Arthritis

Question 1

What are the two categories of multi-system rheumatological disease?

Answer 1

Connective tissue disease

Vasculitis

Question 2

What are the 4 main connective tissue diseases?

Answer 2

SLE
Idiopathic inflammatory myositis
Primary Sjorgren’s syndrome
Scleroderma

Question 3

What are ANAs?

Answer 3

Anti-nuclear antibodies

Group of antibodies that bind to nuclear proteins

Question 4

How do you test for ANAs?

Answer 4

By staining of Hep-2 cells
You will see fluorescent nucleus
Note: low titres are found in normal individuals

Question 5

What is important to note with ANAs?

Answer 5

What are the ANAs binding?

• dsDNA (systemic lupus)
• extractable nuclear antigens

Question 6

How can you be genetically predisposed to lupus?

Answer 6

Polymorphisms in several different genes that code for things like complement and inflammatory molecules

Increased cellular/nuclear debris

Increase B-cell hyperactivity

Promotes loss of tolerance

Leads to ABs directed at intracellular proteins

ABs bind to antigens and form immune complexes

Immune complexes are deposited in blood vessels

Complement activation and infiltration of white cells

Question 7

What are some signs of lupus?

Answer 7

Malar rash
Arthritis (deformities)
Glomerulonephritis
Pleural effusion - pleurtic chest pain
Pericarditis with pericardial effusion

Question 8

What causes symptoms in lupus?

Answer 8

Widespread inflamation

Question 9

How is severity of lupus assessed?

Answer 9

Mild: skin, hair, joints, lymphadenopahty

moderate: lungs and heart

Severe: kidneys and brain

Question 10

What would bloods look like in lupus?

Answer 10

High ANA
High ESR (inflammation)
Low C4
Can have normal CRP

Question 11

What is the management for SLE?

Answer 11

Hydroxychloroquine (most patients)

Prednisolone (moderate/sever)

Other immunosuppressive agents e.g. azothiaoprine

Question 12

What is the balance when treating lupus?

Answer 12

Disease activity

Drug toxcity

Question 13

What happens in Sjorgren’s?

Answer 13

Inflammatory infiltration and destruction of exocrine glands

e.g. lacrimal and salivary glands

Question 14

What are some symptoms of Sjorgren’s?

Answer 14

Dry eyes

Dry mouth

Question 15

What investigatons are done in Sjorgen’s?

Answer 15

Serology:
+ve ANA
+ve ENA
+ve RF (Rheumatoid factor)

Lip gland biposy
- lymphocytic infiltrates

Question 16

How is Sjorgen’s managed?

Answer 16

Tear substitues
Saliva substitutes
Pilocarpine to stimulate saliva

Rarely medications

Question 17

What is the management for Idiopathic inflammatory myositis

Answer 17

Immunosuppression
Prednisolone
Methotrexate

Question 18

What are the symptoms of Scleroderma?

Answer 18

Calcinosis
Raynaud's 
Esophageal dysmotility
Scerlodactyly
Telangectasia

Question 19

What is systemic vasculitis?

Answer 19

Inflammation of blood vessels - usually arterial

Features of systemic inflammation e.g. constitutional

Question 20

What vasculitic condition can cause headaches?

Answer 20

Temporal arteritis

Question 21

What investigations are done for temporal arteritis?

Answer 21

Raised ESR and CRP
Abnormal temporal artery ultrasound scan
Temporal artery biopsy

Question 22

How is temporal arteritis managed?

Answer 22

Prednisolone

Question 23

What is polymyalgia rheumatica?

Answer 23

Inflammation focused on shoulder and hip

Involved bursal sacs and joints
Bursitis and Synovitis

Question 24

What are the main features of polymyalgia rheumatica?

Answer 24

> 50 years
Limb girdle pain and stiffness
Tender over bursae
Restricted shoulder/hip movements

Raised ESR and CRP
Normal CK

Treated by prednisolone

Question 25

What is important to note about polymyalgia rheumatica?

Answer 25

Closely related to temporal arteritis

So ask about headaches, visual symptpms, temporal tenderness

Question 26

What is important to consider when prescribing steroidal medication?

Answer 26

Gastric and bone protection
Omeprazole
Alendronic acid