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Musculoskeletal > Rheumatoid Diagnostics > Flashcards

Rheumatoid Diagnostics Flashcards

1
Q

rheumatology diagnostics can be divided into?

A

blood tests
joint (synovial) fluid analysis
imaging: x-rays, ultrasound, CT, MRI

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2
Q

list ‘basic’ rheumatology blood tests

A 
full blood count
urea and electrolytes
liver function tests
bone profile
erythrocyte sedimentation rate
c-reactive protein
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3
Q

typical FBC in inflammatory arthritis

A

Hb: decreased/normal
MCV: normal
WCC: usually normal
platelets: normal or ^

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4
Q

typical FBC in osteoarthritis

A

Hb: normal
MCV: normal
WCC: normal
platelets: normal

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5
Q

typical FBC in septic arthritis

A

Hb: normal
MCV: normal
WCC: increased
platelets: normal/increased

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6
Q

FBC includes?

A

Hb
MCV
WCC
platelet count

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7
Q

U&E includes?

A

urea
creatinine
sodium
potassium

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8
Q

higher creatinine indicates?

A

worse renal clearance > kidney issues

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9
Q

give examples of how rheumatological diseases can affect the kidneys

A

SLE > lupus nephritis
vasculitis > nephritis
Chronic inflammation in poorly controlled inflammatory disease
-> high levels of serum amyloid A (SAA) protein -> SAA deposits in organs (AA amyloidosis)

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10
Q

what drug class can cause kidney impairment?

A

NSAIDs

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11
Q

liver function tests include?

A

bilirubin
alanine aminotransferase
alkaline phosphatase

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12
Q

relevance of LFTs in rheumatological diseases

A

DMARDs can cause liver damage

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13
Q

low albumin can indicate?

A

reflect problem of synthesis (in liver) or problem of leak from kidney (eg in lupus nephritis)

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14
Q

bone profile includes?

A

calcium
phosphate
alkaline phosphatase

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15
Q

bone profile of Paget’s disease

A

increased ALP

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16
Q

bone profile in osteomalacia

A

ALP normal or ^, Ca and PO4 normal or decreased

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17
Q

bone profile in osteoporosis

A

usually calcium, PO4 and ALP normal

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18
Q

ESR and CRP are useful markers for?

A

inflammation

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19
Q

increased ESR can be due to?

A

elevated immunoglobulin level
paraprotein (myeloma)
anaemia
tends to rise with age

20
Q

typical ESR and CRP for SLE

A

ESR high

CRP normal

21
Q

when is CRP high in SLE?

A

if there is significant synovitis or there is an inflammatory pleural or pericardial effusion

22
Q

what two types of autoantibodies are found in the blood of rheumatoid arthritis?

A

rheumatoid factor

cyclic citrullinated peptides (CCP) antibodies

23
Q

what is rheumatoid factor?

A

Antibodies that recognize the Fc portion of IgG as their target antigen typically IgM antibodies i.e. IgM anti-IgG antibody

24
Q

is CCP more or less specific than rheumatoid factor?

A

more specific

25
Q

cyclic citrullinated peptides (CCP) antibodies are associated with?

A

worse prognosis

26
Q

anti-nuclear antibodies in general population

A

prevalence increases w/ age
sometimes transiently +ve following infection
relatively common at low level in gen pop

27
Q

use of ANA in rheumatology

A

High titre ANA in combination with the correct clinical features may indicate one of the autoimmune connective tissue diseases

28
Q

list autoimmune connective tissue diseases

A

SLE
scleroderma
polymyositis
Sjogren’s syndrome

29
Q

clinical features of SLE

A 
Arthritis
Skin rash
Mouth ulcers
Kidney disease
Haematological
Pleural effusion
Pericardial effusion
30
Q

clinical features of scleroderma

A

Vasculopathy (esp. Raynaud’s phenomenon)
Skin thickening
Organ fibrosis

31
Q

clinical features of polymyositis

A

Muscle inflammation
Weakness
High CK

32
Q

clinical features of Sjogren’s syndrome

A

Dry eyes
Dry mouth
Extra-articular features

33
Q

ANA interpretation

A

Strength of ANA is reported as maximal dilution at which it is still detectable
-ve rules out SLE
+ve doesn’t necessarily mean SLE, suggestive IF there are clinical + lab features to support the diagnosis

34
Q

If ANA is +ve, other tests to order?

A 
ENA (extractable nuclear antigens): a panel of 5 autoantibodies
Double stranded (dsDNA) antibodies
35
Q

ENA includes?

A 
Ro > Lupus, Sjogrens 
La > Lupus, Sjogrens 
RNP	 > Lupus or mixed connective tissue disease
Smith > Lupus
Jo-1	> Polymyositis
36
Q

Double stranded (dsDNA) antibodies test

A

highly specific for lupus, associated with renal involvement, useful for tracking lupus activity over time
Complement levels C3 and C4: may be ↓ in active lupus

37
Q

how is synovial fluid obtained for analysis?

A

aspirating fluid from a joint

38
Q

indications for joint aspiration

A

Diagnostic: to obtain synovial fluid for analysis
Therapeutic: to relief symptoms (+/- concurrent steroid injection)

39
Q

two main diagnostic uses for aspiration?

A

suspected septic arthritis

diagnosing crystal arthritis

40
Q

diagnosis of crystal arthritis is made by?

A

aspirating fluid from the affected joint and examining it under a microscope using polarized light

41
Q

gout vs pseudogout crystal arthritis

A

gout: needle shaped crystals with negative birefringence
pseudogout: rhomboid shaped crystals with positive birefringence

42
Q

septic arthritis vs reactive arthritis key differences

A

synovial fluid culture: SA +ve, RA sterile
antibiotic therapy: SA yes, RA no
joint lavage: SA yes, RA no

43
Q

imaging for rheumatology

A

x-rays
CT
MRI
ultrasound

44
Q

radiographic (x-ray) features in osteoarthritis

A

Joint space narrowing
Subchondral bony sclerosis
Osteophytes
Subchondral cysts

45
Q

radiographic (x-ray) features in rheumatoid arthritis

A

Soft tissue swelling
Peri-articular osteopenia
Bony erosions

46
Q

ultrasound features in rheumatoid arthritis

A 
Synovial hypertrophy (thickening)
Increased blood flow (seen as doppler signal)
May detect erosions not seen on plain X-ray
47
Q

radiographic (x-ray) features in psoriatic arthritis

A

asymmetrical pattern
erosions of interphalangeal joints
MCPJs not affected

Musculoskeletal (7 decks)

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