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Finals HH > Rheumatology > Flashcards

Rheumatology Flashcards

(93 cards)

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1
Q

Signs of OA in the hands?

A

Heberden’s nodes (DIP joints)
Bouchard’s nodes (PIP joints)
Squaring at base of the thumb

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2
Q

What is needed for Dx of OA without Ix? (4)

A

> 45
Activity related pain
No morning stiffness
No stiffness lasting less than 30mins

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3
Q

OA mx?

A
  1. Stepwise analgesia
    a) Oral paracetamol, Topical NSAIDs or topical capsaicin
    b) Oral NSAIDs + PPI
    c) Codeine & morphine
  2. Intra-articular steroid injections
  3. Joint replacement
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4
Q

Key x-ray changes in OA?

A

L - Loss of joint space
O - Osteophytes
S - Subchondral sclerosis
S - Subchondral cysts

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5
Q

Genes associated with RA & RF positive patients?

A

HLA DR1 (RA)
HLA DR4 (RF)

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6
Q

Antibodies in RA?

A

Anti-CCP (more sensitive and specific)
RF (70%)

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7
Q

Common joints in RA?

A

PIP and MCP
Wrist and ankle
Can affect larger but less likely

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8
Q

Hand joint and indicative arhtiritis?

A

DIP = OA
PIP = OA or RA
MCP = RA

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9
Q

Signs of RA in the hands?

A
  • Z shaped deformity to the thumb
  • Swan neck deformity
  • Boutonnieres deformity
  • Ulnar deviation of the fingers at the knuckle
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10
Q

Extra-articular manifestations of RA?

A
  • Pulmonary fibrosis
  • Bronchiolitis obliterans
  • Felty’ syndrome
  • Secondary Sjogren’s
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11
Q

What is the triad of felty’s syndrome?

A

RA, neutropenia and splenomegaly

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12
Q

Ix for rheumatoid arthritis?

A
  • RF
  • If RF -ve -> check anti-CCP
  • CRP & ESR
  • X-ray hands and feet

Ultrasound joints if needed to evaluate synovitis

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13
Q

RA x-ray changes?

A

Joint destruction and deformity
Soft tissue swelling
Periarticular osteopenia
Boney erosions

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14
Q

What scoring system is used to monitor RA?

A

DAS28

Assessment of 28 joints for swelling, tender and ESR.CRP result

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15
Q

RA mx?

A

Flare ups and bridging - steroids

DMARDS:
1. Hydroxychloroquine, methotrexate, leflunomide or sulfsalazine
2. Combination of two
3. Methotrexate + TNF inhibitor (infliximab)
4. Methotrexate + rituximab

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16
Q

Signs of psioratic arthritis?

A
  • Nail pitting
  • Onycholysis (nail separation from nail bed)
  • Dactylitis (finger inflammation)
  • Enthesitis (entheses inflammation - where tendons insert onto bones)
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17
Q

Psoriatic arthritis x-ray changes?

A

Pencil-in-cup appearance
Periostitis (thickened and irregular outline of bone)
Ankylosis (bones joining together -> stiffness)
Osteolysis

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18
Q

What is arthritis mutilans?

A

Severe form of psoriatic arthritis where there is osteolysis of bones around joints in digits -> shortened fingers

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19
Q

Mx of psoriatic arthritis?

A

NSAIDs for pain
DMARDS
Anti-TNF medications (etancercept, inflixmiad or adalimumab)
Ustekinumab is last line

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20
Q

Common infections which trigger reactive arthritis?

A

Gastroenteritis
STIs

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21
Q

Triad of reactive arthritis

A

Bilateral conjunctivitis, anterior uveietis
Balanitis
Arthritis

Can’t see, pee or climb

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22
Q

Emergency rheumatology conditions for prompt hospital admission?

A

Septic arthritis
Systemic vasculitis
Giant cell arteritis

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23
Q

Rheumatology conditions for urgent referral?

A

Rheumatoid arthritis
Psoriatic arthritis
Ankylosing spondylitis
Suspected CTD with systemic involvement

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24
Q

Rheumatology conditions for routine refferral?

A

Suspected CTD without systemic involvement
Polymyalgia rheumatica (PMR)
Crystal arthritis

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25
X-ray changes in AS?
Squaring of the vertebral bodies Subchondral sclerosis and erosions Ossification Joint fusion
26
Mx of AS?
1. NSAIDs 2. Anti-TNF (etanercept, infliximab, adalimumab) 3. Secukinumab Steroids during flares
27
Antibody in SLE?
Anti-nuclear antibodies (ANA) [85%, non-specific] Anti-dsDNA [70% but more specific]
28
Antibodies in systemic sclerosis?
Both - ANA Limited - anti-centromere antibodies Diffuse - anti-Scl-70
29
Antibodies associated with Sjogren's?
Anti-Ro Anti-La
30
Antibodies associated with polymyositis and dermatomyositis?
Anti-Jo-1 - polymyositis, sometimes dermatomyositis Anti-Mi-2 - dermatomyositis ANA - dermatomyositis
31
Mx of SLE?
First line: - NSAIDs - Steroids - Hydroxychloroquine Resistant lupus: - DMARDs Severe disease -> biologics - Rituximab - Belimumab
32
Limited systemic sclerosis px?
C - Calcinosis R - Raynaud's E - oEsophageal dysmotility S - sclerodactyl T - telangiectasia
33
Diffuse systemic sclerosis px?
CREST + systemic involvement: - Hypertension, coronary artery disease (CVD) - Pulmonary hypertension and pulmonary fibrosis (LUNG) - Glomerulonephritis, scleroderma renal crisis (kidneys)
34
Mx of Raynauds?
Nifedipine (CCB)
35
Polymyalgia rheumatica px?
Pain and stiffness in shoulders, pelvic girdle and neck
36
PMR Mx?
Prednisolone 15mg then gradually reduced + osteoporosis prevention (bisphosphonates, calcium and VitD) + gastric protection (PPI)
37
PMR Ix?
Dx is clinical, excluding other causes and +ve response to oral corticosteroids Request ESR, PV and CRP Exclude giant cell arteritis
38
Px of giant cell arteritis?
Severe unilateral headache Scalp tenderness when brushing hair Jaw claudication Blurred or double vision Associated symptoms - fever, myalgia, fatigue, weight loss, loss of appetitie, peripheral oedema
39
Dx of giant cell arteritis?
Clinical presentation Raised ESR Temporal artery biopsy -> multinucleated giant cells
40
Mx of giant cell arteritis?
Immediate steroids (prednisolone 40-60mg) - quick response Aspirin - decreases visual loss & strokes PPI
41
What are myositis, polymyositis and dermatomyositis?
Myositis is inflammation of the muscles Polymyositis is chronic inflammation of the muscles Dermatomyositis is inflammation of the skin and muscles
42
Ix in myositis?
Creatine kinase - is released in muscle inflammation, normally <300 in myositis >1000 indicates polymyositis / dermatomyositis
43
Causes of raised creatine kinase?
Rhabdomyolysis AKI M.I Statins Exercise
44
Common cancers which cause polymyositis / dermatomyositis?
Lung Breast Ovarian Gastric
45
Px of polymyositis?
Muscle pain, fatigue and weakness Bilaterally, proximal muscles Shoulder and pelvic girdle Develops over weeks
46
Dermatomyositis skin features?
Gottron lesions - scaly red knuckles, elbows and knees Photosensitive red rash on back, shoulders and neck Purple rash on face and eyelids Periorbital oedema Subcutaneous calcinosis
47
Definitive dx of polymyositis
Muscle biopsy
48
Mx of polymyositis / dermatomyositis?
Corticosteroids first line If steroids inadequate: - Immunosuppressants (azathioprine) - IV immunoglobulins - Biologics (infliximab, etanercept)
49
What are the anti-phospholipid antibodies?
Lupus anticoagulant Anticardiolipin antibodies Anti-beta-2 glycoprotein I antibodies
50
Antiphospholipid associations?
Venous thromboembolism Arterial thrombosis Recurrent miscarriage, pre-eclampsia Livedo reticularis (purple mottled rash) Endocarditis Thrombocytopenia
51
What is needed for dx of antiphospholipid syndrome?
Hx of thrombosis or pregnancy complications + persistent antibodies
52
Mx of antiphospholipid syndrome?
Long term warfarin If pregnant -> LMWH + aspirin
53
What is Sjogren's syndrome?
Autoimmune condition affecting exocrine glands -> dryness
54
Test for Sjogrens?
Schirmer test - filter paper under lower eyelid
55
Mx of Sjogrens?
Artificial tears Artificial saliva Vaginal lubricants Hydroxychloroquine
56
What is Henoch-Schonlein purpura?
IgA small vessel vasculitis commonly presenting with purpuric rash affecting lower limbs or buttocks in children. Triggered by an URTI or gastroenteritis
57
Features of HSP? (4)
Purpura (100%) Joint pain (75%) Abdo pain (50%) Renal involvement (50%)
58
Mx of HSP?
Supportive
59
What is the blood test for vasculitis?
Anti neutrophil cytoplasmic antibodies (ANCA)
60
What are p-ANCA (MPO antibodies) found in?
Microscopic polyangiitis Churg-Strauss syndrome / Eosinophilic Granulomatosis with Polyangiitis
61
What are c-ANCA (PR3 antibodies) found in?
Granlomatosis with polyangitiis
62
Young Asian woman with weak pulse in one arm?
Takayasu's arteritis
63
Hepatitis B positive vasculitis?
Polyarteritis nodosa
64
Bizarre asthma in adults vasculitis?
Chrug-Strauss syndrome / Eosinophilic granulomatosis with polyangiitis
65
Epistaxis, crusty nasal secretions, sinusitis, URTI, rapidly progressing glomerulonephritis vasculitis?
Wagner's granulomatosis / granulomatosis with polyangiitis
66
Behcet's disease px?
Recurrent oral and genital ulcers - Oral ulcers >3 year, they have a red halo - Genital ulcers often develop on two opposing surfaces facing each other (kissing ulcers)
67
What is the pathergy test?
Used in Ix of Behcet's disease Abrasion created to look for a wheal forming
68
Typical joints for gout?
Base of big toe (metatarsophalangeal joint) Wrists Base of thumb (carpometacarpal joints) Large joints - Knee and ankle
69
What causes gout?
Chronically high uric acid levels -> urate crystals deposited in joint
70
Dx of gout?
Aspiration of joint fluid showing: - Needle shaped crystals - Negatively birefringent of polarised light - Monosodium urate crystals
71
What would a joint x-ray of gout show?
Lytic lesions of bone Punched out erosions Joint space maintained
72
Gout Mx during a flare?
1. NSAIDs 2. Colchine 3. Steroids
73
Gout prophylaxis?
Allopurinol + lifestyle changes (lose weight, stay hydrated, less alcohol, less meat/seafood)
74
What causes pseudogout?
Calcium pyrophosphate crystals deposited in joint (chondrocalcinosis)
75
Common joints for pseudogout?
Knees Shoulders Wrists Hips Chronic condition and can affect multiple joints
76
Dx of pseudogout?
Aspiration of synovial fluid will show? - Calcium pyrophosphate crystals - Rhomboid shaped crystals - Positive birefringent of polarised light
77
What is seen on x-ray of pseudogout?
Chondrocalcinosis - thin white line in joint space showing calcium deposition + LOSS
78
Mx of pseudogout?
Self-limiting over several weeks Symptomatic mx: - NSAIDs - Colchine - Steroid injection - Oral steroids Severe -> joint washout
79
Medications which increase Rx of osteoporosis?
Steroids, SSRIs, PPIs, ant-epileptics and anti-oestrogens
80
Bone mineral density and T-score?
More than -1 = normal -1 to -2.5 = osteopenia Less than -2.5 = osteoporosis
81
Mx of osteoporosis?
Calcium + VitD + bisphosphonates If bisphosphonates contraindicated: - Denosumab - Strontium ranelate - HRT
82
Examples of bisphosphonates?
Alendronate (once weekly, oral) Risedronate (once weekly, oral) Zoledronic acid (one yearly, IV)
83
Bisphosphonate side effects?
Reflux and oesophageal erosions Atypical fractures Osteonecrosis of the jaw Osteonecrosis of the external auditory canal
84
What is osteoporosis and osteopenia?
Osteoporosis is when there is a reduction in the density of bones Osteopenia is a less severe reduction in bone density
85
What is osteomalacia?
This is when there is defective bone mineralisation causing "soft" bones. Due to inadequte VitD.
86
Mx for osteomalacia?
VitD supplements (colecalciferol)
87
What is Paget's disease?
Excessive bone turnover due to excessive activity of osteoblasts and osteoclasts -> patches of sclerosis and lysis Causes enlarged, misshaped bones
88
X-ray findings of Paget's disease?
Bone enlargement and deformity Well defined osteolytic lesions Cotton wool appearance of the skull V-shaped defects in long bones
89
Mx of Paget's disease?
Bisphosphonates + calcium & VitD + NSAIDs for bone pain Monitor ALP
90
Two key complications of Paget's disease?
Osteosarcoma Spinal stenosis and spinal cord compression (Dx - MRI)
91
Side effects of methotrexate? (5)
Bone marrow suppression & leukopenia Liver toxicity Pneumonitis Mouth ulcers and mucositis Highly teratogenic
92
Side effects of sulfasalazine? (2)
Male infertility Bone marrow suppression
93
Side effects of hydroxychloroquine? (4)
Reduced visual acuity Nightmares Liver toxicity Skin pigmentation

Finals HH (21 decks)

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