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402: Rheum and derm > Arthritis > Flashcards

Arthritis Flashcards

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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
What vaccinations are encouraged for RA
Pneumococcal and influenza
26
What blood tests need to be carried out before starting DMARD
FBC, LFTs - Especially for methotrexate (myelosuppression, hepatotoxicity)
27
Gout is caused by intra-articular deposits of ________
Monosodium urate crystals (due to high uric acid levels)
28
Risk factors of gout
Male Metabolic syndrome Alcohol syndrome Diuretics High purine diet (seafood, meat)
29
What joint is most commonly affected in gout
1st metatarsal phalangeal joint
30
What joints are commonly affected in gout
Wrists 1st carpometacarpal joint
31
Presentation of gout
Acute, hot, swollen joint pain (oligo/polyarthritis) Severe pain Gouty tophi (common in DIPJ)
32
Investigations for gout
Bloods - CRP Joint aspirate and microscopy X-ray
33
Joint aspirate findings for gout
Needle-shaped crystals Negative birefringent of polarised light
34
X-ray findings for gout
Maintained joint space Lytic bone/ punched out lesions
35
Non-pharmacological management of gout
Keep affected joint elevated, rest, avoid excessive use Lifestyle - Low alcohol - Low purine diet - Weight loss - Good hydration
36
First line management of acute gout
NSAID (naproxen)
37
Second line management of acute gout
Colchicine
38
First line agent for chronic gout
Allopurinol
39
Second line agent for chronic gout
Febuxostat
40
Pseudogout is caused by intra-articular deposits of ________ crystals
Calcium pyrophosphate
41
Joints most commonly affected in pseudogout are...
Knees most common Shoulder, wrist, hip
42
Joint aspirate investigation in pseudogout will show...
Rhomboid shaped crystals with positive birefringent of polarised light
43
X-ray showing chondrocalcinosis is associated with...
Pseudogout
44
X-ray findings of pseudogout
Chondrocalcinosis LOSS: - Loss of joint space - Osteophytes - Subchondral cysts - Subarticular sclerosis
45
Ankylosing spondylitis is associated with what genetic polymorphism.
HLA B27
46
Joints mainly affected in ankylosing spondylitis are...
Vertebral column Sacroliac joint
47
Ankylosing spondylitis mainly affects what population?
Females > Males (6:1) Adolescents/ young adults - Age 20-30
48
What inflammatory conditions are associated with HLA B27
Ankylosing spondylitis Uveitis IBD Reactive arthritis
49
Symptoms of ankylosing spondylitis
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
MSK signs of ankylosing spondylitis
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
Non articular features of ankylosing spondylitis
Cardiovascular - AV Heart block - Aortitis/ AR Pulmonary - Apical pulmonary fibrosis Bowel - IBD Eye - Anterior uveitis
52
Scober's test will show a reduced lumbar movement of ________ in ankylosing spondylitis
<20cm
53
Investigations for ankylosing spondylitis
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
X-ray findings for ankylosing spondylitis
Joint fusion - Sarcoliliac - Vertebral facets Vertebral syndesmophytes Bamboo spine Subchondral sclerosis/ erosions Ossification of ligaments, discs and joints
55
Syndesmophytes describes ________ and is associated with ________
Describes bony growths within a ligament, associated with ankylosing spondylitis.
56
First line management of ankylosing spondylitis
NSAIDs + physio
57
Non-pharamcological management of ankylosing spond
Physiotherapy + exercise & mobilisation Smoking cessation
58
Psoriatic arthritis occurs in _______ % of patients with psoriasis
10-20%
59
Patterns of psoriatic arthritis
Symmetrical polyarthritis - DIPJ involvement - Wrist, ankle Axial pattern - Back, sacroiliac, atlanto-axial Asymmetrical - Affects digits
60
__________ is a screening tool used to psoriasis patients to assess for psoriatic arthritis
PEST (psoriasis epidemiological screening tool)
61
X-ray findings in psoriatic arthritis
Inflamed perosteum Joint fusion Dactylitis Pencil-in-cup appearance (central erosions) Osteolysis
62
First line therapy for long-term management of psoriatic arthritis
DMARDs (methotrexate)
63
First line biologic for psoriatic arthritis
Anti-TNF - Infliximab - Adalimumab - Etanercept
64
The joints most commonly affected in osteoarthritis are...
Knee Hip DIP Shoulder
65
Joints most commonly affected in rheumatoid arthritis are...
MCPJ PIPJ MTPJ
66
Heberden's and Bouchard's nodes are associated with....
Osteoarthritis
67
Herbeden's nodes appear on _______ whilst Bouchard's nodes appear on ________
Herbeden's= DIPJs Bouchards= PIPJs
68
The surgical management of knee osteoarthritis with mechanical locking is...
Arthroscopic lavage & debridement 2nd line= knee replacement
69
Non pharmacological advise for OA
Weight loss Exercise/ physio to strengthen muscle around the joint Appropriate footwear/ bracing/ walking device
70
Infections that common cause reactive arthritis
GI - Campylobacter - E.coli O157 - Shigella, Salmonella STI - Chlamydia - Gonorrhea - HIV
71
Features of Reiter's syndrome
Conjuctivitis ("can't see") Urethritis ("can't pee") Arthritis ("Can't bend the knee")
72
Complications of reactive arthritis
Cervicitis Pericarditis
73
Reactive arthritis has what genetic association
HLA-B27
74
Kertoderma blenorrhagicum is associated with _______
Reactive arthritis
75
First-line investigations for reactive arthritis
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
Reactive arthritis usually resolves within...
6 months
77
Acute management of reactive arthritis
NSAIDs Intra-articular steroid injection/ systemic steroids (if polyarthritis)
78
Felty's syndrome describes a triad of...
Low WCC Splenomegaly RA
79
Acute management of symptomatic sarcoidosis
Oral corticosteroids
80
______% of sarcoidosis resolves within _____months
60% within 6 months
81
What are the indications for urate lowering therapy for gout
Multiple/ troublesome flares CKD 3+ Diuretics use Gouty tophi/ chronic gouty arthritis
82
How is urate lowering therapy started
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
Indications for specialist management of gout
Chronic kidney disease >3b History of organ transplant Uncertain diagnosis Contraindicated/ ineffective treatment
84
What is rheumatoid factor?
Autoantibody that binds to the Fc region of IgG. Primary IgM but can be any immunoglobulin isotype.
85
First line biologics used for ankylosing spondylitis?
Anti-TNFa - Etanercept - Infliximab - Adalimumab
86
Second line biologics used for ankylosing spondylitis?
Secukinumab - Anti IL-17

402: Rheum and derm (12 decks)

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