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Rheumatology > MSK > Flashcards

MSK Flashcards

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1
Q

Which medicine is used in long-treatment of gout and what is its mechanism of action?

A

Allopurinol.

Reduces blood levels of uric acid.

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2
Q

CTDs:

  • no early morning stiffness
  • diffuse pain
A

Chronic Pain Syndrome

Malignancy

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3
Q

CTDs:

  • no early morning stiffness
  • localized pain
  • no joint swelling
A
  • osteoarthritis/arthropathy
  • tendonitis
  • bursitis
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4
Q

CTDs:

  • early morning stiffness
  • diffused pain
A
  • PMR (Polymyalgia Rheumatica)

- Inflammatory Myositis (Dermatomyositis and Polymyositis)

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5
Q

CTDs:

  • early morning stiffness
  • localised pain
  • joint swelling
  • monoarticular
A
  • sepsis
  • reactive
  • spondyloarthritis
  • crystals (e.g. gout)
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6
Q

CTDs:

  • early morning stiffness
  • diffuse pain
  • joint swelling
  • polyarticular
A
  • rheumatoid arthritis
  • SLE
  • viral
  • spondyloarthritis
  • crystals (e.g. gout)
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7
Q

Name 5 autoimmune diseases affecting connective tissues:

A
  • Systemic Sclerosis
  • Dermatomyositis
  • Polymyositis
  • Sjogren syndrome
  • Systemic Lupus Erythematosus (SLE)
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8
Q

Name clinical criteria for Lupus (10)

A

1) Acute cutaneous Lupus (Malar rash (butterfly rash) or Discoid rash)
2) Chronic cutaneous Lupus
3) Photosensitivity
4) Oral/nasal ulcers
5) Non-erosive arhritis
6) Serositis (pleuritis or pericarditis)
7) Renal problems (proteinuria or cellular casts)
8) Neurological problems (seizures, psychosis)
9) Haematological disorders (haemolytic
anaemia/leukopaenia/lymphocytopaenia/thrombocytopaenia)
10) Non-scaring alopecia

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9
Q

What are the diagnostic criteria for Lupus, according to the SLICC?

A

4 criteria, with at least one clinical and one immunological

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10
Q

Name immunological criteria for Lupus (7)

A
  • ANA antibodies
  • anti-ds DNA antibodies
  • anti-Sm antibodies
  • false positive syphilis test
  • antiphospholipid antibodies
  • low complement (C3, C4, CH50)
  • direct Coomb’s test
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11
Q

What is an ENA screen?

Name 6 factors that it tests for.

A

ENA=Extractable Nuclear Antigens
Screen for autoimmune connective tissue disorders.

1x SLE: anti-Sm
1x MCTD: ant-RNP
2x Sjogren: anti-La, anti-Ro
1xScleroderma/systemic sclerosis: anti-Scl70
1x Dermatitis: ant-Jo
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12
Q

What investigations would you undertake if you were suspecting Lupus (8)

A

1) urine dipstick (renal dysfunction)
2) FBC (cytopaenias)
3) High ESR, normal CRP
4) Coagulation screen: prolonged APTT
5) U&Es
6) Liver function (low albumin)
7) Autoantibodies
8) Complement (expect low)

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13
Q

Name 2 autoantibodies in Systemic Sclerosis

A

anti-Scl70

CREST

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14
Q

Name 2 autoantibodies in Dermatitis

A

anti-Jo

anti-Mi

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15
Q

Name 2 autoantibodies in Sjogren

A

anti-La

anti-Ro

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16
Q

Name 2 autoantibodies in SLE

A

anti-ds DNA

anti-Sm

17
Q

Treatment in SLE (AMP)

A

1) Patient education
2) Symptomatic treatment: pain relief, topical treatment
3) Photosensitivity: UVA, UVB Sunblocks

4) IMMUNOMODULATORY
A) Common: antimalarials: HYDROXYCHLOROQUINE

B) Severe:
Azathioprine
Methotrexate
Prednisolone

C) If non-responsive to any of the above:
RITUXIMAB (ab that binds to CDC20 on B-cells and prevents their destruction by NK cells)

18
Q

Name 5 features associated with Sjogren syndrome

A

1) Dry mouth and dry eyes (sicca syndromes)
2) B cell hyperactivity and hypergammaglobulinaemia
3) Positive rheumatoid factor (as often 2ndary to rheumatoid arthritis)
4) Autoantibodies: ANA, Anti-La, Anti-Ro.
5) Increased risk of LYMPHOMA

19
Q

Treatment in Sjogren

A

1) Patient education
2) Symptomatic treatment: pain relief, topical treatment

4) IMMUNOMODULATORY
A) Common: antimalarials: HYDROXYCHLOROQUINE

B) Severe:
Azathioprine
Methotrexate
Prednisolone

C) If non-responsive to any of the above:
RITUXIMAB (ab that binds to CDC20 on B-cells and prevents their destruction by NK cells)

20
Q

Name 3 similarities between SLE and Sjogren

A
  • both autoimmune
  • same immunomodulators to treat
  • both have plasma ANA
21
Q

Name symptoms of inflammatory myositis (dermatomyositis and polymyositis)

A
  • patient is STIFF and WEAK
  • inflammatory disease
  • diffuse pain (achy muscles and joints everywhere)
  • vasculitis
  • also associated with lung fibrosis

-dermatomyositis is additionally linked to rashes:HELIOTROPE (purple eyelid) rash and malignanacy

22
Q

Which other disease is polymyalgia rheumatica (PMR) associated with?

A

GCA (Giant Cell Arteritis), which is a type of vasculitis

23
Q

What investigations would you undertake if suspecting inflammatory myositis (dermatomyositis or polymyositis)?

A

DIAGNOSTIC:

  • muscle biopsy
  • MRI
  • EMG (electromyography)
  • autoantibodies (e.g. ANA/ENA screen; ab expected anti-Jo and anti-Mi)
  • malignancy screen (as dermatomyelitis increases the risk)
  • ESR and other blood tests may be normal!
24
Q

What condition to consider if diffuse joint pain with morning stiffness and the patient is STIFF and WEAK and YOUNG?

A

inflammatory myositis (dermatomyositis or polymyositis)

25
Q

What’s the treatment for polymylagia rhematica, PMR?

A

Steroids (e.g. prednisolone)

26
Q

Give 4 features of systemic sclerosis

A
  • chronic inflammatory disease (fatigue and tiredness)
  • Raynauds phenomenon
  • two subtypes: limited cutaneous and systemic cutaneous
  • caused by an abnormal deposition of collagen and injury to small arteries
27
Q

5+2 features of limited cutaneous systemic sclerosis

A
  • Calcinosis
  • Raynauds phenomenon
  • Oesophageal dysmotility
  • Sclerodactyly
  • Telangectasia

Pulmonary arterial hypertension
CREST autoantibodies

28
Q

5+2 features of diffuse cutaneous systemic sclerosis

A
  • Raynauds
  • malignant hypertension
  • pulmonary fibrosis
  • cardiac disease
  • GI disease

AFFECTS negatively live expectancy
Associated with anti-Scl70 autoantibodies

29
Q

Treatment of vasculitis

A
  • large (GCA and aortitis) and very small arteries: STEROIDS

- medium arteries (GPA, EGPA and MPA) and small arteries (with ANCA): CYCLOPHOSPHAMIDE and STEROIDS

30
Q

Name 3 types of medium artery vasculitis:

A
  • GPA: Granulomatosis with Polyangitis (Wegener’s granulomatosis)
  • EGPA (Eosinophilic granulomatosis with polyangitis): Churg Strauss
  • MPA (Microscopic Polyangitis)
31
Q

Symptoms associated with Granulomatosis with Polyangitis, GPA

A

ENT
pulmonary
ANCA

renal
skin

32
Q

Symptoms associated with Eosinophilic Granulomatosis with Polyangitis, EGPA

A

asthma
neuropathy
eosinophilia

renal
skin

NO ANCA!

33
Q

Symptoms associated with Microscopic Polyangitis, MPA

A

pulmonary
ANCA

renal
skin

34
Q

Symptoms of Polymyalgia Rheumatica, PMR

A
  • pain and tiredness
  • early morning stiffness
  • often retired
  • felt particularly in proximal limbs
  • girdle disease
  • associated with headaches
  • jaw claudiacation
  • associated with giant cell arteritis (vasculitis)

Rheumatology (1 decks)

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