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RACP > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Best way to distinguish primary and secondary raynauds

A

Nailfold Capilloroscopy - normal in primary raynauds

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2
Q

Why is febuxistat second line to allopurinol in gout prophylaxis?

A

Inhibits both reduced and oxidised forms of Xanthine Oxidase making it more potent but with higher risk of CVD and all-cause mortality

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3
Q

Treatment GCA

A

High dose steroids
Methotrexate
Tocilizumab (anti-IL6)

Anti-TNF inhibitors NOT recommended

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4
Q

Inclusion Body Myositis distribution

A

Asymmetrical Proximal and Distal weakness
- Quadracips
- Finger flexors - distinguishing factor
- Ankle dorsiflexion
- Cricopharyngeal involvement with dysphagia

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5
Q

Investigation findings inclusion body myositis

A
  • Normal or mildly raised CK
  • Biopsy;
    1. Endomysial inflammation
    2. Rimmed Vacuoles
    3. Proteinaceous inclusions
  • EMG showing mixed myopathic and neuropathic process
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6
Q

Management of OA

A

Weight loss
Exercise
CBT
Proper footwear
NSAIDS
Duloxetine
Intra-articular steroids
Joint replacement

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7
Q

Renal transporters of uric acid

A

ABCG2 - excretion at proximal tubule (and gut)
URAT1 - reabsorption

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8
Q

Serology of drug-induced lupus

A
  • ANA (without anti-dsDNA. Anti-smith, Anti-Ro)
  • Anti-histone
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8
Q

ANCA Vasculitis types

A
  • Granulomatosis with polyangitis (Wegners) - cANCA/PR3 - GN, Lung, Sinus, ENT
  • Microscopic polyangitis - pANCA, MPO - GN and Lung
  • Eosinophilic polyangitis Granulomatosis (Churg-Strauss) - pANCA - Asthma, Nasal polyps, atopy, GN
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9
Q

Anti-synthetase syndrome

A
  • Anti-tRNA Ab - Anti-Jo and Anti-PL12
  • Dermatomyositis
  • Interstitial Lung Disease
  • Raynauds
  • Non-Erosive Arthritis
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10
Q

Diagnostic criteria for PMR

A

Must have;
Age > 50
Bilateral shoulder aching
Abnormal CRP or ESR

Plus > 4 of;
Morning stiffness > 45 minutes (2 points)
Hip pain/limited ROM
Absence of RF or Anti-CCP (2 points)
Absence of other joint involvement
USS findings of shoulder or hip bursitis/synovitis

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11
Q

Antibody associated with limited Scleroderma

A

Anti-Centromere

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12
Q

Antibodies associated with diffuse scleroderma

A

Anti-topoisomerase 1 (Scl-70)
Anti- RNA polymerase - increased risk of renal cell crisis and malignancy

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13
Q

Antibody associated with scleroderma renal crisis

A

Anti-RNA polymerase

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14
Q

Antibody associated with scleroderma interstitial lung disease

A

Anti-topoisomerase (Anti Scl-70)

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15
Q

Definition ‘Extensive’ scleroderma ILD

A

> 20% lung involvement on HRCT
FVC < 70%
DLCO < 55%

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16
Q

Treatment of Scleroderma renal crisis

A

ACE inhibitors

Due to RAAS blockade which leads to resolution of malignant HTN

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16
Q

Treatment of Scleroderma renal crisis

A

ACE inhibitors

Due to RAAS blockade which leads to resolution of malignant HTN

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17
Q

Rheumatoid arthritis diagnostic criteria

A
  • Number of joints
  • Seropositivity (RF +/- Anti-CCP)
  • CRP or ESR
  • Duration of symptoms > 6 weeks
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18
Q

Feltys syndrome

A

Neutropenia
Splenomegaly
Rheumatoid arthritis
Leg Ulcers

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19
Q

Imaging findings in RA

A

Symmetrical
Sparing of DIP
Joint space narrowing with Ankylosis
Erosions
Periarticular ostopenia
Soft-tissue swelling
Subluxation

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20
Q

Major cause of death in RA

A

Cardiovascular disease (associated with higher CRP levels at baseline)

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21
Q

Abatacept

A

CTLA receptor agonist which inactivates CD4 cells.
Can lead to normal CRP in patients despite infection or inflammation

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22
Q

Side effect of hydroxychloroquine

A

Retinopathy
Hyperpigmentation

23
Q

Rheumatoid Factor - False positives

A
  • Chronic infection (most common)
  • Other Rheumatological pathologies
  • Hep B and C
  • Cryoglobulinemia
  • Endocarditis
  • Malignancy
  • Primary Biliary cirrhosis
  • 4% young population
24
Q

Rheumatoid factor negative conditions

A
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Enteropathic arthritis
  • PMR
25
Q

Best predictor of RA severity

A

Early bony erosions on imaging

26
Q

Indicator of disease activity in RA

A

CRP

NOT anti-CCP or RF

Note: indictor of disease severity is early erosive bone disease

27
Q

Rescue Rx for MTX toxicity

A

Folinic acid - utilisation of reduced folates for nucleic acid synthesis

28
Q

Treatment of Latent Tb pre-TNF inhibitor use

A

9 months Isoniazid
4 months Rifampicin
3 months Isoniazid and Rifampicin

28
Q

Treatment of Latent Tb pre-TNF inhibitor use

A

9 months Isoniazid
4 months Rifampicin
3 months Isoniazid and Rifampicin

29
Q

First line DMARD for Rheumatoid

A

Methotrexate

30
Q

Adult Onset Still’s disease

A

Young adults, often during pregnancy
Fever
Pharyngitis
Salmon coloured rash
Adenopathy
Hepatosplenomegaly
Lymphadenopathy
High Ferritin
Inflammatory arthritis
negative Rheumatoid and ANA

31
Q

Reiters syndrome

A

Reactive Arthritis - asymmetrical oligoarthriritis of lower limbs
Urtheritis
Conjunctivitis

32
Q

Serological marker indicating disease severity in Lupus

A
  • Low complement levels
  • dsDNA indicative of severity of renal disease

ANA does not indicate severity

33
Q

Serological marker of mixed connective tissue disorder

A

Anti - RNP

34
Q

Serological markers of Sjogrens

A

Anti-Ro
Anti- La

35
Q

Serological marker drug-induced lupus

A

Anti- Histone

36
Q

All serological markers of Lupus

A

ANA (Nuclear)
dsDNA (Homogenous)
Anti-histone - drug induced (homogenous)
Anti-Smith
Anti-Ro
Anti-lupus Anticoagulant
Anti-ribosomal P
Anti-beta-glycoprotein 1

37
Q

DISH - diffuse idiopathic skeletal hyperostosis

A

> 4 Vertebral ossification
50, Men, Diabetic
No involvement of SI joints
HLA-B27 negative

38
Q

Treatment of Ankylosing Spondylitis

A

Exercise
NSAIDs
Smoking cessation

If failed after 12 weeks -
Anti-TNF (do not slow radiological progression in AS, but do in psoriatic arthritis)
Anti-IL17- Secukinumab

Methotrexate has no effect in AS

39
Q

Pencil-in-cup XR appearance

A

Characteristic for psoriatic arthritis

40
Q

Behcets Syndrome

A

Systemic Vasculitis
Oral Ulcer > 3 times/1 year
Genital Ulcers
Pathergy (Inflammatory response to skin prick with a sterile needle)
Erythema Nodosum
Inflammatory arthriris
Uveitis
Elevated ESR
Occurs along “Silk Road” demographic

41
Q

Small vessel vasculitis associations with Hepatitis

A

Polyarteritis Nodosum - Hepatitis B
Cryoglobulinemic vasculitis - Hepatitis C

42
Q

Urate transporters

A

ABCG2 - excretion at kidneys and gut
URAT1 - reabsorption at kidneys

43
Q

Imaging findings of OA

A

Joint space narrowing
Subchondral cysts
Osetophytes
Sclerosis
Gull wing deformity of DIP

44
Q

Rheumatoid Arthritis HLA associations

A

HLA DRB1-04

45
Q

How does smoking increase RA risk?

A

Increased conversion arginine -> citrulline -> target for anti-CCP

46
Q

Stimulants for RA

A
  • Smoking
  • Periodontal infection via Porphyromonas Gingivalis
  • Gut bacteria

Convert Arginine to citrulline which up regulates Anti-CCP

47
Q

Mechanism of action of Leflunomide

A
  • Blocks DHODH which is required in pyrimidine synthesis
  • Reversed by Cholecystyramine if severe side effects of ILD or hepatitis
48
Q

Best TNF-inhibitor in pregnancy

A

Certolizumab

49
Q

Risk factors scleroderma renal crisis

A
  • Anti- RNA polymerase and Anti-topoisomerase (Scl-70)
  • Steroid use
  • Tendon Friction rub
  • Cyclosporins
50
Q

Most common ILD pattern in diffuse scleroderma

A

Non-specific interstitial pneumonia

50
Q

Most common ILD pattern in diffuse scleroderma

A

Non-specific interstitial pneumonia - diffuse

(RA = UIP, basal, AS = apical, Sjogrens = lymphoid)

51
Q

Treatment ILD associated with Scleroderma

A

Cyclophosphomide or Mycophenolate

52
Q

Nail change in psoriatic arthritis

A

Nail pitting/Onychodystrophy

53
Q

Jaccoud Arthropathy

A

Non-erosive arthritis as a result of recurrent joint inflammation from other forms of arthritis.
It is distinguished from RA because it is non-erosive and reversible

54
Q

Uric acid level targets in gout

A

< 0.3 if tophi
< 0.36 if no tophi

RACP (17 decks)

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