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Finals COPY (FdCi) > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

anti-dsDNA

A

SLE

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2
Q

anti-centromere

A

limited cutaneous systemic sclerosis

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3
Q

what is the cardiovascular risk of a patient with rheumatoid arthritis?

A

2-3 x higher than the normal population

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4
Q

what are the common causes of a monoarthritis?

A

crystal arthropathy

septic arthropathy

osteoarthritis

trauma (haemarthrosis)

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5
Q

what are the common causes of oligoarthropathy?

A

crystal arthritis

psoriatic arthritis

reactive arthritis

ankylosing spondylitis/osteoarthritis

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6
Q

what are the 7 clinical features common to all seronegative arthropathies

A
  1. seronegative (Rh negative)
  2. HLA B27 association
  3. axial arthritis (spine or sacroiliac joints)
  4. asymmetrical, large joint oligoarthritis
  5. enthesitis: inflammation at the site of tendon insertion to bone
  6. dactylitis: inflammation of an entire digit
  7. extra-articular manifestations: anterior uveitis, psoriaform rash, oral ulceration, aortic regurgitation and inflammatory bowel disease
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7
Q

what is the treatment of pseudogout in acute attacks?

what is the effective prevention for pseudogout?

A

similar to gout:

  • rest, elevation and ice packs
  • aspiration and intra-articular steroids
  • NSAIDs (+ PPI) and colchicine

prevention: methotrexate and hydroxychloroquine

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8
Q

anti-Ro / anti-La

AKA SSA/SSB

A

Sjogren (& SLE)

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9
Q

what are the nail changes associated with psoriatic arthritis?

how frequently do they occur?

A

in 80% of patients

  • onycholysis
  • nail pitting
  • subungual keratosis
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10
Q

what are the surgical options for the management of septic arthritis?

A

surgical arthrocentesis, washout and debridement

prosthetic septic arthritis should always be referred to the surgeons for consideration of replacing the prosthesis because medical therapy will not penetrate the joint space effectively

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11
Q

what is the global prevalence of osteoarthritis?

A

>10% of people >60 years old

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12
Q

what are are the radiographic features of osteoarthritis?

A

‘LOSS’

  • loss of joint space
  • osteophites
  • subarticular sclerosis
  • subchondral cysts
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13
Q

what are two pathognemonic feature of ank spond on plain film of the spine?

A

vertebral syndesmophytes

bamboo spine - calcification of spinal ligaments

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14
Q

what are some suitable biologic agents for the control of rheumatoid arthritis?

what must be checked before starting any of these biologics?

A
  • anti-TNF-alpha: infliximab
  • B-cell depletion: rituximab
  • IL-1 and IL-6 inhibition: tocilizumab
  • anti-T cell: abatacept

always a change to reactivate latent TB and hepatitis B, so all patients must be screened.

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15
Q

anti-Sm

A

SLE

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16
Q

what blood tests are best for monitoring SLE disease activity?

A
  1. anti-dsDNA titres
  2. c3 and c4
  3. ESR (clasically normal CRP though)

can also monitor BP, red cell casts in urine, urine protein

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17
Q

what tests should be run on a synovial fluid sample?

A

cytology - white cell count

micro - Gram stain and culture

biochem - polarised light microscopy

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18
Q

other than DMARDs and biologics, what is the management strategy for rheumatoid arthritis?

A
  • physiotherapy, exercise, OT and rehab
  • NSAIDs for breakthrough pain
  • steroids for acute flares, systemic > intra-articular
  • surgery: relieve pain and improve functioning (joint fusion), prevent deformity
  • managing cardiovascular and cerebrovascular risk factors
    • atherosclerotic process is sped up in RhA patients
  • smoking worsens symptoms of RhA, so encouraging them to stop
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19
Q

what are the extra-articular manifestations of rheumatoid arthritis?

A

nodules

  • elbows
  • lungs
  • heart
  • brain/meningies
  • lymphadenopathy

lungs

  • pleurisy
  • interstitial fibrosis

cardiac

  • ischaemic heart disease
  • pericarditis/pericardial effusion

eye

  • episcleritis
  • scleritis
  • keratoconjunctivitis sicca

other

  • splenomegaly (not always Felty syndrome)
    • RA, splenomegaly, neutropenia
  • osteoporosis
  • amyloidosis
  • anaemia of chronic disease
  • carpel tunnel syndrome
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20
Q

what are the common causes of polyarthritis?

A

symmetrical

  • rheumatoid arthritis
  • osteoarthritis

asymmetrical

  • reactive arthritis
  • psoriatic arthritis
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21
Q

what is the typical pattern of back pain experienced in ank spond?

A

low back pain that gradually gets worse throughout the night, peaks in the morning and gets better with exercise

pain radiates from the back to the buttocks/hips

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22
Q

how do you monitor disease activity in rheumatoid arthritis?

A

using the DAS28 score

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23
Q

palmo-plantar pustulosis is associated with what disease?

A

psoriatic arthritis

24
Q

what is a suitable choice of medication to control blood pressure in severe lupus nephritis flare?

A

ace-i

along with drugs to control the underlying disease process such as immunosuppression with high-dose steroids, MMF or cyclophosphamide

25
Q

how would you investigate dermatomyositis?

A
  • muscle enzymes (CK, aldolase, ALT, AST, LDH)
  • associated auto-antibodies (Anti-Jo1, anti-Mi2)
  • EMG - classic fibrilation potentials
  • muscle biopsy
  • MRI - muscle oedema
26
Q

anti-Scl70

A

diffuse cutaneous systemic sclerosis

27
Q

which is the most commonly affected joint by septic arthritis?

A

knee, in >50% of cases

28
Q

what are some differentials for proximal myopathy?

A

PMR

polymyositis, dermatomyositis

hypothyroidism

primary muscle disease (muscular dystrophy)

osteoarthritis (cervical spondylosis/shoulder OA)

spinal stenosis

29
Q

apart from the joints, what other features of rheumatoid arthritis are common in the hands?

A

(extensor) tenosynovitis and bursitis

extensor tendor nodularity or rupture

30
Q

what are some suitable DMARDs for rheumatoid arthritis?

what are their major side effects?

A

best control is usually achieved with a combination of

  • methotrexate (pulmonary and liver fibrosis, myelosuppression, teratogenic)
  • hydroxychloroquine - retinopathy, eye screening yearly
  • sulfasalazine - rash, oligospermia, oral ulcers, GI upset

other option

  • leflunomide - teratogenic (M & F), oral ulcers, hypertension, hepatotoxic
31
Q

what is the difference between NSAIDs and colchicine in the management of acute gout?

what patients are both CI? what is the next treatment option?

A

NSAIDs are preferred - but CI in many cases (GI, cardio, renal)

colchicine has a slower onset of action but still effective

CKD/renal disease - then use steroids (po, im, intra-articular)

32
Q

anti-RNP

A

mixed CTD

33
Q

what are the radiographic features of rheumatoid arthritis?

A

juxta-articular osteopenia

joint subluxation and loss of joint space

soft tissue swelling (better appreciated on USS)

erosions

34
Q

anti-histone

A

drug-induced SLE

35
Q

what are the features of gout arthropathy on plain radiograph?

A

periarticular erosions

soft tissue swelling (best appreciated on USS)

normal joint space (until late in disease course)

no evidence of sclerosis

36
Q

dermatomyositis is associated with?

A

is a paraneoplasitc phenomenon from a visceral organ solid tumour

investigate for

  • gastric CA (1/3rd patients)
  • lung
  • pancreas
  • ovarian
  • bowel
37
Q

what is the typical course of antimicrobials in septic arthritis?

A

typically 2 weeks IV as an inpatient, then 2-4 weeks oral when discharged

38
Q

how do you manage ank spond?

what are the biologic agents of use?

A
  • intense, specialist physio-led exercise program
  • Pain
    • NSAIDs
    • local steroid injections
  • biologics
    • TNF-alpha blocker = etanercept, adalimumab
  • surgery
    • hip replacement (if mobility is affected)
    • spinal-osteotomy (rarely)
  • osteoprotection with bisphosphonates
39
Q

what are the common causative organisms for septic arthritis?

A
  • N gonorrhoeae*
  • Staph. aureas*
  • Strep. pneumo*

Gram -ve bacilli

40
Q

what are some causes of secondary osteoarthritis?

A

obesity and occupation (kneeling, squatting, climbing, lifting)

haemochromatosis

41
Q

what are the signs of dermatomyositis?

A

heliotrope rash around the eyes with oedema

nail fold erythema

macular rash - ‘shawl sign’ when distributed over shoulders

Gottron’s papules over knuckles, elbows and knees

42
Q

beyond acute gout, what are the features of hyperuricaemia seen in long-term gout sufferers?

A

gouty tophi

interstitial nephritis

urate renal stones

43
Q

what are the signs of cauda equina compression?

A

alternating or bilateral lower limb pain

saddle (perianal anaesthesia)

urinary retention and faecal incontinence

erectile dysfunction

44
Q

why is it important to examine the spine of a rheumatoid arthritis patient?

A

atlanto-axial joint subluxation can threaten the cord

always check the C-spine

45
Q

risk factors for rheumatoid arthritis

A
  • smoking
  • F>M
  • 5th-6th decade of life
  • HLA DR4/DR1 genotype
46
Q

what are the features of reactive arthritis?

A
  • arthritis, enthesitis
  • keratoderma blenorrhagica
  • circinate balanitis
  • conjunctivitis/iritis
  • mouth ulcers
47
Q

anti-Jo-1, anti-Mi-2

A

polymyositis and dermatomyositis

48
Q

anti-phospholipid / anti-cardiolipin

A

antiphospholipid syndrome / SLE

49
Q

a high RF is associated with…

A

severe disease & extra-articular manifestations

50
Q

what are the clinical features of APLS?

A

‘CLOT’

  • coagulation defects (arterial and venous thrombosis)
  • livedo reticularis
  • obstetric (recurrent miscarriage)
  • thrombocytopenia
51
Q

what are some common agents precipitating drug-induced lupus?

A

procainamide, hydralazine

isoniazid, minocycline, phenytoin

52
Q

what are the associated features of ankylosing spondylitis?

A

the A’s of ank spond

  • anterior uveitis
  • achilles tendonitis
  • aortic regurgitation
  • apical fibrosis
  • AV nodal block
  • amyloidosis
  • and cauda equina
53
Q

which antibiotic is associated with achilles tendon disorders?

A

ciprofloxacin

54
Q

besides the skin, what are the other organ systems involved in systemic sclerosis?

which is the most important cause of mortality in these patients?

A
  • renal - malignant hypertension, glomerulonephritis
  • msk - arthritis, polymyositis
  • lung - pulmonary fibrosis, pleural effusions
  • heart - restrictive cardiomyopathy, pericarditis, pulmonary hypertension
  • gi - dysphagia, GORD, dysmotility, PBC

most common cause of death is renal failure

55
Q

what is the difference in features of limited and diffuse systemic sclerosis?

A

limited

invovles skin of the hand, face and maybe neck. renal crises rarely occur. late involvement of the lungs, manifesting as pulmonary hypertension.

diffuse

diffuse skin involvement, including trunk and proximal limbs. early involvement of the lungs, kidney, gut and heart.

56
Q

what are the features of APLS?

A

CLOTs

  • coagulation (venous and arterial)
  • livedo reticularis
  • obstetric (recurrent miscarriage)
  • thrombocytopenia

Finals COPY (FdCi) (10 decks)

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