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Musculoskeletal > Seropositive Arthropathies > Flashcards

Seropositive Arthropathies Flashcards

1
Q

list all the seropositive arthropathies

A 
rheumatoid arthritis 
SLE
systemic sclerosis 
sjogrens 
vasculitis
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2
Q

what do seropositive arthropathies have in common

A

all diagnosed through blood tests as have certain auto-antibodies present in disease

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3
Q

what is the most common seropositive arthropathy

A

rheumatoid arthritis

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4
Q

what is the aetiology for RA

A

females > males
peak incidence between 35-50 years
certain HLA subtypes and environmental factors such as smoking increase risk

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5
Q

describe the pathogenesis of RA

A

immune response against synovium, immune cells attack which destroys articular cartilage
lining of the joint thickens producing excess fluid and wears away bone underneath

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6
Q

which joints are affected in RA

A

small joints, PIPs, MCP, MTP, wrists but not DIPs

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7
Q

describe the presentation of RA

A

morning stiffness >30 mins
pain improves on movement
joints symmetrically affected
visible synovitis - hands appear boggy and soft

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8
Q

RA increases risk of spinal cord compression true/false

A

true - atlanto-axial subluxation is later complication

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9
Q

describe a swan neck deformity

A

hyperextension at PIP, flexion at DIP

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10
Q

describe a boutonniere deformity

A

flexion at PIP, hyperextension at DIP

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11
Q

list some of the extra-articular manifestations of RA

A

rheumatoid nodules - found on extensor surfaces
increased cardiovascular morbidity
interstitial lung disease
ocular involvement

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12
Q

list the ocular symptoms of RA

A

uveitis, scleritis

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13
Q

which auto-antibodies are present in RA

A

rheumatoid factor

anti-CCP

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14
Q

describe the x-ray findings of early and late RA

A

early - normal x-ray possibly with swelling

late - erosions of bone and subluxations

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15
Q

what factors must be present to diagnose RA

A

involvement of several joints, positive serology, acute phase reactants positive eg CRP and duration longer than 6 weeks

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16
Q

what is the first line treatment for RA

A

DMARDs - specifically methotrexate unless contraindicated

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17
Q

what is the window of time DMARDs must be commenced from start of disease

A

3 months

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18
Q

what must initially be added to methotrexate and why

A

corticosteroid as lag time - acts as short term pain relief

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19
Q

list some other examples of DMARDs and their side effects

A

leflunomide, sulfalazine and hydroxychloroquine

methotrexate and leflunomide are teratogenic, all increase risk of infection and bone marrow suppression

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20
Q

if RA doesnt respond to DMARDs what is the next line of treatment and give examples

A

biologics
TNFalpha inhibitors - infliximab and adalinumab
B cell depletion - rituximab

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21
Q

what calculator is used to assess severity of RA

A

DAS28

22
Q

DAS28 score of what indicates remission of RA

A

<2.6

23
Q

DAS28 score of what indicates severe disease requiring biologics

A

> 5.1

24
Q

describe the pathogenesis of SLE

A

defect in apoptosis causing increased cell death - allows inadequate clearance of antigens and deposition of immune complexes - type 3 hypersensitivity

25
Q

who is lupus most likely to present in

A

women of child bearing age, more common in black women

26
Q

describe the skin and mucocutaneous presentation of lupus

A

skin - butterfly malar rash with sparing of nasolabial fold, discoid dermatitis too
muco-cutaneous - oral ulceration and Raynauds phenomenon

27
Q

describe the other organ involvement of lupus

A 
renal - lupus nephritis 
resp - interstitial lung disease and pleurisy 
neuro - seizures and psychosis 
cardiac - pericarditis and ischaemia 
MSK - myalgia and inflammatory arthritis
28
Q

there is one specific diagnostic test for lupus true/false

A

false

29
Q

list some of the investigation findings of lupus

A

FBC showing thrombocytopenia and leucopenia

Anti-dsDNA positive, ANA positive, Anti-sm (low sensitivity)

30
Q

what happens to C3/4 levels in active lupus disease

A

lowered

31
Q

which test is used in lupus to assess for renal involvement

A

urinalysis

32
Q

what is the treatment for lupus

A

depends on manifestations, skin disease and arthralgia give hydroxychloroquine and NSAIDs, arthritis or organ involvement requires immunosuppression
if unresponsive may require IV immunoglobulin

33
Q

what is Sjogrens syndrome

A

autoimmune condition characterised by lymphatic infiltrates in exocrine glands - causes dryness, arthralgia and fatigue

34
Q

list the clinical features of Sjogrens

A

reduced salivary and lacrimal gland production
vaginal dryness
polyarthritis
peripheral neuropathy and interstitial lung disease

35
Q

which connective tissue disease has an increased risk of lymphoma

A

Sjogrens

36
Q

which test is used to assess ocular dryness in Sjogrens

A

Schrimers test

37
Q

other than Schrimers test, list investigations for Sjogrens

A

lip gland biopsy for dryness

positive anti-Ro and anti-La antibodies

38
Q

what is the management of systemic sclerosis

A

symptom management as no cure
lubricating eye drops, saliva replavements, hydroxychloroquine for joint pain, immunosuppressant if extreme organ involvement

39
Q

what is systemic sclerosis

A

connective tissue disease causing vasculopathy and autoimmunity due to excessive collagen deposition

40
Q

describe the difference between limited and diffuse systemic sclerosis

A

limited - confined to hands, feet and forearms

diffuse - spread all across limbs and trunk

41
Q

what is usually the first manifestation of systemic sclerosis

A

Raynauds phenomenon - blanching, acrocyanosis and reactive hyperaemia

42
Q

what is the treatment for raynauds

A

calcium channel blockers, ARBs and nitrates

43
Q

what is the pneumonic for limited systemic sclerosis

A

CREST - calcinosis, raynauds, oesophageal dysmotility, sclerodactyly and telangiectasia

44
Q

list some symptoms of systemic sclerosis

A

dysphagia
telangiectasia
skin tightening - beaking of the nose
calcinosis - deposition of calcium in the digits

45
Q

state the antibodies present in systemic sclerosis

A

limited - anti-centromere

diffuse - anti-scl-70

46
Q

how is systemic sclerosis managed

A

no curative treatment, manage underlying organ damage

immunosuppressant for lung disease, PPI for GI symptoms

47
Q

how does anti-phospholipid syndrome present

A

migraines
increased risk of stroke, MI esp in younger patients
recurrent loss of pregnancy typically in second and third trimester
recurrent pulmonary emboli

48
Q

what type of rash presents with anti-phospholipid syndrome

A

livedo reticularis - mottled vascular rash with lace like purple discolouration

49
Q

what investigations are carried out for anti-phospholipid syndrome

A

bloods - thrombocytopenia

lupus anticoagulant and anti-beta 2 glycoprotein positive

50
Q

what is the management of anti-phospholipid syndrome

A

if one episode of thrombosis - lifelong anticoagulation eg warfarin, if pregnant give LMWH instead

Musculoskeletal (11 decks)

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