Rheumatology

Question 1

Middle aged woman visits her GO with recurrent nose bleeds, nose-saddling(dipping of the shape of the nose), anaemia, haematuria, proteinuria, and elevated creatinine. What is the most likely diagnosis?

Answer 1

Granulomatosis with polyangitis (formerly Wegener’s)

c-ANCAs, biopsy of affected organs showing necrotising granulomas and vasculitis, and imaging are used to aid diagnosis.

Question 2

23- year old man who is a known smoker with mild asthma was referred to AMU with rapidly increasing SOB and haemoptysis for the second time in 3 weeks. Urinalysis reveals microscopic haematuria and proteinuria. Creatinine=345, HB=105g/L, serum ANCA=negative. CXR=fluffy pulmonary infiltrates. What is the diagnosis?

Answer 2

Antiglomerular base membrane(GBM) disease.

Male:Female=6:1. Accounts for 5% of rapidly progressive glomerulonephritis. This disease is characterised by the triad of glomerulonephritis, pulmonary haemorrhage, and anti-GBM antibody. 80% are HLA-DR2 positive.

Question 3

48 year old woman presents with Raynaud’s phenomenon, sclerodactyly, calcinosis, and telangiectasiae. There is also loss of fine-touch sensation and bilateral hearing loss. What is the diagnosis?

Answer 3

Systemic sclerosis.

There is often renal impairment and hypertension seen in this condition. 20-40% have some degree of hearing loss; reflux oesophagitis may also be seen.

Question 4

30-year old man being managed for anterior uveitis presents with orogenital ulceration, erythema nodosum, diarrhoea, and raised CRP. What is the most likely diagnosis?

Answer 4

Behçet’s syndrome

Question 5

Middle aged man presents with proximal weakness, joint pain, nail fold haemorrhages, signs of interstitial lung disease(cough, CXR-diffuse reticular infiltrates, restrictive lung function), and raised creatinine kinase. What is the diagnosis?

Answer 5

Polymyositis.