Rheumatology (2)

Question 1

Simply, what’s myositis and dermatomyositis

Answer 1

Striated muscle inflammation

(striated muscle in cardiac and skeletal muscles)

Question 2

General features of polymyositis and dermatomyositis

Answer 2

Progressive symmetrical proximal muscle weakness

• Wasting of the shoulder and pelvic girdle
• Dysphagia, dysphonia, respiratory weakness

Myalgia and arthralgia

Often a paraneoplastic phenomenon

-Lung, pancreas, ovarian, bowel cancers

Question 3

Simply, what’s dermatomyositis

Answer 3

Dermatomyositis = myositis + skin signs

Question 4

Presentaiton of dermatomyositis

Answer 4

Dermatomyositis = myositis + skin signs

• Heliotrope rash (redish/purple rash) on eyelids ± oedema
• Macular rash (shawl sign +ve: over back and shoulders)
• Nailfold erythema
• Gottron’s papules: knuckles, elbows, knees
• Mechanics hands: painful, rough skin cracking of fingertips
• Retinopathy: haemorrhages and cotton wool spots
• Subcutaneous calcifications

Question 5

Extra-muscular features of dermatomyositis and myositis

Answer 5

• Fever
• Arthritis
• Bibasal pulmonary fibrosis
• Raynaud’s phenomenon
• Myocardial involvement: myocarditis, arrhythmias

Question 7

Ix for myositis/dermatomyositis

Answer 7

• Muscle enzymes: ↑CK, ↑AST, ↑ALT, ↑LDH
• Antibodies: Anti-Jo1 (associated with extra-muscular features)
• EMG
• Muscle biopsy
• Screen for malignancy

​- Tumour markers

• CXR
• Mammogram
• Pelvic/abdo US
• CT

Question 8

Management of dermatomyositis/myositis

Answer 8

• Screen for malignancy
• Immunosuppression
• Steroids
• Cytotoxics: azathioprine, methotrexate

Question 9

What’s another name for Sjorgen’s syndrome?

Answer 9

Sjogren’s Syndrome = Keratoconjunctivitis Sicca

Question 10

Classification of Sjorgen’s syndrome (2)

Answer 10

• ↓ tear production → dry eyes
• ↓ salivation → xerostomia
• Bilateral parotid swelling
• Vaginal dryness → dyspareunia
• Systemic
• Polyarthritis
• Raynaud’s
• Bibasal pulmonary fibrosis
• Vasculitis
• Myositis

Question 11

Diseases associated with Sjorgen’s syndrome

Answer 11

• Autoimmune disease: thyroid disease, autoimmune haemolytic anaemia, PBC
• Marginal zone MALT lymphoma

Question 12

Ix of Sjorgen’s syndrome

Answer 12

• Schirmer tear test
• Antibodies: ANA – Ro and La, RF
• Hypergammaglobulinaemia
• Parotid biopsy

Question 13

Management of Sjorgen’s syndrome

Answer 13

• Artificial tears
• Saliva replacement solutions
• NSAIDs and hydroxychloroquine for arthralgia
• Immunosuppression for severe systemic disease

Question 14

Examples of large vessel vasculitis (2)

Answer 14

Large Vessel

• Giant Cell Arteritis
• Takayasu’s Arteritis

Question 15

Examples of medium vessel vasculitis

Answer 15

Medium Vessel

• Polyarteritis Nodosa
• Kawasaki Disease

Question 16

Examples of small vessel pANCA vasculitis (2)

Answer 16

pANCA

• Churg-Straus
• Microscopic Polyangiitis

Question 17

Example of small vessel cANCA vasculitis (1)

Answer 17

cANCA: Wegener’s Granulomatosis

Question 18

Examples of small vessel ANCA -ve vasculitis (4)

Answer 18

ANCA –ve

• Henoch-Schonlein Purpura
• Goodpasture’s Disease
• Cryoglobulinaemia
• Cutaneous Leukocytoclastic Vasculitis

Question 19

Another name for Giant CellArteritis

Answer 19

Temporal arteritis