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402: Rheum and derm > Arthritis > Flashcards

Arthritis Flashcards

1
Q

Rheumatoid arthritis is an…

A

Inflammatory symmetrical, polyarticular arthritis of the small joints.

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2
Q

Risk factors for R. arthritis

A

Family history

Female > Male (3:1)

Other autoimmune disorders:

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3
Q

Rheumatoid arthritis is associated with HLA ______

A

DR1 and DR4

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4
Q

Pathophysiology of rheumatoid arthritis involves the chronic inflamamtion of…

A

Synovial lining of the joints, tendon sheaths and bursa

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5
Q

Symptoms of rheumatoid arthritis

A

Morning stiffness (45 mins)
- Relieved after movement

Swollen, tender joints

Constitutional features: fatigue, myalgia, mild fever, weight loss

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6
Q

Signs of rheumatoid arthritis

A

Hand deformities
- Swan neck
- Boutonnière
- Ulnar deviation of MCPJ
- Z thumb

Atlantoaxial subluxation

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7
Q

Extra-articular features of rheumatoid arthritis

A

Pulmonary
- Pulmonary fibrosis/ nodules
- Bronchiolitis obliterans (small airway obstruction)

Secondary Sjogren’s

Episcleritis/ Scleritis

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8
Q

Swan neck deformity describes the…

A

Hyperextension of the PIP and flexion of the DIP

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9
Q

Boutonnière deformity describes the…

A

Flexion of the PIP and hyperextension of the DIPs.

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10
Q

Rheumatoid factor (RF) is a _________ that binds to _________

A

IgM autoantibody that binds to the Fc region of IgG

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11
Q

Initial investigations for rheumatoid arthritis

A

FBC
- Anaemia of chronic disease

CRP, ESR
- May be raised

RF
- Raised in majority

Anti-CCP
- Most specific

X-ray hands

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12
Q

Early X-ray findings of rheumatoid arthritis

A

Periarticular osteopenia

Loss of joint space

Soft tissue swelling

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13
Q

Late X-ray findings of rheumatoid arthritis

A

Periarticular erosions

Subluxation

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14
Q

The DAS28 score describes ________ for ________

A

Disease activity score for rheumatoid arthritis.

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15
Q

Features of DAS28 score

A

28 joints:
- Number of swollen joints
- Number of tender joints
- ESR/ CRP level
- Patient’s global assessment of health (0-10, higher being worse)

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16
Q

The DAS28 score is used to…

A

Establish a baseline and assess the effectiveness of therapy used in Rheumatoid arthritis.

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17
Q

The DAS28 score is used to…

A

Establish a baseline and assess the effectiveness of therapy used in Rheumatoid arthritis.

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18
Q

Non-pharmacological management of RA

A

Physiotherapy

Occupational therapy

Podiatry

Good diet

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19
Q

Acute flares in Rheumatoid arthritis are controlled by…

A

NSAIDs

Corticosteroids (Prednisolone)

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20
Q

The first-line long-term pharamacological management of RA is…

A

DMARD monotherapy
- Methotrexate
- Leflunomide
- Sulfasalazine

Mild disease= hydroxychloroquine

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21
Q

Second-line long term pharmacological management of RA is…

A

Combination of DMARDs
- Methotrexate
- Sulfasalazine
- Leflunomide

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22
Q

Biologics are used to treat RA when…

A

A trial of at least 2 DMARDs fail to show substantial improvement.

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23
Q

RA has a worse prognosis for…

A

Younger, males

When a higher number of joints are affected

When there are erosions on an X-ray

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24
Q

What co-morbidities need to be screened for in RA

A

Osteoporosis/ osteopenia (FRAX)

Hypertension

Cardiovascular disease (QRISK)

Mood disorder

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25
Q

What vaccinations are encouraged for RA

A

Pneumococcal and influenza

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26
Q

What blood tests need to be carried out before starting DMARD

A

FBC, LFTs
- Especially for methotrexate (myelosuppression, hepatotoxicity)

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27
Q

Gout is caused by intra-articular deposits of ________

A

Monosodium urate crystals (due to high uric acid levels)

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28
Q

Risk factors of gout

A

Male

Metabolic syndrome

Alcohol syndrome

Diuretics

High purine diet (seafood, meat)

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29
Q

What joint is most commonly affected in gout

A

1st metatarsal phalangeal joint

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30
Q

What joints are commonly affected in gout

A

Wrists

1st carpometacarpal joint

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31
Q

Presentation of gout

A

Acute, hot, swollen joint pain (oligo/polyarthritis)

Severe pain

Gouty tophi (common in DIPJ)

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32
Q

Investigations for gout

A

Bloods
- CRP

Joint aspirate and microscopy

X-ray

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33
Q

Joint aspirate findings for gout

A

Needle-shaped crystals

Negative birefringent of polarised light

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34
Q

X-ray findings for gout

A

Maintained joint space

Lytic bone/ punched out lesions

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35
Q

Non-pharmacological management of gout

A

Keep affected joint elevated, rest, avoid excessive use

Lifestyle
- Low alcohol
- Low purine diet
- Weight loss
- Good hydration

36
Q

First line management of acute gout

A

NSAID (naproxen)

37
Q

Second line management of acute gout

A

Colchicine

38
Q

First line agent for chronic gout

A

Allopurinol

39
Q

Second line agent for chronic gout

A

Febuxostat

40
Q

Pseudogout is caused by intra-articular deposits of ________ crystals

A

Calcium pyrophosphate

41
Q

Joints most commonly affected in pseudogout are…

A

Knees most common

Shoulder, wrist, hip

42
Q

Joint aspirate investigation in pseudogout will show…

A

Rhomboid shaped crystals with positive birefringent of polarised light

43
Q

X-ray showing chondrocalcinosis is associated with…

A

Pseudogout

44
Q

X-ray findings of pseudogout

A

Chondrocalcinosis

LOSS:
- Loss of joint space
- Osteophytes
- Subchondral cysts
- Subarticular sclerosis

45
Q

Ankylosing spondylitis is associated with what genetic polymorphism.

A

HLA B27

46
Q

Joints mainly affected in ankylosing spondylitis are…

A

Vertebral column

Sacroliac joint

47
Q

Ankylosing spondylitis mainly affects what population?

A

Females > Males (6:1)

Adolescents/ young adults
- Age 20-30

48
Q

What inflammatory conditions are associated with HLA B27

A

Ankylosing spondylitis

Uveitis

IBD

Reactive arthritis

49
Q

Symptoms of ankylosing spondylitis

A

Neck/ sarcoiliac stiffness
- Worse in morning, improves with activity

Lower back pain

Constitutional: fatigue, weight loss, myalgia

Chest pain:
- costovertebral/ costosternal pain
- Pulmonary fibrosis

Eye pain (anterior uveitis)

50
Q

MSK signs of ankylosing spondylitis

A

Loss of lumbar and cervical lordosis
- Hyperextended spine

Reduced lumbar flexion (Schober’s test) and lateral cervical flexion

Enthesitis
- Plantar fasciitis
- Achiles tendonitis

Spinal tenderness

Dactylitis

51
Q

Non articular features of ankylosing spondylitis

A

Cardiovascular
- AV Heart block
- Aortitis/ AR

Pulmonary
- Apical pulmonary fibrosis

Bowel
- IBD

Eye
- Anterior uveitis

52
Q

Scober’s test will show a reduced lumbar movement of ________ in ankylosing spondylitis

A

<20cm

53
Q

Investigations for ankylosing spondylitis

A

Bloods
- Raised ESR and CRP
- Anaemia
- Negative RF and anti-CCP

Genetic HLA B27 testing

Whole spine X-ray/ MRI spine

High resolution CT= apical pulmonary fibrosis

Echocardiogram= aortic regurgitation, aortitis

ECG= AV heart block

54
Q

X-ray findings for ankylosing spondylitis

A

Joint fusion
- Sarcoliliac
- Vertebral facets

Vertebral syndesmophytes

Bamboo spine

Subchondral sclerosis/ erosions

Ossification of ligaments, discs and joints

55
Q

Syndesmophytes describes ________ and is associated with ________

A

Describes bony growths within a ligament, associated with ankylosing spondylitis.

56
Q

First line management of ankylosing spondylitis

A

NSAIDs + physio

57
Q

Non-pharamcological management of ankylosing spond

A

Physiotherapy + exercise & mobilisation

Smoking cessation

58
Q

Psoriatic arthritis occurs in _______ % of patients with psoriasis

A

10-20%

59
Q

Patterns of psoriatic arthritis

A

Symmetrical polyarthritis
- DIPJ involvement
- Wrist, ankle

Axial pattern
- Back, sacroiliac, atlanto-axial

Asymmetrical
- Affects digits

60
Q

__________ is a screening tool used to psoriasis patients to assess for psoriatic arthritis

A

PEST (psoriasis epidemiological screening tool)

61
Q

X-ray findings in psoriatic arthritis

A

Inflamed perosteum

Joint fusion

Dactylitis

Pencil-in-cup appearance (central erosions)

Osteolysis

62
Q

First line therapy for long-term management of psoriatic arthritis

A

DMARDs (methotrexate)

63
Q

First line biologic for psoriatic arthritis

A

Anti-TNF
- Infliximab
- Adalimumab
- Etanercept

64
Q

The joints most commonly affected in osteoarthritis are…

A

Knee

Hip

DIP

Shoulder

65
Q

Joints most commonly affected in rheumatoid arthritis are…

A

MCPJ

PIPJ

MTPJ

66
Q

Heberden’s and Bouchard’s nodes are associated with….

A

Osteoarthritis

67
Q

Herbeden’s nodes appear on _______ whilst Bouchard’s nodes appear on ________

A

Herbeden’s= DIPJs

Bouchards= PIPJs

68
Q

The surgical management of knee osteoarthritis with mechanical locking is…

A

Arthroscopic lavage & debridement

2nd line= knee replacement

69
Q

Non pharmacological advise for OA

A

Weight loss

Exercise/ physio to strengthen muscle around the joint

Appropriate footwear/ bracing/ walking device

70
Q

Infections that common cause reactive arthritis

A

GI
- Campylobacter
- E.coli O157
- Shigella, Salmonella

STI
- Chlamydia
- Gonorrhea
- HIV

71
Q

Features of Reiter’s syndrome

A

Conjuctivitis (“can’t see”)

Urethritis (“can’t pee”)

Arthritis (“Can’t bend the knee”)

72
Q

Complications of reactive arthritis

A

Cervicitis

Pericarditis

73
Q

Reactive arthritis has what genetic association

A

HLA-B27

74
Q

Kertoderma blenorrhagicum is associated with _______

A

Reactive arthritis

75
Q

First-line investigations for reactive arthritis

A

Bloods
- FBC= raised WCC
- CRP= raised
- Blood culture

GI symptoms
- Stool culture

Urine dip, MC+S

Joint aspirate

Joint X-ray

STI screen, HIV test

76
Q

Reactive arthritis usually resolves within…

A

6 months

77
Q

Acute management of reactive arthritis

A

NSAIDs

Intra-articular steroid injection/ systemic steroids (if polyarthritis)

78
Q

Felty’s syndrome describes a triad of…

A

Low WCC

Splenomegaly

RA

79
Q

Acute management of symptomatic sarcoidosis

A

Oral corticosteroids

80
Q

______% of sarcoidosis resolves within _____months

A

60% within 6 months

81
Q

What are the indications for urate lowering therapy for gout

A

Multiple/ troublesome flares

CKD 3+

Diuretics use

Gouty tophi/ chronic gouty arthritis

82
Q

How is urate lowering therapy started

A

Treat to target
- Start at low dose and aim for serum urate <360 umol/L or <300 (in severe/ resistant)
- Monitoring urate monthly until target is reached

83
Q

Indications for specialist management of gout

A

Chronic kidney disease >3b

History of organ transplant

Uncertain diagnosis

Contraindicated/ ineffective treatment

84
Q

What is rheumatoid factor?

A

Autoantibody that binds to the Fc region of IgG.

Primary IgM but can be any immunoglobulin isotype.

85
Q

First line biologics used for ankylosing spondylitis?

A

Anti-TNFa
- Etanercept
- Infliximab
- Adalimumab

86
Q

Second line biologics used for ankylosing spondylitis?

A

Secukinumab
- Anti IL-17

402: Rheum and derm (12 decks)

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