutrophil cytoplasmic antibodies (ANCA) in blood, suggestive of autoimmune vasculitis

Question 14

what does a positive ANCA test point towards ?

Answer 14

small vessel vasculitis

Question 15

what are the two types of ANCA test and how are they different ?

Answer 15

c-ANCA
p-ANCA

they target different proteins so have a different staining pattern

c- ANCA stains the cytoplasm
p-ANCA stains the perinuclear cells

Question 16

Which condition is most commonly associated with a positive c-ANCA test ?

Answer 16

granulomatosis with polyangiitis (GPA)

Question 17

Which condition is most commonly associated with a positive p-ANCA test ?

Answer 17

eosinophilic granulomatosis with polyangiitis (EGPA)

Question 18

What criteria are used to diagnose eosinohilic granulomatosis with polyangiitis (EGPA) ?

Answer 18

lanham diagnostic criteria

• eosinophilia
• asthma
• multi-organ involvement

Question 19

What investigations (after bloods) are best for supporting a diagnosis of vasculitis ?

Answer 19

urine dip - renal involvement (glomerular nephritis)

CXR - looking for lung cavities caused by vasculitis (specifically granulomatous polyangiitis)

Question 20

In a query vasculitis patient, what should you do with the urine sample of blood is detected ?

Answer 20

send off for red cell casts

confirms glomerulonephritis

Question 21

what type of glomerulonephritis can present with nephrotic and nephritic features clinically ?

Answer 21

crescentic glomerulonephritis

Question 22

How is small vessel vasculitis treated ?

Answer 22

phase 1 = induction
- rapid start of strong immunosuppression via steroids in combination with a second immunosuppressant

phase 2 = maintenance
- after remission is achieved, switch Pt to methotrexate or another steroid-sparing agent

Question 23

Name two examples of immunosuppressants …

Answer 23

• rituximab
• cyclophosphamide

Question 24

which steroids are given in small vessel vasculitis ?

Answer 24

prednisone
methylprednisolone

Question 25

When starting patients on high dose steroids, what other factors do you need to consider ?

Answer 25

• bone protection
• gastro protection
• screen for diabetes
• monitor BP and BMI

Question 26

What are the common manifestations and complications that cna occur with eosinophilic granulomatosis with polyangiitis (EPGA) ?

Answer 26

• LRT signs e.g asthma, pneumonitis, haemoptysis
• URT signs e.g allergic rhinitis, nasal polyps
• heart signs e.g pericardial effusion, MI, myocarditis (heart signs is a negative prognostic marker)
• skin signs e.g purpura nodules, livedo reticularis
• renal signs e.g crescentic glomerulonephritis, hypertension, renal failure
• neuro signs e.g strokes, transient limb weakness
• eye signs e.g anterior uveitis
• gastro signs e.g bowel perforation, mesenteric infarction

Question 27

Which drug classically causes an exacerbation of asthma symptoms in someone with EGPA ?

Answer 27

Montelukast

Question 28

what are the common symptoms of temporal arteritis?

Answer 28

• temporal headache
• scalp tenderness
• jaw clarification
• temporary visual loss or diplopia

Question 29

Give two examples of large vessel vasculitis …

Answer 29

• Giant cell arteritis (GCA) aka temporal arteritis
• takayasu arteritis

Question 30

Give two examples of medium vessel vasculitis …

Answer 30

• polyarteritis nodosa
• kawasaki

Question 31

Give two examples of medium vessel vasculitis …

Answer 31

• polyarteritis nodosa
• kawasaki

Question 32

give three examples of small vessel vasculitis …

Answer 32

• microscopic polyangiitis
• granulomatosis with polyangiitis (GPA)
• eosinophilic granulomatosis with polyangiitis (EGPA)