Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Musculoskeletal > Introduction to Rheumatology > Flashcards

Introduction to Rheumatology Flashcards

1
Q

what is a tendon?

A

cords of strong fibrous collagen tissue attaching muscle to bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is a ligament?

A

flexible fibrous connective tissue which connect two bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

components of a synovial joint

A

synovium
synovial fluid
articular cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

two major divisions of arthritis are?

A 
osteoarthritis (degenerative)
inflammatory arthritis (main type is rheumatoid arthritis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is inflammation?

A

physiological response to deal with injury or infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

inflammation manifests clinically as?

A 
rubor (redness)
dolor (pain)
calor (heat)
tumor (swelling)
loss of function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

list physiological, cellular and molecular changes of inflammation

A

increased blood flow
migration of WBC
activation/differentiation of leucocytes
cytokine production e.g. TNFalpha, IL1, IL6, IL17

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

two main types of crystal arthritis

A

gout

pseudogout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

immune mediated joint inflammation

A

rheumatoid arthritis
Seronegative spondyloarthropathies
Connective tissue diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

infective causes of joint arthritis

A

septic arthritis

tuberculosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is gout?

A

syndrome caused by deposition of urate (uric acid) crystals -> inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

risk factor for gout

A

High uric acid levels (hyperuricaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

causes of hyperuricaemia

A 
genetic tendency
increased intake of purine rich food
reduced excretion (kidney failure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is pseudogout?

A

syndrome caused by deposition of calcium pyrophosphate dihydrate (CPPD) crystal deposition crystals -> inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

risk factors for pseudogout

A

background osteoarthritis
elderly patients
intercurrent infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

acute gout can lead to?

A

gouty arthritis

tophi (aggregated deposits of MSU in tissue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

gouty arthritis commonly affects which joint?

A

metatarsophalangeal joint of the big toe (‘1st MTP joint’)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

overview of gouty arthritis

A

Abrupt onset
Extremely painful
Joint red, warm, swollen and tender
Resolves spontaneously over 3-10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

gout finding on x-ray

A

juxta-articular ‘rat bite’ erosions at the MTPJ of the great toe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

investigations for suspected crystal arthritis (gout)

A

joint aspiration - synovial fluid analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

management for an acute attack of gout

A

colcihine
NSAIDs
steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

management for chronic gout

A

allopurinol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

synovial fluid samples are analysed for

A

pathogens + crystals
rapid Gram stain > culture > antibiotic sensitivity assay
polarising light microscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

gout vs pseudogout examination findings

A

gout: urate crystals, needle shape, negative birefrigence
pseudogout: calcium pyrophosphate dihydrate crystals, brick shaped, positive birefrigence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what is rheumatoid arthritis?
chronic autoimmune disease characterised by pain, stiffness and symmetrical synovitis (inflammation of the synovial membrane) of synovial (diarthrodial) joints
26
synovium becomes a pannus in rheumatoid arthritis due to?
``` Neovascularisation Lymphangiogenesis inflammatory cells: activated B and T cells plasma cells mast cells activated macrophages ```
27
pathogenesis of rheumatoid arthritis
Dominant detrimental role of TNFα (GO BACK TO SLIDES)
28
how is TNFα inhibition achieved?
parenteral administration (most commonly sub-cutaneous injection) of antibodies or fusion proteins
29
key features of rheumatoid arthritis
``` chronic arthritis (polyarthritis, early morning stiffness, joint erosions on radiographs) extra articular disease can occur e.g. rheumatoid nodules autoantibody against IgG may be in blood ```
30
pattern of joint involvement of rheumatoid arthritis
symmetrical affects multiple joints (polyarthritis) particularly hands and feet
31
commonest affected joints in rheumatoid arthritis
Metacarpophalangeal joints (MCP), proximal interphalangeal joints (PIP), wrists , knees, ankles, metatarsophalangeal joints (MTP)
32
primary site of synovial inflammation in rheumatoid arthritis is?
synovium
33
synovial inflammation in rheumatoid arthritis includes?
proximal inter-phalangeal joint synovitis extensor tenosynovitis olecranon bursitis
34
common extra-articular features of rheumatoid arthritis
fever weight loss subcutaneous nodules
35
uncommon extra-articular features of rheumatoid arthritis
vasculitis Ocular inflammation e.g. episcleritis Neuropathies Amyloidosis Lung disease – nodules, fibrosis, pleuritis Felty’s syndrome – triad of splenomegaly, leukopenia and rheumatoid arthritis
36
what are subcutaneous nodules in rheumatoid arthritis?
central area of fibrinoid necrosis surrounded by histiocytes and peripheral layer of connective tissue
37
subcutaneous nodules in rheumatoid arthritis occurs in what percentage of patients?
approximately 30%
38
subcutaneous nodules in rheumatoid arthritis are associated with?
severe disease extra-articular manifestations rheumatoid factor
39
list the two antibodies found in the blood of patients with rheumatoid arthritis
``` rheumatoid factor (recognize the Fc portion of IgG as target antigen, typically IgM antibodies) antibodies to citrullinated protein antigens ```
40
Patients with RA test with rheumatoid factor present at __% at disease onset and further __% over first 2 years of diagnosis.
70 | 10-15
41
treatment goal for RA
prevent joint damage
42
RA treatment requires?
Early recognition of symptoms, referral and diagnosis Prompt initiation of treatment: joint destruction = inflammation x time Aggressive treatment to suppress inflammation
43
1st line drug treatment for RA
methotrexate in combination with hydroxychloroquine or sulfasalazine
44
2nd line drug treatment for RA
Biological therapies offer potent and targeted treatment strategies New therapies include Janus Kinase inhibitors : Tofacitinib & Baricitinib
45
what are DMARDs?
Disease-modifying anti-rheumatic drugs
46
avoid long term use of what in the treatment of RA and for what reason?
glucocorticoid therapy (prednisolone) side effects
47
what are biological therapies?
proteins (usually antibodies) that specifically target a protein such as an inflammatory cytokine
48
examples of biological therapies mechanisms for rheumatoid arthritis
inhibition of TNFalpha B cell depletion modulation of T cell co-stimulation inhibition of IL6 signalling
49
name the biological therapies that treat RA via inhibition of TNFalpha
``` antibodies (infliximab, and others) fusion proteins (etanercept) ```
50
name the biological therapies that treat RA via B cell depletion
Rituximab – antibody against the B cell antigen, CD20
51
name the biological therapies that treat RA via modulation of T cell co-stimulation
Abatacept - fusion protein - extracellular domain of human cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) linked to modified Fc (hinge, CH2, and CH3 domains) of human immunoglobulin G1
52
name the biological therapies that treat RA via inhibition of IL6 signalling
Tocilizumab (RoActemra) – antibody against interleukin-6 receptor. Sarilumab (Kevzara) – antibody against interleukin-6 receptor.
53
difference between joints in RA and osteoarthritis on x-ray
osteo no spaces but still some space for RA
54
what is ankylosing spondylitis?
type of arthritis in the spine, causing inflammation and gradual fusing of the vertebrae
55
common demographic of ankylosing spondylitis
20-30 years | male
56
ankylosing spondylitis is associated with what genetic marker on the MHC?
HLA B27
57
clinical presentation of ankylosing spondylitis
``` lower back pain + stiffness (early morning, improves w/ exercise) reduced spinal movement peripheral arthritis plantar fascitis, achilles tendonitis fatigue ```
58
investigations for ankylosing spondylitis
bloods | imaging: x-ray, MRI
59
positive results in bloods for ankylosing spondylitis?
Normocytic anaemia Raised CRP, ESR HLA-B27
60
positive results in imaging for ankylosing spondylitis?
Squaring Vertebral bodies, Romanus lesion Erosion, sclerosis, narrowing SIJ Bamboo Spine Bone marrow oedema
61
management of ankylosing spondylitis
physiotherapy exercise regime NSAIDs peripheral joint disease - DMARDs
62
are rheumatoid factors present in ankylosing arthritis?
no | 'seronegative'
63
what is psoriasis?
autoimmune disease affecting the skin (scaly red plaques on extensor surfaces eg elbows and knees)
64
psoriatic arthritis classically clinically presents as?
asymmetrical arthritis affecting IPJs
65
psoriatic arthritis can also manifest as?
Symmetrical involvement of small joints (rheumatoid pattern) Spinal and sacroiliac joint inflammation Oligoarthritis of large joints Arthritis mutilans
66
investigations for psoriatic arthritis?
X-rays of affected joints – pencil in cup abnormality MRI – sacroiliitis and enthesitis Bloods – no antibodies as seronegative
67
management for psoriatic arthritis?
DMARDs – methotrexate
68
avoid what drug in the treatment of psoriatic arthritis? why?
oral steroids | risk of pustular psoriasis due to skin lesions
69
list other connective tissue diseases
Systemic Sclerosis Myositis Sjogrens syndrome Mixed connective tissue disease
70
what is Reiter syndrome?
describes the triad of arthritis, urethritis and conjunctivitis in a patient following a bacterial infection
71
reactive arthritis
Sterile inflammation in joints following infection especially urogenital (e.g. Chlamydia trachomatis) and gastrointestinal (e.g. Salmonella, Shigella, Campylobacter infections) infections
72
Important extra-articular manifestations of reactive arthritis include?
Enthesitis (tendon inflammation) Skin inflammation Eye inflammation
73
Reactive arthritis may be first manifestation of what infections?
HIV | hepatitis C
74
reactive arthritis commonly presents in what demographic?
young adults with genetic predisposition (e.g. HLA-B27) and environmental trigger (e.g. Salmonella infection)
75
management of reactive arthritis
usually self-limiting – can be managed with NSAIDS or DMARDs if required
76
epidemiology of SLE
F:M ratio 9:1 Presentation 15 - 40 yrs Increased prevalence in African and Asian ancestry populations Prevalence varies 4-280/100,000
77
clinical tests for SLE
Antinuclear antibodies: ^ sensitivity for SLE but not specific, -ve test rules out SLE, but a + ve test does not mean SLE. Anti-double stranded DNA antibodies
78
what is lupus?
multi-system autoimmune disease

Musculoskeletal (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions