Arthritic Conditions Flashcards by Jenna Cook

Women 40 years presents with symmetrical pain in her MCP joints, she complains of morning stiffness lasting more than 30 minutes, she feels SOB, and is dull on her left chest side on percussion. This has been going on for >6weeks. She is also a heavy smoker. On bloods you find anti-CCP antibodies. Diagnosis?

Rheumatoid arthritis with pleural effusion

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Treatment for rheumatoid arthritis?

DMARD therapy e.g methotrexate, steroids, NSAIDs

If DAS 28 score >5.1 and tried 2 DMARDS then can give TNF alpha blockers

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Women of 22 years presents with fever, tiredness, arthralgia, oral ulcers and gets white fingers when outside, she has also noticed clumps of hair on her pillow when she wakes. You do bloods and find anti-double stranded antibody and anti-sm. diagnosis?

Systemic lupus erythematosis

Due to antibodies anti-dsDNA and anti-sm hallmarks for SLE, and raynauds phenomenon

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Once SLE diagnosis made, what should do next?

URINALYSIS to check for glomerulonephritis, CT to check for lung involvement (pneumonitis/ effusions)

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Treatment for SLE?

For cutaneous symptoms and arthralgia then HYDROXYLCHLOROQUINE
If inflammatory arthritis/pericardial disease/ILD then immunosuppression AZIATHIOPRINE
If nephritis or CNS involvmeent IV STEROIDS AND CYCLOPHOSPHAMIDE (immunosuppresant

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In SLE what blood results would you expect for a flare?

CRP stay the same
Drop in C3/4
Anti-dsDNA to rise

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Anti-CCP antibody and RF present in blood. Diagnosis?

Rheumatoid arthritis

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?Anti-dsDNA, anti-sm, anti-ro, anti-RNP, ANCA present in blood. Diagnosis

Systemic lupus erythematosis

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Anti-cardiolipid antibody, lupus anticoagulant, anti beta 2 glycoprotein present in blood. Diagnoss?

Anti-phospholipid syndrome

Think as causes blood clots then cardio

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Anti-ro antibody and anti-la antibody present in blood. Diagnisos?

Sjogrens syndrome

SchgROgens

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Anti-centromere antibody present in blood. Diagnosis?

Systemic sclerosis limited (opposite as what think as it effects the peripheris not centrally

ANTI centre so why it effects the peripheries

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Anti-scl-70 antibody present in the blood. Diagnisos?

Systemic sclerosis diffuse

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cANCA and PR3 present in the blood. Diagnosis?

Granulomatosis with polyagitis

Think c- as causes Collapse of the nose

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Women 40yrs presents with joint pain in both her PIP joints, its been going on for 6 weeks. She gets stiffness in the morning bettering throughout the day, her joints are swollen. She mentions that now both her MCP joints are also sore. On examination you notice both her lower lungs fields are dull, she mentions she has been taking ibuprofen and it has helped the pain. Diagnosis?

Rheumatoid arthritis

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What is the treatment for 1st stage arthritis, then 2nd stage

Methotrexate with NSAIDs for the first 6 weeks

Add another DMARD like sulfasalazine

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Women with known rheumatoid arthritis wants to get pregnant, she is currently on methotrexate and NSAID therapy. What advice would you give her?

She has to STOP the methotrexate as it is tetragenic aka causes deformities. So switch to sulphasalazine and use protection for at least 3 months before trying for a family.

Women has been diagnosed with rheumatoid arthritis, what do you do/prescribe?

Methotrexate & NSAIDs

Urinanalysis to see kidney involvement

What DAS score is required in rheumatoid arthritis to qualify a patient for biologic therapy like adalimumab?

> 5.1

Asian women of 22 years with known anti-phospholipid syndrome presents with fever, weight loss, painful DIP/ PIP joints and nasal ulcers. They are currently on the pill. What investigations would you do? Likely diagnosis?

Bloods for anti-double stranded antibody (dsDNA) and C3/4 low

Systemic lupus erythematosis

What is the step up treatment for systemic lupus erythematosis?

Hydroxychloroquine (everyone gets this then add other things) + NSAIDs, Steroids

If arthritis or pericardial disease, ILD give immunosuppression like aziathioprine or methotrexate

If a person is negative for glomerulonephritis what should their urine protein/ creatine be?

> 15

And their serum albumin will be low

If positive for lupus nephritis then what should be given?

IV steroids and cyclophsophamide (immunosuppressant)

Women 29 years presents with multiple misscarriages, persistent headaches and mottled legs. You do an antibody test and she si anti-beta 2 glycoprotein positive. Diagnosis?

Anti-phospholipid syndrome

Mottled legs known as livedo reticularis

Young women presents with multiple PE’s occuring frequently in the space of 2 years, she also has suffered MI in the past. You do bloods and discover thrombocytopenia and prolonged APTT. She is lupus anti-coagulant positive. Diagnosis?

Anti-phospholipid syndrome

Due to recurrent thrombitic episodes and prolonged coagulation time. Other antibodies you could find would be anti-cardiolipin, anti-beta 2 glycoprotein.

Women presents with extremely dry eyes, mouth, vagina and pain in her wrists lasting > 3 months. On examination there is swelling of the parotid gland and schirmers test positive. Diagnosis?

Sjogrens syndrome with rheumatoid arthritis | Due to SICCA symptoms of dry eyes, mouth and CT disorders so painful wrists. Also females more likely

Women presents with caries, dry mouth and generalised fatigue. You do bloods and find anti-ro and anti-la antibodies. Diagnosis?

Sjogrens syndrome Caries are tooth decay

What are the treatments for sjogrens syndrome?

Symptoms based, so eye drops, saliva replacement, hydroychloroquine for arthralgia/ fatigue, immunosuppression if organ involvment like ILD

Women presents with whitening of fingers when cold, tightness of her the skin round her fingers, heart burn after eating and red marks around her face. What is the likley diagnosis? What investigations would you request?

CREST symptoms so likely limited systemic sclerosis (raynauds, oesophgesal dysfunction, sclerodactyl, telangectasia) Antibody for anti-centromere

What are the treatents for systemic sclerosis?

Symptomatic so calcium channel blockers for raynauds, PPI for reflux, if ILD then azathioprine,

Man 22 presents with back pain, stiff in themorning but better as day goes on, it gets worse with rest. On examination there is a question mark spine, and reduced chest expansion and he is schobers test positive. This has been going on for more than 3 months. On bloods he is HLA B27 +. What investigations would you do? Likley diagnosis?

MRI scan for inflammation of the spine showing osteopenia, sacroiliac joint fusion, syndesmophytes (bony spurs) Ankylosing spondylitis

What is the treatment for ankylosing sponylitis?

NSAIDs (naproxene or ibuprofen) and physiotherapy

Women presents with pain in her DIP joints, and sausage fingers, occuring for more than 4 months. It started in her DIP but now also in her wrists and PIP. On examination she has onycholysis, pitting nails but none of her joints are red. She has a family history of psoriasis. Diagnosis and treatment?

Psoriatic arthritis DMARDS (methotrexate)

Young female recently back from T in the park presents with painful knee about 3 weeks after the event. She also has urethritis. What questions would you like to ask? Likely diagnosis? Treament?

Did you have any unprotected sex? Any stomach/ GI upset in the last 3 weeks? Reactive arthritis likely secondary to chlyamydia or campylobacter. If secondary to STI treat STI, otherwise this is self limiting.

Young man with crohns disease presents with painful right knee and left elbow. He feels awful with a fever and has some weight loss. He has been having watery stool. Investigations? Likely diagnosis?

Endoscopy if not already had one Joint aspirates to exclude other diagnosis Enteropathic arthritis

Treatment for enteropathic arthritis?

Treat underyling condition like crohns/ UC NSAIDs if no contraindications but not in crohns due to gastric ulceration Steroidal injection to jionts, If doesnt settle then methotrexate

Man presents with intensely painful red hot swollen big toe, occuring overnight. He is a body builder so has a high red meat diet. You do an aspiration of the joint and find negatively bifringement monosodium urate crystals. What is the diagnosis and treatment?

Gout | Self limiting 7-10 days but can give NSAIDs or colchicine

You suspect pseudogout, what would you expect to find under microscope from joint aspiration?

Positively bifringenent crystals of calcium pyrophsophate

You can give allopurinol for prophylaxis for pseudogout. T/F?

FALSE Urate lowering drug and pseudogout is calcium pyrophosphate crystals

Man of 70 years presents with groin pain with movement, it is relieved by rest and he has had this worsening for last 5 years. On examination there is joint tenderness, you do an Xray and find osteophyte presence, loss of joint space and some sclerosis of the femoral head. Diagnosis?

Osteoarthritis