Rheum

Question 1

RA - Extra-articular Manifestations

Answer 1

• CTD-ILD
• Anaemia of chronic disease
• Functional immunosuppression
• Serositis (pericarditis/effusions)
• Felty’s syndrome
• Secondary Sjogrens
• Nephrotic syndrome
• Atlanto-axial subluxation
• Scleritis/episcleritis
• Peripheral neuropathy

Question 2

RA - Med considerations: MTX

Answer 2

• Need folate supplementation
• MTX Pneumonitis
• Myelosuppression
• Trimethoprim C/I (increased risk of Myelosuppression)
• GI side-effects (can give s/c)
• Hepatic Fibrosis
• Teratogenic

Question 3

RA - Med considerations: Sulfasalazine

Answer 3

• Red/orange urine
• Nausea
• Pancreatitis
• Safe in pregnancy

Question 4

RA - Med considerations: HCQ

Answer 4

• Retinal screening: 6 months then 5 years (if no retinal damage found)
• Safe in pregnancy
• Can be allergenic (skin rash)

Question 5

RA - Med considerations: Leflunomide

Answer 5

• Myelosuppression
• Teratogenic
• Remains detectable for 1-2 years

Question 6

RA - Med considerations: Anti-TNF

Answer 6

• Screen for BBV & TB
• C/I if FHx of demyelination
• Need vaccinations (flu, COVID, pneumovax)

Question 7

Systemic Sclerosis - Antibodies

Answer 7

• Anti-centromere = Limited SS/CREST
• Anti-topo-isomerase 1/SCL-70 = Diffuse SS, fibrotic
• Anti-RNA-polymerase 3 = Diffuse SS, heavy skin involvement, renal crises

Question 8

Systemic Sclerosis - Treatment

Answer 8

Raynaud’s/P-HTN:
- Amlodipine/nifedipine
- Sildenafil

Fibrotic disease:
- MMF
- Nintedanib (if ILD)

Renal Crisis:
- ACEi
- Home BP monitoring for early detection

GORD:
- PPI

Yearly TTE and PFTs in high risk pts

Question 9

Raynaud’s - Causes

Answer 9

Unilateral Reynaud’s:
- Thoracic outlet syndrome
- Large vessel vasculitis
- Subclavian stenosis/aneurysm

Bilateral Reynauds:
- Primary Reynaud’s (young, family hx)
- Systemic sclerosis
- SLE
- RA
- Dermatomyositis/Polymyositis
- Sjogren’s
- Mixed CTD
- Cold agglutinin disease
- Drugs (beta blockers, cytotoxics)
- Buerger’s disease