Rheumatology Flashcards
(41 cards)
What are the hand findings in scleroderma?
Sclerodactyly
Raynaud’s phenomenon
Soft tissue atrophy
Calcinosis cutis
Nail dystrophy
Ulceration
Gangrene
Flexion deformities
Oedema
Telangiectasia
Vitiligo
Morphoea
Pigmentation
Pruritis
What are the musculoskeletal findings in scleroderma?
Arthritis
Myositis and myopathy
Intra-articular calcification
Osteopaenia
What are the gastrointestinal findings of scleroderma?
Dysphagia
GORD
Steatorrhoea and malabsorption due to SIBO
Pneumatosis coli
Diverticulosis
Primary biliary cirrhosis
Bowel obstruction
What are the renal findings of scleroderma?
Malignant hypertension
Glomerulonephritis
Scleroderma renal crisis
What are the respiratory findings of scleroderma?
Interstitial lung disease with basal predominance
Restrictive lung defects
Pleural effusions
Atelectasis
What are the cardiovascular findings of scleroderma?
Restrictive cardiomyopathy
Pericarditis
Pericardial effusion
Pulmonary hypertension
Conduction defects
What two arthropathies are typically DIP sparing?
Rheumatoid arthritis and SLE
What are the three eponymous deformities seen in rheumatic hands?
Swan neck - PIP hyperflexion with MCP/DIP extension
Boutonniere’s - PIP hyperextension with MCP/DIP flexion
Z deformity - Thumb IP joint flexion and MCP hyperextension
What are the differentials for rheumatoid nodules?
Gouty tophi
Cutaneous sarcoidosis
Granuloma annulare
Tendon xanthomata
What are the other manifestations of RA?
Shoulder, elbow, knee and foot involvement
Atlanto-axial subluxation leading to cervical myelopathy
Episcleritis, scleritis, cataracts, Sjogren’s syndrome, scleromalacia perforans
Anaemia
Pleural effusions, pulmonary fibrosis, bronchiectasis, Caplan’s syndrome
Pericarditis
Pyoderma gangrenosum
Felty’s syndrome, hepatosplenomegaly from secondary amyloidosis
Nephrotic syndrome
Mononeuritis multiplex, polyneuropathy
What are the diagnostic criteria for RA?
Morning stiffness >1 hour
Symmetrical joint involvement
>/3 joints affected
Involvement of the small joints of the hand
Positive rheumatoid factor
Rheumatoid nodules
Radiographic evidence
Where eligible, present for at least 6 weeks. At least four of the above needed.
What is rheumatoid factor?
IgM targeted against the Fc portion of IgG in 75% of RA patients
Also present in SLE and Sjogren’s, malignancy, chronic infection and 5% of the population
Seropositive RA is more aggressive with more extra-articular manifestations
What are the poor prognostic markers in RA?
Positive serology (anti-CCP or RF)
Early radiographic evidence of erosive disease
Impaired functional status
Persistently active synovitis
What are the general treatment principles in RA?
Patient education
Physiotherapy
Bone protection
Vaccination
Corticosteroids to induce remission
DMARDs (MTX first line for all RA)
Biologics (more rapid onset but higher cost, risk of TV and hepatosplenic T-cell lymphoma)
What are the five patterns of psoriatic arthritis?
Asymmetrical oligoarthritis with DIP predominance
Symmetrical polyarthritis with PIP/MCP predominance and DIP sparing (similar to RA)
DIP arthritis
Arthritis mutilans
Spondylitis +/- sacroiliitis
What are the three typical nail findings in psoriatic arthritis?
Nail pitting (correlates with disease activity)
Onycholysis
Transverse ridging
What are some examples of anti-TNFa therapy?
Infliximab, etanercept, adalimumab
What are the hallmark findings of ankylosing spondylitis?
Protuberant abdomen
Increased kyphosis
Decreased cervical movement
Decreased spinal movement with increased occiput to wall distance
Positive modified Schober’s test
Decreased chest expansion
What features are associated with ankylosing spondylitis?
Anterior uveitis
Aortic regurgitation and MVP
Atrioventricular conduction defects
Apical pulmonary fibrosis
Atlanto-axial subluxation
Achilles tendonitis
Amyloidosis
What are the sacroiliac joint changes in ankylosing spondylitis?
Loss of cortical outline
Juxta-articular osteosclerosis
Erosions
Joint ankylosis
What are the lumbar spine changes in ankylosing spondylitis?
Loss of lumbar lordosis
Vertebral squaring
Thoracolumbar syndesmophytes
Bamboo spine
Osteoporosis
Apophyseal joint fusion
What features suggest a mixed connective tissue disease?
Overlap features of rheumatoid arthritis, systemic sclerosis, dermatomyositis and SLE
What skin involvement is seen with SLE?
Butterfly rash with nasolabial sparing
Photosensitivity
Palmar erythema
Vasculitic lesions
Purpura
Urticaria
Livedo reticularis
Telangiectasia
Alopecia
Subcutaneous nodules
Raynaud’s phenomenon
What musculoskeletal involvement is seen with SLE?
Non-erosive polyarthritis of the MCPs, PIPs, wrists and knees
Jacoud’s arthropathy - Deforming non-erosive arthropathy of the MCPs due to subluxation
Splinter haemorrhages
Nailfold capillaries
Periungual infarcts
Avascular necrosis
