Rheuma

Question 1

What is systemic sclerosis and how may it present ?

Answer 1

Chronic abnormal diffuse of connective tissue
Can be diffuse or limited

Thickening of skin / hardening
Loss of face expression
Joint pain
Can fange heart lung kidneys ( lifetreathening )

Question 2

What is limited systemic sclerosis associated with ?

Answer 2

CREST syndrome 
Calcinosis cutis
Raynods phenomenon 
Esophageal dysmotility
Sclerodacyly
Telangiectasia

Question 3

Name 3 autoimmune and 3 inherited connective tissue disorders

Answer 3

Rheumatoid arthritis 
SLE
Sjörgen syndrome 
Systemic sclerosis 
Inflammatory myositis

Marfan syndrome
Alport syndrome
Ehlers Danos
Osteogenesis imperfecta

Question 4

Which antibodies can be found in patients with vascultits ?

Answer 4

ANCA

Question 5

A patient presents with sudden blurred vision on one eye , headaches , jaw claudification and a tender scalp. On examination he shows an RAPD and and a pale and swollen optic disk. ESR and CRP are raised . What’s the diagnosis and treatment ?

Answer 5

Temporal arteritis

IV steroids

Question 6

In a patient with polymyalgia rheumatica, what do you have to examine to exclude an associated condition ?

Answer 6

Temporal arthritis

Eyes

Question 7

A patient presents with tender points and chronic pain. What condition would you think of ?

Answer 7

Fibromyalgia

• neurosensory disorder
  Treat with exercise and antidepressants

Question 8

A patient presents with dry eyes and mouth . Which test would you perform ? What’s this condition called ?

Answer 8

Schirmers test for tear production

Sjörgen syndrome - sicca syndrome

Question 9

What is secondary sjörgen syndrome associated with?

Which markers would you find in the blood ?

Answer 9

RA,SLE

ANA and anti-SSA/Ro

Question 10

A patient with sjörgen syndrome is at risk of developing which condition?

Answer 10

B cell lymphoma and MALT lymphoma

Question 11

A patient suffered a group A streptococcus tonsillitis 2 weeks ago.
He know presents with fever, joint pain that was in his feet first and now moved to the hips and skins nodules.
What’s the diagnosis ?

Answer 11

Rheumatic fever

Question 12

In rheumatic fever , which organs might be affected ?

Answer 12

Heart - mitral / aortic valve and pancarditis
Skin nodules, erythema marginatum
Migratory polyarthritis

Question 13

14 year old patient presents with joint inflammation and morning stiffness . What’s the diagnosis ?

Answer 13

Juvenile idiopathic arthritis

Question 14

What is Gout?

Answer 14

Inflammatory , mono articular athropathy

Causes by increase levels of urea leading to deposition of Uric acid crystals in joints

Chronic: repeated attacks & giant cell accumulation

Causes
Genetic
Drugs, kidney disease , ketoacidosis
Leukaemia, psoriasis ,

Question 15

What can trigger an episode of gout?

Answer 15

Alcohol

Purin rich food: meat , fish

Question 16

In gout , which joint is commonly affected ?

Answer 16

MTP joint

Most common big toe = podagra

Question 17

In gout , which finding would you make in a synovial fluid sample (arthrocentesis )?

Answer 17

Crystals in shape of needle

Question 18

What is pseudogout?

Answer 18

Deposition of calcium

Crystals causing inflammation in a joint

Question 19

Name the 4 seronegative inflammatory arthritis .

What do they all have in common?

Answer 19

Psoriasis arthritis
Enterohepatic arthritis
Reactive arthritis
Ankylosing spondylitis

HLA-B27 genetic predisposition

Question 20

In seronegatives arthritis , what are characteristic symptoms ?

Answer 20

They all have a negative rheumatoid factor !

Asymmetrical involvement of joints

Predominant : spine 
Non-musculoskeletal symptoms 
Anterior uveitis 
Skin nails 
Conjunctivitis 
Nephritis 
Gut inflammation

Question 21

In Reiters Syndrome , there are 3 characteristic clinical features

Answer 21

=reactive arthritis

Urethritis
Conjunctivitis
Arthritis

“Can’t see , pee or climb a tree “

Question 22

What is psoriatic arthritis ?

Answer 22

Inflammation of joints like hand . Spine , feet that occur in patients with psoriasis

Question 23

Inflammatory rheumatic disease can affect one joint (monoarricular) or several (polyarticular ). Give examples

Answer 23

Mono

• gout
• infection / trauma

Poly

• polyarthritis :RA, SLE, scleroderma,
• spondyloarthritis: Reiters , psoriatic, ankylosing spondylitis
• post infectious : rheumatic fever , Lyme

Question 24

What are the differences of osteoarthritis and rheumatoid arthritis ?

Answer 24

RA
- synovial disease 
- MCP, PIP
- early morning stiffness >30
Min
- pain on decreased exercise 
- high inflammatory markers 
-extraarticular manifestations 
- bone erosions 

OA:

• cartilage disease
• DIPs and 1st CMCJs
• morning stiffness <30 min
• pain worse at night / resting
• no other manifestations
• osteophytes

Question 25

Explain the typical symptoms in a patient with RA

Answer 25

``` Symmetrical Hands , wrist , feet Inflammation Morning stiffness General unwell "flu like" malaise fever Pain on rest PIP and MCP joints ( never DIP) Rheumatoid nodules ```

Question 26

Give 5 organic manifestations of patients with RA

Answer 26

- bursitis - Carpal tunnel syndrome - rheumatic nodules - sjörgen syndrome - scleritis -episcleritis Feltys syndrome

Question 27

What can be seen on an X-ray in patients with RA?

Answer 27

Joint space narrowing Bone erosions Cysts Peri-auricular osteoporosis

Question 28

What are classical features of a rheumatoid hand ?

Answer 28

``` Ulnar deviation Swan neck Atrophy of muscles Boutonnière deformity Hitchhiker thumb ```

Question 29

Classical blood parameters of rheumatoid arthritis

Answer 29

Rheumatoid factor ANA Anti CCP ( ACPA) High esr, crp

Question 30

Explain treatment of rheumatoid arthritis

Answer 30

General - resting during acute attack - exercise to strengthen muscles Weight loos and good foot wear Pain Paracetamol , NSAIDs Immunosuppression MTX

Question 31

Risk factors for osteoarthritis

Answer 31

``` Age Female gender Family history Occupation Overweight ```

Question 32

Pathophysiology of osteoarthritis

Answer 32

``` Degenerative break down of cartilage ( and secondary inflammation ) Leading to remodelling processes - subchondral sclerosis - osteophytes - crystal deposition ```

Question 33

Describe typical symptoms of osteoarthritis

Answer 33

``` Pain Crepitus Morning stiffness <30 Min Restricted movement Drumstick fingers ```

Question 34

Classic features of osteoarthritis in the hands

Answer 34

``` Drumstick fingers DIP affected ( knuckles normal) Bourchards nodes ```

Question 35

The X-ray of a joint of a patient with osteoarthritis shows ?

Answer 35

``` Irregular joint space narrowing Osteophytes Subchondral sclerosis & cysts Malalignement Chondrocalcinosis ```

Question 36

I blood test of a patient with osteoarthritis shows ?

Answer 36

Nothing Low ESR and CRP No Rheumatoid factor Synovial fluid shows no inflammation

Question 37

Treatment of osteoarthritis

Answer 37

``` Huge impact on life !! Stay low on medication as they Will be forever Education Advice Strengthen exercise Weight loss ``` ``` Paracetamol topical NSAIDs Capsacain Oral NSAIDs Local heat and cold Support and braves Shoes Manual therapy ```