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Rheumatology Flashcards

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1
Q

What auto-antibodies are found in SLE?

What is the initial test?

A

Anti- dsDNA
Anti-smith

Initial test - ANA *** very sensitive.

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2
Q

What auto-antibodies are found in drug induced Lupus? E.g. Hydralazine

A

Anti-histone

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3
Q

What auto-antibodies are found in systemic sclerosis

A

Anti-scl70

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4
Q

What auto-antibodies are found in CREST syndrome/ limited sclerosis?

A

Anti-centromere

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5
Q

What auto-antibodies are found in polymyositis?

A

Anti-Jo1

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6
Q

What auto-antibodies are found in Sjogren’s disease

A

Anti-Ro

Anti-La

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7
Q

What auto-antibodies are found in primary biliary cirrhosis?

A

Anti- mitochondrial

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8
Q

What auto-antibodies are found in autoimmune hepatitis?

A

Anti-Smooth muscle

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9
Q

What auto-antibodies are found in Churg strauss, Ulcerative colitis and primary sclerosis group cholangitis?

A

pANCA

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10
Q

What auto-antibodies are found in wegeners granulomatosis?

A

cANCA

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11
Q

What auto-antibodies are found in Coeliac disease?

A

Anti-tissue transglutaminase (TTG)
Anti - gliadin
Anti- endomysial

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12
Q

What auto-antibodies are found in Rheumatoid arthritis?

A

ANA

Can be found in many other auto-immune diseases
It is also the initial one found in SLE

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13
Q

Screening test & confirmatory test of SLE?

A

ANA - screening, more sensitive

Anti-dsDNA - specific
= can be used for disease monitoring ( but its not present in all patients*
)

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14
Q

What is SLE?

A

Multisystem autoimmune disorder
Women >men
Typically appears early adulthood

Remember - +ve ANA, -be ANCA, raised ESR
+/- proteinuria & hematuria - depends on renal involvement
Painful joints and morning stiffness

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15
Q

C3 C4 use in SLE?

A

C3 C4 - complement levels - LOW during active disease

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16
Q

What is chronic fatigue syndrome?

Features seen?

A

> /= 4 months of disabling fatigue that affects physical or mental function >50% of the time in absence of other cause

Women > Men

Features =
Sleep problems - lack/excessive
Muscle/joint problems
Headaches

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17
Q

Investigation for chronic fatigue syndrome?

A 
FBC
U&E
LFT
Glucose
TFT
ESR CRP
CK 
Ferritin
Coeliac screening 
Urinalysis
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18
Q

Management of chronic fatigue syndrome

A

Cognitive behaviour therapy * very effective

Graded excercise therap

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19
Q

What is polymyositis?

What are its features?

A

It’s an inflammatory myopathy
Features=
Symmetrical and diffuse muscle weakness = PROXIMAl>DISTAL
Common problems - rising from chair, combing hair, lifting objects, getting out of bath, climbing stairs

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20
Q

Lab investigations for polymyositis

DX??

A

Creative Kinase - elevated
Anti-Jo1 antibodies

DX- Muscle biopsy

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21
Q

Labs for polymyalgia rheumatica

A

CK - normal
ESR >30 ** initial test
CRP > 6

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22
Q

Features of polymyalgia rheumatica

A

Aching and stiffness - proximal
- difficulty getting out of bed, getting up from chair, raising arm above head

50% have temporal arteritis***

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23
Q

Treatment of polymyalgia rheumatica

A

Prednisolone

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24
Q

What is Sjögren’s syndrome?

A

Autoimmune disorder affects EXOCRINE glands = dry mucosal surfaces

F>M (9:1)

Can be primary or secondary
Secondary = SLE, RA

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25
Features of Sjögren’s syndrome
Dry eyes - keratoconjunctivitis sicca = itchy eyes, sandy = SCHIRMER’s test = decreased tear prod = Rose Bengal stain - may show corneal ulceration 2ry to dry eyes Dry mouth - difficulty swallowing food Recurrent parotitis - BILATERAL enlarge the of parotid glands
26
Investigations of Sjögren’s syndrome
``` Schirmer’s test Rose Bengal stain Rheumatoid factor * positive in 100% patients ANti- RO (SSA)70% Anti-LA (SSB) 30% ```
27
Management of Sjögren’s syndrome
No cure. | Artificial saliva and tears - HYPERMELLOSE DROPS
28
What is systemic sclerosis (SCLERODERMA)
Unknown ethology Hardened sclerotic skin + connective tissue F>M (4:1) 2 types Limited - CREST Diffuse
29
What is Raynaud’s phenomenon? | Management?
Raynaud’s - pale digits, hands =due to ischemia — blue when exposed to cold Due to deoxygentaion - they then become red. Management - Nifedipine- only drug licences to treat raynauds
30
What is CREST syndrome?
Subtype of scleroderma - affects FACE + DISTAL LIMBS Calcinosis,Raynauds,Esophageal dysmotility,Sclerodactyly,Telangectasia Raynauds first - slow onset and progression therefore other CREST seen later. SCL-70 antibodies negative ANA +ve (mostly) Associated with anti-centromere antibodies
31
What is diffuse scleroderma?
``` Affects TRUNK + PROXIMAL LIMBS Rapid/ fast progression Poor prognosis SCL -70 POSITIVE ANA +ve ```
32
Complications and most common cause of death in diffuse systemic sclerosis
Most common cause of death - respiratory involvement = 80% - ILD, Pulmonary arterial hypertension (PAH) Other complications - Renal disease, HTN
33
What is giant cell arteritis? | Features?
Temporal cell arteritis - arterial inflammation LARGE vessel vasculitis Sometimes associated with PMR (50%) Features? >55 y/o Rapid onset - < 1 month Headache, blurry vision , jaw claudication, scalp tenderness
34
Investigations for temporal arteritis | How do you confirm the diagnosis?
Raised ESR , CRP may be elevated Dx - temporal artery biopsy note - CK and EMG = normal
35
Treatment temporal arteritis
High dose Prednisolone Urgent ophthalmic review Added on med - aspirin - decrease stroke and visual loss Bisphosphonates - high doses of steroids can cause osteopenia and osteoporosis
36
Features of gout
Gout - form of inflammatory arthritis Main features- pain swelling erythema 70% of presentation affect 1st MTP - big toe - podagra Others - ankle wrist knee
37
Medications that can cause gout
Thiazides diuretic - bendroflumethiazide Loop diuretics - furosemide Alcohol
38
How do you diagnose gout
Synovial fluid aspiration and analysis = negative birefringent *send for culture only if feverish Serum Uric acid - normal/low in acute gout - measure 4-6 weeks after acute stage is relieved
39
Management of acute attack of gout Long term management
1st line - NSAID - ibuprofen, Naproxen 2nd line - Colchicine Long term -after 2 weeks of acute attack Allopurinol + NSAIDs + colchicine
40
When should you think of septic arthritis?
Mono arthritis - single joint involvement (knee common, shoulder) + fever, pain, swelling, limited movement, hotness + RF = DM steroid HIV RA
41
Commonest causative organism of septic arthritis?
Staph aureus
42
Commonest causative organism of septic arthritis in young sexually active ?
N.Gonorrhoea
43
Diagnosis of septic arthritis
Aspiration of synovial fluid - culture + sensitivity | Blood culture
44
Management of septic arthritis?
** IV antibiotic 1 week until BC negative and swelling resolves Oral antibiotics 4 weeks Flucloxacillin - 4-6 weeks = 1st line If allergic to penicillin - Clindamycin If organism is Gonorrhoea - Cefotaxime, Ceftriaxone Not responding — repeated percutaneous aspiration
45
What is reactive arthritis?
Seronagtive spondyloarthritis Asymmetric = migratory oligoarthritis of LL (knees. Ankles) + back pain + extraarticular features - Reiters triad + skin (maculopapular rash) Young adults, typically no fever Follows STI or GI infection (dysentery cell illness)
46
Reiters triad
Extraarticular features of reactive arthritis - conjunctivitis, uveitis - urethritis - arthritis Can’t see, can’t pee, can’t climb a tree
47
Management of reactive arthritis Symptomatic Persistent disease
-Symptomatic - analgesia, NSAIDs, intractable-articulate steroids = symptoms rarely last > 10 months -Sulfasalzine+ methotrexate for persistent disease
48
What is De Quervain’s disease?
Gamer thumb/mummy thumb Pain under root of thumb Common after pregnancy - RSI of extensor pollicis brevis +abductor pollicis longus
49
Tennis elbow
Lateral epicondylitis Wrist extension affected
50
Golfer’s elbow
Medial epicondylitis Finger flexors and pronation are affected - baseball,construction,plumber injury
51
Features of Churg Strauss/ Eosinophilic Granulomatosis w/ polyangiitis
Asthma + nasal polyps+allergic rhinitis Eosinophilia +other organs = purpurin, glomerluonephritis, HF, skin nodules
52
Lab and imaging findings Churg Strauss
CT - ground glass attenuation Eosinophilia Raised ESR CRP IgE ****pANCA
53
Features of Wegener’s granulomatosis / Granulomatosis w/ polyangiitis
URT - sinusitis/ nasal septum perforation/epistaxis/nasal crusting + hematuria/hemoptysis Bleeding = nose, lung, kidney *** c-ANCA
54
Rheumatoid arthritis - management
DMARD mono therapy - methrotrexate +/- short course prednisolone NSAIDs for severe joint pain
55
Feature of ankylosing spondylitis
Morning stiffness Uveitis (painful eye) Low back pain - worse in morning, improves with excercise Tenderness of SI joint
56
ankylosing spondylitis To diagnose - Treatment
NSAIDs — 1st line Anti-TNF - 2nd line Dx - X-RAY of SI joint **
57
Lab investigations ankylosing spondylitis
Raised WBC ESR +/- Anemia HLA-B27 - positive in 10%, has strong association
58
ankylosing spondylitis - associations
Anterior uveitis | Aortic regurgitation
59
What is Schober’s test?
assesses the amount of lumbar flexion
60
Features of Sarcoidosis
Erythema nodosum. - tender red nodules over shins Bilateral hilar lymphadenopathy - common on CXR Polyarthralgia Hypercalcemia,fever. >2 or more = consider sarcoidosis
61
3 Syndromes associated with sarcoidosis
1.Lofgren’s - acute form of sarcoidosis = bilateral hilar lymphadenopathy + erythema nodosum, fever, polyarthralgia -excellent prognosis 2. Mikulicz - parotid enlargement + lacrimal gland enlargement = dry mouth, face swelling - due to sarcoidosis, TB, lymphoma 3. Heerfordt’s syndrome Uveoparotid fever - parotid enlargement + fever + uveitis 2ry to sarcoidosis
62
Diagnostic criteria of Rheumatic Fever
RF - immunological reaction to recent strept pyogene infection (2-6 is) Criteria = 2 major or 1 major + 2 minor Evidence of recent strept infection - raised antibodies /+ throat swab/+ group A strept antigen test
63
Major criteria of RF (5)
``` Erythema marginatum - pink annular rash trunk limbs =seen in 10% children, rare in adults Sydenham chorea - late Poly arthritis Pancarditis Subcutaneous nodules ``` ** J♥️NES
64
Minor criteria of RF (4)
Raised ESR CRP Fever Arthralgia Prolonged PR
65
Labs in RF
raised ESR - most likely to be abnormal Most SPECIFIC = ASO antibodies (antistreptolysin O antibodies) - the most appropriate test
66
Management of RF
Antibiotics - Oral penicillin V Anti-inflammatory- NSAIDs 1st line Treatment of complications

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