Rheum - corrections

Question 1

Define arthropathy

Answer 1

disease of a joint

Question 2

Define arthritis

Answer 2

inflammation of a joint

Question 3

Define arthralgia

Answer 3

pain in a joint

Question 4

State the 2 main categories of arthritis

Answer 4

• inflam (commonly osteoarthritis)

- non- inflam

Question 5

State the 2 main categories of inflam arthritis

Answer 5

• seropositive (has antibody tests)

- seronegative

Question 6

State some examples of seropositive and seronegative arthritis

Answer 6

+ve - RA, lupus, scleroderma, vasculitis, sjogren’s

-ve - ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis

Question 7

State the associated condition to Anti-CCP

Answer 7

Rheumatoid arthritis

Question 8

State the associated condition to Anti-nuclear antibody (ANA)

Answer 8

• SLE (all px, but not specific)
• Sjogrens
• Systemic sclerosis

Question 9

State the associated condition to Anti-double stranded DNA antibody (dsDNA)

Answer 9

SLE (specific, but only 60% px)

Question 10

State the associated condition to Anti-Sm

Answer 10

SLE (highly specific)

Question 11

State the associated condition to Anti-Ro

Answer 11

• SLE (neonatal lupus)

- Sjogrens

Question 12

State the associated condition to Anti-La

Answer 12

Sjogrens

Question 13

State the associated condition to Anti-centromere antibody

Answer 13

Systemic sclerosis (limited)

Question 14

State the associated condition to Anti-Scl-70 antibody

Answer 14

SLE

MCTD

Question 15

State the associated condition to Anti-Jo-1 antibody

Answer 15

Myositis

Question 16

State the associated condition to Anti-neutrophil cytoplasmic antibody (ANCA)

Answer 16

Small vessel vasculitis (GPA, EGPA, MPA)

Question 17

State the findings on X-ray in osteoarthritis

Answer 17

L - loss of joint space
O - osteophytes
S - sclerosis (looks more white)
S - subchondral cysts

Question 18

State the hallmark features of Osteoarthritis

Answer 18

• morning stiffness (less than 30mins)
• knee, hip, hand or joint involvement
• non symmetrical

Question 19

State the hallmark features of Rheumatoid arthritis

Answer 19

• symmetrical
• small joints (spreads as disease progresses)
• morning stiffness (over 30mins)
• rheumatoid nodules (25% px)

Question 20

State the auto-antibody tests for RA

Answer 20

Rheumatoid factor (RF)
Anti-CCP (v specific)

Question 21

State the 1st line treatment for RA

Answer 21

DMARDs (methotrexate)

Question 22

What gene do the 4 seronegative inflammatory arthropathies have in common?

Answer 22

HLA-B27

Question 23

State the 4 seronegative inflammatory arthropathies

Answer 23

• ankylosing spondylitis
• psoriatic arthritis
• reactive arthritis
• enteropathic arthritis

Question 24

What happens to the spine in ankylosing spondylitis?

Answer 24

• spinal morning stiffness, improved by exercise
• loss spinal movement
• ? spine

Question 25

State what Reiter's syndrome consists on in Reactive arthritis

Answer 25

- urethritis - uveitis/conjunctivitis - arthritis

Question 26

Summarise the pathology behind SLE

Answer 26

- defective apoptosis - released nuclear materials which act as auto-antigens - B + T cells stimulated - produce auto-antibodies - immune complexes form from antigen/antibodys - deposition of these in BM - activation of complement + cytokines

Question 27

State the drug used for all SLE px

Answer 27

hydroxychloroquine

Question 28

State what characterises Sjogrens

Answer 28

``` dryness (mouth, eyes) arthralgia fatigue parotid gland swelling increased cavities ```

Question 29

State what characterises systemic sclerosis

Answer 29

- Raynauds - fibrosis - atrophy of skin and subcutaneous tissue - telangiectasia

Question 30

State the antibodies for systemic sclerosis

Answer 30

anti-centromere (limited) | anti-scl-70 (diffuse)

Question 31

State the hallmarks for polymyalgia rheumatica

Answer 31

- muscle STIFFNESS - ache in shoulder + hip area - over 50yrs

Question 32

What other condition is associated with polymyalgia rheumatica?

Answer 32

temporal (giant cell) arthritis

Question 33

State the hallmarks for polymyositis and dermatomyositis

Answer 33

- muscle WEAKNESS | - under 40yrs

Question 34

What is the best diagnostic test for polymyositis and dermatomyositis?

Answer 34

muscle biopsy (perivascular inflam, muscle necrosis)

Question 35

Describe the difference between the 2 types of large vessel vasculitis

Answer 35

``` Takayasu arteritis (TA) - less than 50 yrs Temporal (giant cell) arteritis (GCA) - more than 50 ```

Question 36

What is the best diagnostic test for the 2 types of large vessel vasculitis?

Answer 36

MR angiogram (detects thickened vessel walls and stenosis)

Question 37

Define the difference between GPA and EGPA

Answer 37

similar features but EGPA associated with late onset asthma and raised eosinophils