Week 2

Question 1

Women 30 years presents with 6 weeks history of bilateral wrist pain, its worse in the morning lasting over an hour before easing off. The wrists appear swollen. She also smokes. No medications but takes overcounter aspirin which helps pain. Diagnosis?

Answer 1

Rheumatoid arthritis due to morning stiffness, bilateral involvement and synovial joints effected. NSAIDs known treatment

Question 2

What type of joints does rheumatoid arthritis effect?

Answer 2

Synovial joints aside from DIP due to the small quantity of synovial fluid e.g PIP, MCP, shoulders, elbows, C1/C2

Question 3

What are some of the complications of long term untreated rheumatoid arthritis?

Answer 3

Joint destruction
Extensor tenosynovitis
Swan necking of tarsals and sublaxation of the tendons in feet (walking on pebbles)

Question 4

What is osteoarthritis

Answer 4

Degradation of the cartilage on the articular surfaces of the bones making the joint. Causes inflammation and swelling of the osteophyte and pain. Common in joints that weight bear and have excessive use. Will have loss of joint space

Question 5

What is epidemiology of people osteoarthritis?

Answer 5

45years + and 70years++

Females, obese, previous injuries like high impact athletes

Question 6

What is cartilage composed of? 3 components, where mutation of any of these can cause OA

Answer 6

Chondrocytes
Type 2 collagen fibres
Proteoglycon

Question 7

45 yrs women presents with worsening pain in her right knee over the last 3 years, she was a previous sprinter. Aggrevated with movement and relieved by rest. On exam it is swollen, crepitus present and there is genu varus present. Investigations? Likely diagnosis?

Answer 7

Xray of the knee would show loss of joint space but more a clinical diagnosis.

Osteoarthritis due to long time onset, former athelete, unilateral joint involvement andn mechanical pain

Question 8

What condition is heberdens and bouchards nodes associated with? What are they?

Answer 8

Bony enlargments of the DIP and PIP joints in the hands respectively

Osteoarthritis

Question 9

What are the treatments for OA if surgery its not optional

Answer 9

Just for pain management so analgesia, paracetamol, NSAIDS, amitriptyline, steroids

Physiotherapy

Question 10

What factors increase your predispostion to gout? Genetic and environmental

Answer 10

Increased urate production like in psoriasis, myeloproliferative disorders, haemolytic disorders, alcohol, high red meat (purine)

Decreased urate excretion; renal impairment, heart failure, hypothyroidism, DIURETICS, cytotoxic drugs

Question 11

How would you treat acute gout?

Answer 11

It will settle within 10 days usually, or can use NSAIDs, Colchine, steroids

Question 12

What would you use as prophylaxis of someone prone to gout?

Answer 12

Allopurinol with NSAID

Question 13

Male athlete is on a high protein diet presenting with red, inflamed, painful big toe. It has occurred over the last day and is incredible sore. He has no fever. You take an aspiration of the synovial fluid and it shows negative bifringent crystals. Diagnosis ?

Answer 13

Gout

Question 14

What condition has deposition of calcium pyrophosphate crystals in joints?

Answer 14

Pseudo gout

Question 15

What results would you expect in someone newly diagnosed with Rheumatoid arthritis? FBC, Xrays, ultrasound,

Answer 15

FBC; low haemoglobin but normal MCV due to bone not producing enough RBCs, inflammatory markers elevated, autoantibodies (RF)
Xrays; if caught early then normal, later stages show bone erosion
Ultrasound; show increased blood flow to area indicitive of damage (pannus)

Question 16

Gout doesnt occur in premenopausal women. T/F? Why?

Answer 16

True due to oestrogen having a protective effect, hence why this condition more common in men

Question 17

Women 70 presents with bilateral tenosynovitis of the hands, early morning stiffness, swelling of the PIP and MCP joints. Occuring over the 6-8 weeks with worsening pain. She is a heavy smoker. Diagnosis?

Answer 17

Rheumatoid arthritis

Question 18

What are some of the features on xray you would expect from someone with osteoarthritis

Answer 18

Joint space narrowing
Cysts
Osteophytes (bony projections)
Subchondral sclerosis (increased whiteness of bone)

Question 19

Young man presents with swollen red painful ankle, he has a fever, shivering and sweaty this occured over the last 2 days. What main questions would you like to know?

Answer 19

Any open wounds previously as this is likely septic arthritis and is an emergency. So need antibiotics

Medications for gout (diuretics) but gout unlikley due to systemic involvments

Question 20

Why might during a flare of gout, urate be low inthe blood?

Answer 20

As it has all crystalised in the joints

Question 21

Man 50yrs presents with red eyes, constantly painful hands with swollen PIP joints and a high white cell count. This occured over the last few days. He is a heavy drinker. Diagnosis? Treatment?

Answer 21

Gout

NSAIDS

Question 22

Women presents with episodic joint inflammation of her PIP and MCPs, when inflammed they are swollen and red then relieve over a few days. Likely diagnosis?

Answer 22

Palandromic rheumatism

Question 23

When prescribing methotrexate to a young women what must you consider?

Answer 23

If they want to start a family , as bad contraindications during pregnancy to the baby

Question 24

What are common syndrome to occur with lupus?

Answer 24

Antiphospholipid syndrome
Rheumatoid arthritis
Sjogrens syndrome
Scleroderma
Myositis 
UCTD
Myositis

Question 25

Young women 30 years presents with reccurent miscarriages, and mottled leg appearance. She has anti-cardiolipin antibody. Diagnosis?

Answer 25

Antiphospholipid syndrome

Question 26

Describe the pathogenesis of SLE

Answer 26

When cells die after apoptosis, they aren’t immediately cleared by the immune system, so there is constant exposure of the DNA and intracellular components. Immune system then mounts an auto response against this

Question 27

What groups of people does systemic lupus erythmatosus usually effect

Answer 27

Females 30-60 years, more severe and likely in asians, agro americans, afrocaribbeans

In those with higher oestrogen so dont prescribe oestrogen pill to those with SLE

Question 28

Young women of 32years presents with mouth ulcers, hair on pillow in morning, and a rash across her face sparing the nasolabular folds. She also has joint pain in her feet and hands, and elarged nodes around her neck. Investigations? Diagnosis?

Answer 28

Antibodies; Anti-dsDNA, anti-nuclear antibody

Systemic lupus erythematosus

Question 29

If have mild SLE and antiphospholipid syndrome what is the treatment?

Answer 29

Hydroxychloroquinine, NSAIDs

Warfarin (as anti… causes blood clots)

Question 30

If diagnose SLE what is the next thing to do?

Answer 30

Urinanalysis to determine if kidneys involved as there will be no symptoms, chekcing for protein in urine or bllod as this would signify damage on the way to glomerulo nephritis

Question 31

What is sjogrens syndorme\? Treat?

Answer 31

Where there is inflammation of the endocrine glands (eyes, mouth, vaginlal dryness, salivary glands, increased tooth decay). Associated with ANTI-RO antibody.
Artifical tears and salivary supplements, fluoride toothpaste, hydroxychloroquine for fatigue and arthralgia

Question 32

What is the significane of anti-RO antibody during pregancy?

Answer 32

Dangerous as this cna cross the placenta and cause congenital heart block in the fetus

Question 33

In osteoarthritis pain in joints commonly occurs in the morning and lasts <30 minutes. T/F?

Answer 33

True, it gets better with movement

Question 34

What is the treatment/ advice for those suffering from Osteoarthritis?

Answer 34

Surgery an option but wait and see as could improve naturally
Explanation to encourage normal movement
Physiotherapy
Lose weight

Question 35

Women presents with hard nodules in the skin, white finger tips that return red when going from cold to hot, what feels like heartburn, and some red blanchable marks on her cheeks. She is anti-centromere antibody positive. Diagnosis? Treatment?

Answer 35

Limited systemic sclerosis
Anti-CENTRE so the peripheries

Treat symptoms so calcium blockers (raynauds), immunosuppresants as it is a antibody mediated condition, PPI for reflux