Rheumatology Flashcards
Abatacept
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Alkylating Agents
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Anti-CCP or ACPA
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Auto-antibodies of scleroderma (systemic sclerosis)
- Which (1) related to limited disease
- Which (2) related to diffuse disease
- Which (1) decreases the risk of severe lung disease
- Which (1) increases the risk of ILD
- Which (1) is associated with renal disease, skin involvement and malignancy
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Autoantibodies in SLE
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Autoantibodies in SLE
Most Sensitive
Most Specific
Implication of Dense Fine Speckled ANA
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Azathioprine
Cyclosporin
Leflunomide
Methotrexate
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Azathioprine and TMPT
Drugs not to combine with AZA
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Behcet’s disease
- HLA association
- Describe disease course and Rx
HLA-B51!
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Belimumab - drug profile
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Best treatment for palindromic Rheumatism
Palindromic rheumatism (PR) is a syndrome characterised by recurrent, self-resolving inflammatory attacks in and around the joints, consists of arthritis or periarticular soft tissue inflammation. Course is often acute onset, with sudden and rapidly developing attacks or flares. There is pain, redness, swelling, and disability of one or multiple joints. The interval between recurrent palindromic attacks and the length of an attack is extremely variable from few hours to days. Attacks may become more frequent with time but there is no joint damage after attacks. It is thought to be an autoimmune disease, possibly an abortive form of rheumatoid arthritis.
Hydroxychloroquine
Causes of Visual Loss in GCA
- ?most common
- and which vessel is involved
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Comparison of the various forms of Spondyloarthritis
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Contraindications to anti-TNFa therapy (5)
Malignancy within the past 5 years
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Contraindications to pregnancy in SLE (7)
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Cytokine Modulators in RA
- abatacept
- anakinra
- baricitinib
- rituximab
- tocilizumab
- tofacitinib
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Definition of Inflammatory Back Pain:
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Diagnosis of Sjogren’s Syndrome
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Diagnosis of Sjogren’s Syndrome
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Diagnostic Criteria for SLE
Definitions
- Discoid rash - red rash raisedm disk-shaped patches
- serositis - inflamamtion of linign around the lungs
- Kidney disoder - persistent proteinuria or celular casts in the urine
- Neurologic disorder - seizures or psychosis
- Blood disorder - anaemia, leukopenia, lymphopenia or thrombocytopenia
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Difference between limited and generalised GPA (Wegner’s)
The absence/presence of renal involvement
DMARDs and pregnancy
csDMARDs during pregnancy
- Minimal foetal and maternal risk
- hydroxychlorquinine, sulfalazine and azathioprine
- May be used selectively
- corticosteroids, ored does nto cross the placenta, try to limit to 10mg per day - risk of gestational diabetes, small for gestational age babies, preterm delivery
- NSAIDs, safest during 2nd trimester, avoid during 3rd trimester due to risk of premature closure of ductus arteriosus
- Moderate to high risk of foetal harm
- Methotrexate
- Leflunomide
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Epidemiology and Causes of Polyarteritis Nodosa
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Epidemiology and Pathogenesis of Takayasu arteritis
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Epidemiology and Presentation of Ank. Spond
Most common spondylitis - 1% of the population
- males > females 3:1
- main determinant = frequency of HLA B27 in population approx 5%
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Epidemiology of Scleroderma (Systemic Sclerosis)
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Features Favouring MCTD over SLE other primary autoimmunes
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Felty’s syndrome HLA association
HLA DRW4
General Management of SLE (5)
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Hydroxychloroquine
- which SLE patient’s should be prescribed
- Benefits (7)
- Main concerning SE and RF for this
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Hypersensitivity Vasculitis
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Impact on SLE on:
Fertility
Pregnancy
Flares
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Implications of anti-Ro and anti-La antibodies in SLE and pregnancy
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Implications of anti-Ro and anti-La antibodies in SLE and pregnancy
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Implications of APLS antibiodies in SLE and pregnancy
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Implications of Primary Sjogren’s Syndrome
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Indications for Renal Bx in SLE
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Indicators of Poor Prognosis in RA (6)
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Induction and Maintence Therapies for lupus nephritis
Class III, IV +/- V
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Interpretation of Synovial Fluid
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Is plasma exchange of benefit in ANCA associated pauci-immune glomerulonephritis? What do the trials show for management of ANCA associated vasculitis according to disease severity?
Yes MEPEX trial
- better renal recovery but no change in mortality
- should be used in those with severe renal involvement (Cr >500)
Key driver of pathology in CPP arthropathy
NLRP3 -> activates IL-1
Limited vs Diffuse Systemic Sclerosis
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Management of Fibromyalgia
Education is key!
Medications:
- TCAs
- Gabapentinoids
- SNRIs
- Tramadol
- Low-dose naltrexone
- Propranolol
Management – interventions best AVOIDED
- Opioids
- Paracetamol
- NSAIDs
- Glucocorticoids
- Benzodiazepines
- Most CAM therapies
- Cannabinoids?
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Management of Raynaud’s Disease
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Measures of Disease Activity in SLE (5)
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Most common cardiovascular manifestation of SLE
Pericarditis
Most common cause of drug induced ANCA+ vasculitis
Hydralazine
Most sensitive autoantibody for drug induced lupus
Anti Histone
Most significant complication of SLE in pregnancy
CHB for baby! :(
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