Rhuematology Flashcards
What are some seronegative spondyloarthropathies?
Psoriatic arthritis, ankylosing spondylitis, reactive artheritis, enteropathic arthropathy, juvenile idiopathic arthritis
What is scleroderma and what are the types?
Thickening of skin and involvement if visceral organs.
Diffuse cutaneous (systemic sclerosis) - Anti-ScL70
Limited (CREST) - anti-centromere
Localised scleroderma
What dies CREST syndrome stand for in limited scleroderma?
Calcinosis, Raynauds, oesophgeal involvement, sclerodactyly, telangiectasia
How might cutaneous vasculaitis present?
Petechiae, palpable purpura, macules, haemorrhagic bullae, SC nodules, urticaria
What therapies can be used in an acute attack of gout?
1st line - High dose NSAIDs
Colchicine, steroids (IA or IM), analgesia
What therapies are used for chronic gout?
Urate lowering therapies:
Allopurinol, Febuxostat
What medications can put you at risk of gout?
Aspirin, cyclosporin, diuretics, nicotinic acid
What conditions are associated with pseudogout?
Hyperparathyroidism, hypo- or hyperthyroidism, haemochromatosis, renal impairment, OA
What condition is associated with PMR?
GCA
What condition is associated with myasthenia gravis?
Thymoma
What is Myasthenia gravis?
AI condition causing muscle weakness that gets progressively worse with activity and improves with rest
ACh receptor antibodies
How might a patient with MG present?
Progressive weakness with repetitive movements:
Worse symptoms at the end of the day
Ptosis, diplopia, facial weakness, slurred speech, jaw fatigue, weak swallow
What examinations might you do in suspected MG?
Repeated blinking - ptosis Prolonges upward gaze - diplopia Repeated abduction - weakness Check for thymectomy scar Test FVC*
What is a Myasthenic crisis?
Life threatening acute worsening of Sx, triggered usually by RTI
May need BiPAP or intubation due to weak respiratory muscles and risk of respiratory failure
IV immunoglobulins or plasma exchange
What is Ankylosing spondylitis?
A chronic (>3 months) inflammatory disease of the spine and sacroiliac joints of unknown aetiology
How might a patient with ankylosing spondylitis present?
Man < 30, peripheral arthropathy, limited chest expansion,
Reduced lumbar movements, question mark spine (thoracic kyphosis and neck hyperextension),
Gradual onset lower back pain, worse at night with stiffness in the morning >30min relieved by exercise,
Pain radiates from sacroliliac joints to hip/buttocks,
Usually improves towards end of the day
What disease tools can be used in Ank spond?
Bath AS disease activity index (BASDAI)
Bath AS functional index (BASFI)
Bath AS metrology index (BASMI)
What is reactive arthritis?
An inflammatory, sterile arthritis usually in the lower limbs following an infection elsewhere in the body
?enteric infection - salmonella, shigella, campylobacter
?GU - Chlaymidia, gonorrhoea, mycoplasma genitalium
How might a patient with reactive arthritis present?
Systemically unwell
2-6 weeks post-infection
Arthritis, conjunctivitis, urethritis
Dactylitis, anterior uveitis, sacroilitis, keraroderma blenorrhagica
What are the different types of psoriatic arthritis?
Oligoarthritis Asymmetric DIP Symmetrical polyarthritis Psoraitic spondyloarthritis Arthritis mutalins
What is sjögrens syndrome?
AI chronic inflammation of exocrine glands
Dry eyes and mouth
What antibodies can be seen in sjögrens?
Anti-Ro
Anti-La
What is a potential harmful problem associated with Anti-Ro in pregnancy?
It can cross the placenta and cause neonatal lupus and complete heart block
What is SLE?
A multisystem AI disease
Remitting and relapsing
How might a patient with SLE present?
Photosensitive butterfly rash / malar rash
Pain and tender PIP joint
Raynauds
Fever, fatigue, weight loss, hair loss, lymphadenopathy
What ab can be seen in SLE?
> 95% have ANA
Anti-dsDNA
Anti-Ro, Anti-La, Anti-RNP, anti-SM, anti-phospholipid
What is RA?
A multisystem inflammatory condition characterised by symmetrical polyarticular arthritis, usually involving the hands, follows a chronic course and results in disability
How might you assess disease activity in RA?
DAS-28
How might you manage a patient with RA?
1 - NSAIDs (only for inflammation, they do not suppress disease activity)
Cox2i - etoricoxib
Steroids - PO/IM/IA
2- cDMARDs (slow onset, suppress disease activity) - methotrexate, sulfalazine, leflunomide
3 - bDMARDs (suppress disease activity)- abatercept, infliximab, enteracept
What is a important side effect of Methotrexate?
Pulmonary fibrosis
What is a important side effect of Leflunomide?
HTN, peripheral neuropathy
What is a important side effect of Sulfasalazine?
Male infertility (reduced sperm count)
What is a important side effect of Hydroxychloroquine?
Nightmares, reduced VA
What is a important side effect of anti-TNF?
Reactivation of TB or hep B
What is a important side effect of Rituximab?
Night sweats and thrombocytopenia
How would you manage reactive arthritis - mild, mod and severe?
Mild- NSAIDs and simple analgesia + bed rest
Moderate - NSAIDs, Joint aspiration, steroids
Severe - DMARDs?
Its usually self limiting and can take 6months to resolve *
What is JIA?
AI inflammation
Diagnosed when a child <16 has arthritis without a known cause/ another cause for >6 weeks
What are the different types of Jia?
Systemic Polyarticular Oligoarticular Enthesis related arthritis Juvenile psoriatic arthritis
What would make u think of systemic JIA or stills disease?
Subtle salmon pink rash
High swinging fevers
Joint pain and inflammation
Lymphadenopthay, pericarditis, weight loss, splenomeagly, pleuritis
What is a life threatening complication of systemic JIA or stills disease?
Macrophage activation syndrome
Severe activation of the immune system with a massive inflammatory response.
An acutely unwell child with
DIC, anaemia, thrombocytopenia, leukopenia, a non blanching rash ans a LOW ESR
What drug can cause drug induced lupus? (clue, tb abx)
Isoniazid
methyldopa, enteracept, hydralazine, phenytoin
What protein is mutated in marfans?
Fibrillin - AD
What is a side effect of hydroxychloroquinine (used in SLE)?
Severe and permanent retinopathy - ‘Bulls eye retinopathy’
So need to monitor VA
How can CES present?
Cauda equina syndrome classically presents with lower back pain, sciatica, reduced perianal sensation. Late signs include urinary incontinence
