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Flashcards in Rheumatology Deck (177)
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1

risk factors for OA?

- obesity
- ageing
- occupation
- trauma
- being female
- FHx

2

LOSS: XR changes seen in OA?

- Loss of joint space
- Osteophytes
- Subarticular sclerosis
- Subchondral cysts

3

presentation of OA?

- joint pain
- joint stiffness
- worsened by activity
- joint deformity
- atlantoaxial subluxation of C-spine
- reduced ROM

4

commonly affected joints in OA?

- hips
- knees
- sacro-iliac joints
- DIPs
- MCP of thumb
- wrist
- C-spine

5

hand signs in OA?

- herberden's nodes at DIPs (never seen in RA)
- bouchard's nodes at PIPs
- squaring at base of thumb
- weakened grip
- reduced ROM

6

how is OA diagnosed?

- clinical diagnosis if >45 and these 2 present:
- activity-related joint pain
- no morning stiffness (or lasts <30 mins)

7

management of OA?

- advise to lose weight
- physiotherapy
- occupational therapy
- orthotics
- analgesia
- intra-articular steroid injections
- hip / knee replacements

8

describe the 3 steps in analgesia for OA

1. PO paracetamol / topical NSAIDs / topical capsaicin
2. PO NSAIDs + PPI (omeprazole for gut)
3. opiates (codeine, morphine)

9

what is RA? what gets affected by it?

- autoimmune chronic inflammation of the synovial lining
- inflammatory, symmetrical polyarthritis

affects:
- joints
- tendon sheaths
- bursa

10

genetic associations for RA?

- HLA DR4
- HLA DR1

11

antibodies found in RA?

- anti-CCP (gold standard)
- RF in 70%

12

presentation of RA?

- joint pain, swelling, stiffness
- onset can be as fast as overnight or take months-years
- typically MCPs and PIPs of hands affected (DIP-sparing)
- fatigue
- weight loss
- flu-like illness
- muscle aches and weakness
- short duration if palindromic rheumatism
- atlantoaxial subluxation

13

what is palindromic rheumatism? when would you worry?

- short, self-limiting episode of inflamm arthritis
- when anti-CCP present in blood (almost definitely goes on to develop RA)

14

what is atlantoaxial subluxation? what is the main complication?

- axis (C2) and atlas (C1) fuse together
- spinal cord compression

15

hand signs in active RA?

- "boggy" feeling synovium around joints
- Z-shaped deformity of thumb
- swan neck deformity
- boutonnieres deformity
- ulnar deviation at MCP joints

16

describe swan neck deformity

- hyperextended PIP
- flexed DIP

17

describe boutonnieres deformity

- hypextended DIP
- flexed PIP

18

systemic signs of RA?

- caplan's syndrome
- bronchiolitis obliterans
- felty syndrome (RA, neutropenia and splenomegaly)
- sjogren's syndrome
- anaemia of chronic disease
- CVD
- eye signs
- rheumatoid nodules
- lymphadenopathy
- carpel tunnel syndrome
- amyloidosis

19

what is caplan's syndrome? where is it seen?

- pulmonary fibrosis with pulmonary nodules
- RA

20

triad of felty syndrome?

- RA
- neutropenia
- splenomegaly

21

eye signs of RA? hint: everything inflamed af

- scleritis
- episcleritis
- keratitis (inflamed cornea)
- keratoconjunctivitis sicca (dry conjunctiva and cornea)
- cataracts (due to steroids)
- retinopathy (due to chloroquine)

22

investigations in RA?

- bloods (RF, anti-CCP, CRP, ESR)
- XR hands
- XR feet
- USS shows synovitis

23

X-ray changes seen in RA?

- joint destruction
- joint deformity
- soft tissue swelling
- periarticular osteopenia
- bony erosions

24

why should patients with persistent synovitis be referred? when does it become urgent?

- to rule out RA
- when symptoms have persisted >3m or small joints of hands / feet affected

25

scoring system used in RA diagnosis? how is it calculated? hint: it u

- disease activity score 28 (DAS28)
- looks at tenderness / swelling in 28 joints
- takes ESR and CRP into account too

26

what is the health assessment questionnaire (HAQ) used for? when is it used?

- to measure functional ability in RA
- done at diagnosis to monitor response to treatment

27

factors indicating a poor prognosis in RA?

- being male
- younger onset
- more joints / organs affected
- RF / anti-CCP antibodies present
- erosions on XR

28

management of RA?

- steroids for initial presentation and acute flare ups
- DMARDs, following ladder
- surgery

29

describe the DMARD ladder in RA?

- 1st line: monotherapy with methotrexate / leflunomide / sulfasalazine / hydroxychloroquine (mild)
- 2nd: add another one of above
- 3rd: methotrexate + TNF inhibitor (e.g. infliximab)
- 4th: methotrexate + CD20 inhibitor (rituximab)

30

examples of TNF inhibitors? important side effect of these?

- adalimumab
- infliximab
- immunosuppression