rheuma 1 Flashcards
(131 cards)
1
Q
arthropathy means
A
something wrong with joint
2
Q
arthralgia is?
A
joint pain
3
Q
extra articular features of Rheumatoid arthritis (6)
A
raynauds sicca (mucosal dryness) interstitial lung disease neuropathy vasculitis scleritis
4
Q
Inflammatory conditions will have what features? (5)
A
morning stiffness soft tissue swelling incr plasma viscosity incr ESR Incr C-reactive protein
5
Q
joint distribution of SLE
A
same as RA (but with out radiological findings)
6
Q
drug associated with SLE
A
contraceptive pill
7
Q
anti-nuclear antibody (ANA) ratio that indicates disease
A
1:160 or more
8
Q
auto antibody that indicates SLE activity
A
anti dsDNA
9
Q
auto antibody that is SLE specific
A
anti dsDNA
10
Q
auto antibody Sm indicates what about SLE
A
neurological involvement
11
Q
Ro in SLE indicates?
A
cutaneous manifestations
12
Q
RNP auto antibody indicates?
A
scleroderma
raynauds
myositis
13
Q
which 2 things can indicates high SLE activity
A
high anti-dsDNA antibodies and low C3/C4 levels
14
Q
what is associated with late stages of SLE (4)
A
malar rash
seizures
pericarditis
nephritis
15
Q
auto antibodies associated with SLE (4)
A
anti: dsDNA, Sm, Ro, RNP
16
Q
treatment of SLE
A
NSAIDS analgesia chloriquine/hydroxychloroquine steroids (short term) immunosuppression (DMARDS) biologicals
17
Q
what results will indicate someone with SLE
A
blood and protein in urine
ANA >1:160 (esp anti-dsDNA)
low C3/C4
18
Q
buzzword: recurrent foetal loss or thrombosis or livedo reticularis
A
anti-phospholipid syndrome
19
Q
treatment of anti-phospholipid syndrome
A
life long anti-coagulation
20
Q
what is sjogrens?
A
lymphocytes destroy exocrine glands (mostly salivary and lacrimal)
21
Q
Buzzwords: dry eyes/dry mouth
A
sjogrens
22
Q
what is keratoconjunctivitis sicca
A
dry eyes
23
Q
what is xerostoma
A
dry mouth
24
Q
test for tear production?
A
schirmers test
25
types of scleroderma
limited
| diffuse/systemic
26
limited scleroderma also known as?
CREST syndrome
27
CREST stands for?
Calcinosis (calcium deposition in skin)
Raynauds (vaso spasm)
Esophageal dysmotility
Sclerodactyly (thickenening & tightening of skin on fingers
Telangiectasia (spider veins usually around eyes and nose)
28
treatment for scleroderma
calcium channel blockers
prostacyclin (platelet inhibitor/vasodilator)
ACE inhibitors
immunosuppression
29
what is scleroderma and pathophysiology?
autoimmune, resulting in incr collagen synthesis which it turn leads to thickening of skin, t cell activation, small artery damage (raynauds), pulmonary hypertension (fibrosis due to collagen deposition)
30
synovium is derived from?
```
hyaluronic acid (mucin)
lubricin (glycoprotein)
```
31
what produces synovial fluid?
fibroblasts
32
synovium contains few cells, which are these?
mononuclear leucocyctes
33
Normal synovium WBC and polymorphs
<25/mm polymorphs
34
synovial colours:
yellow -
opaque -
red -
cause:
inflammation (crystals etc)
septic
trauma
35
WBC in septic synovium
>100 000
36
WBC in inflamed synovium
2000-75000
37
cartilage zones from deepest to superficial
calcified > deep > middle > superficial
38
articular cartilage is made up of?
70% ECM
20% water
10% proteoglycans
type 2 cartilage
39
which zones of cartilage has highest proteoglycan concentration?
middle & deep
40
ECM = ____% of cartilage volume?
98% (for load bearing)
41
markers of cartilage degeneration
serum and synovial keratin sulphate
| type 2 collagen in synovial fluid
42
what cytokines stimulate proteolytic enzymes and inhibit proteoglycan synthesis
TNF alpha
| IL-1
43
cytokines that promote cartilage growth
TGF-beta
IGF-1
(promote proteoglycan synthesis and counteracts IL-1)
44
HLA associated with RA
HLA-DR4 and DR1
45
what cells are found in synovium in RA (3)
macrophages
fibroblasts
multi nucleated giant cells
46
pathophysiology of RA
synovial membrane (pannus) expands actively invading and eroding surrounding bone and cartilage
47
In RA, _____ classification used, and must be ___
EULAR/ACR and 6/10
48
RA specific auto antibody
anti-CCP (cyclic citrullinated peptide)
49
RA treatment
DMARDS + steroids to cover 'lag' phase
50
DMARD examples
```
methotrexate
sulfasalazine
lefunoamide
hydroxychloriquine
gold
pencillamine
```
51
Types of biologicals
```
TNF inhibitors
B-cell depletion
IL-1 inhibitors
IL-6 inhibitors
disruption of T cell co-stimulation
```
**end in -mab or -cept
52
what is vascultis
presence of leucytes and immune complexes in vessel walls with reactive damage to mural structures
53
examples of large vessel vasculitis (2)
takayasu
| giant cell
54
examples of medium vessel vasculitis
PAN
| kawasaki's
55
example of small vessel vasculitis
churg-strauss
wegeners (granulomatosis with polyangiitis)
microscopic pollyangitis
56
which form of vasculitis is ANCA possitive?
small vessel (wegneres, churg-strauss)
57
how do you differentiate between different small vessel vasculitis
microscopic polyangitis = no granulomas
churg strauss syndrome = granulomas + asthma/eosinphils
wegeners + granulomas NO asthma/eosinophils
58
ANCA is
anto neutrophil cytoplasmic Ab - auto antibody of IgG against cytoplasm of neutrophils
59
P-ANCA staines
perinuclear staining
60
C-ANCA STAINS
cytoplasmic staining
61
what does LOSS stand for in OA
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis
62
pathophysiology of OA
loss of matrix, release of cytokines including IL-1, TNF, and mixed metalloproteinases and protoglandins by chondrocytes
63
Joints affected by OA
```
DIP
base of thumb
c-spine
1st CMC (trapeziummetacarpal joint)
weight bearing joints (hip, knee, lower back)
```
64
heberedian nodes found where
DIP
65
Bouchards nodes found where
PIP
66
Where may hip OA pain be felt
groin, knee, lower back
67
treatment of OA
analgesics
NSAIDS
pain modulators (gabapentin, amtriptyline)
intra-articular steroids/hyaluronic acid
arthroscopic wash out
soft tissue trimming
joint replacement
68
gout crystals are described as?
negatively bifringent needle shaped
69
what causes high uric acid
beer, red meat, corn syrup, seafood = inc purine synthesis
| renal failure, heart failure, diuretics = reduced urate excretion
70
join affected by gout
1st MTP > ankle > knee
71
what can diuretics cause
chronic tophaceous gout
72
what do you treat acute gout with
NSAIDS, colchicin, steroids
73
what do you use for gout prophylaxis
allopurinol (xanthine oxidase inhibitor)
| ** requires cover with NSAIDS cos it takes 2-4 wks to work**
74
pseudo gout crystals
calcium pyrophosphate crystals **positive bifringent, envelope shaped**
75
what is Milwaukee shoulder
hydroxyapatite deposition in and around joint causing release of collagens, serine proteases, Il-1
76
who gets Milwaukee shoulder
woman 50-60yrs
77
treatment for Milwaukee shoulder
NSAIDS, intra-articular steroids, physio
78
2 types of inflammatory arthritis
RA
| sero-neg arthropathies
79
list sero negative arthropathies (4)
ankylosing
psoriatic
reactive
inflam bowel disease arthritis
80
list ser-positive arthropathies (5)
```
RA
SLE
Scleroderma
vasculitis
Sjogrens
```
81
RA usually affects which joints
hands
feet
cervical spine
**symmetrical polyarthropathy**
82
x-ray features of RA
hypotrophic: loss of joint space, periarticular erosion
83
enthesitis is
inflam at site where tendon attaches to bone
84
arthropathies associated with what genetics
HLA-B27
85
what are the "A's" of anchylosing (6)
```
axial arthritis
anterior uveitis
aortic regurgitation
apical fibrosis
achilles tendonitis
plAntar fasciitis
```
86
bussword: pencil in cup
psoriatic arthritis
87
features of psoriatic
asymmetric sacroilitis
nail involvmant (pitting and onycholysis)
dactylitis
enthetitis
88
usual organisms associated with reactive arthritis
chlamydia
salmonela
shigella
yersinia
** infection + HLA-B27**
89
reiters triad
arthritis, uveitis, urethritis (cant see, cant pee, sore knee)
90
3 types of muscle disease
dystrophies
myopathies
neurogen
91
what would indicate muscle disease
weakness, high creatine kinase, atrophy
92
CK levels in:
dystrophies
myopathies
neurogen
dystrophies 200-300 x normal
myopathies 20-30
neurogen 2-5
93
examples of inflammatory muscle diseases (4)
polymyositis
dermatomyositis
inclusion body myositis
polymyalgia rheumatica
94
what causes:
symmetrical proximal muscle wasting
gotrons sign (mcp scaly eruption)
shawl sign (red over upper back/shoulders)
dermatomysoitis
95
dermatomyositis auto Ab
ANA & anti-Jo-1
96
what causes asymmetrical distal muscle wasting
inclusion body myositis (these seen in biopsy)
**more common in men**
97
who gets polymyalgia
>50yrs
98
features of polymyalgia rheumatica
```
shoulder & girdle pain
fatigue
fever
weight loss
associated with temperal arteritis
```
99
which muscle disease is associated with increased incidence of malignancy
dermatomyositis
**ovarian, breast, stomach, lung, bladder**
100
mutation of dystrophin gene =
duchennes
101
cell mediated CD8+
| segmental fibre necrosis
polymyositis
102
what happens in duchennes
dystrophin mutation. altered anchoring of actin cytoskeleton to basement membrane = fibre tears and uncontrolled calcium entry into cells
103
dystrophy of type 1 muscle cells
central nuclei
ring fibres
becker muscular dystrophy (less sever form of duchennes)
104
types of class 2 HLA in human cells
HLA-DR, HLA-DQ, HLA-DP
105
Types of class 1 HLA
A/B/C
106
HLA for goodpastures
HLA-DR2
107
HLA- DR3 FOR
graves and SLE
108
HLA for type 1 diabetes
DR3/4
109
HLA for RA
DR4
110
SLE is a type ___ hypersensitivity condition
type 3 hypersensitivity
111
anti-centromere Ab
CREST scleroderma
112
anti-Jo-1 Ab
polymyositis, dermatomyositis (esp with interstitial lung disease)
113
anti-RNP Ab
mixed connective tissue disease & SLE
114
anto-La Ab
Sjogrens and SLE
115
anti-smith Ab
very specific for SLE
116
anti-Scl70
diffuse scleroderma especially if sever organ involvement
117
which antigens are extra cellular and show a speckled appearance
Ro and La
**shows SLE and sjogrens**
118
biopsy in someone with SLe will show what
neutrophil, macrophage and immune complexes (IgG)
119
RA is what type of hypersensitivity
type 4 (CD4+, macrophages, B cells, IL-1, TNF)
120
goodpastures is what type of hypersensitivity
type 2
121
which conditions can you give infliximab
RA, crohns, psoriatic arth, ankylosing
122
what is rheumatoid factor
Ab against Fc region of IgG = immune complexes
123
examples of NSAIDS
naproxin
diclofenac
**these can damage kidneys**
124
what drug is teratogenic
methotrexate - stop 3 months prior to pregnancy in both sexes
125
what disease do you use hydroxychloraquine in
SLE, SJOGRENS, RA
** rare retinopathy**
126
who dont you give anti TNF to
Tb
pulmonary fibrosis
heart failure
127
side affects of colchicine
diarrhoea and vomiting
128
allopurinol works how
inhibits xanthine oxidase that turns xanthine into uric acid
129
side affects of allopurinol
rash
| inhibits warfarin metabolism
130
what do you give to people who cannot tolerate allopurinol
febuxostat
131
side affects of corticosteroids (10)
```
weight gain
muscle wasting
skin atrophy
osteoporosis
diabetes hypertension
cataracts
glaucoma
fluid retention
adrenal suppression
avascular necrosis of femoral head
```
