MSK

Question 1

What does an X-ray for gout show

Answer 1

• Earliest sign: joint effusion, with relatively preserved joint space
• Well-defined ‘punched out’ erosions with sclerotic margins and overhanging edges in a juxta-articular distribution (rat-bite erosions)
• Eccentric erosions and soft tissue tophi may be observed
• An absenceof periarticular osteopenia (unlike rheumatoid arthritis)
• Late sign: loss of joint space

Question 2

Prevention of gout

Answer 2

• Lifestyle advice - food low in purine, lose weight, avoid alcohol
• Xanthine oxidase inhibitors - reduces uric acid
  
  • Allopurinol - 1st line
  • Febuxostat - 2nd line
    Note: when initiating these medications, they should be given at least 2 weeks after an acute attack.
    Uricosuric agent - This increases the excretion of uric acid in the urine.

Question 3

X-ray of pseudogout

Answer 3

• Joint X-ray: chondrocalcinosis (calcification of articular cartilage) is seen in 40% of casesand is highly suggestive of pseudogout but is not diagnostic; theabsenceof chondrocalcinosis doesnotexclude pseudogout
  
  • In the knee, this is seen as linear calcifications of the articular cartilage and meniscus

Question 4

medication for ankylosing spondylitis (in order)

Answer 4

• NSAIDs e.g. ibuprofen or naproxen (2-4 weeks. If no improvement, switch to another NSAID)
• Steroids- used during flares (oral, IM or directly into joints)
• Anti-TNF e.g. etanercept or monoclonal antibodies against TNF e.g. infliximab, adalimumab
• Monoclonal antibodies targeting IL-7 - e.g. secukinumab

Question 5

What is SLE

Answer 5

Systemic Lupus Erythematosus
Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune condition caused by a type 3 hypersensitivity reaction due to a complex interplay between genetic and environmental factors.

Question 6

Treatment of mild SLE

Answer 6

Prednisolone (corticosteroid) + hydroxychloroquine + NSAIDs

Question 7

Treatment of moderate and severe SLE

Answer 7

Prednisolone and hydroxychloroquine and an immunosuppressant
Immunosuppressents commonly used: Methotrexate, Azathioprine, Ciclosporin

Question 8

What can you use in refractory cases of SLE

Answer 8

biologics such as belimumab or rituximab may be considered

Question 9

HLA associations with SLE

Answer 9

B8, DR2, DR3

Question 10

Antibodies found in SLE

Answer 10

• ANA
• Anti-dsDNA
• Anti-Smith: most specific, low sensitivity