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Flashcards in Rheumatology Deck (56):
1

Is gout more common in M of F

Men

2

Causes of hyperuricaemia?

psoriasis, haemolytic disorders, alcohol, purine intake

3

treatment of acute gout

NSAIDs/colchicine
corticosteroids
opiod analgesics

4

treatment of chronic gout

allopurinol (febuxostat if can't tolerate allopurinol i.e. renal impairment)

5

What is calcium pyrophosphate deposition disease related to? who gets it? where does it affect? treatment?

related to OA
elderly get it
affects knee, wrist and ankle
treatment = NSAIDS, colchicine, steroids, rehydration

6

What is chondrocalcinosis?

calcium pyrophosphate deposition in cartilage/soft tissues without inflammation

7

What is scleroderma?

excessive fibrosis of organs and tissues

8

What is scleroderma associated with?

CREST
- calcinosis
- Raynauds
- oEsophageal dysfunction
- sclerodactyly
- telangiectasia

9

Limited scleroderma
- which antibody
- where is skin involvement
- organ involvement early or late

anti centromere antibody
skin: face, hands, forearms, feet

10

Diffuse scleroderma
- which antibody
- where is skin involvement
- organ involvement early or late

anti scl 70 antibody
skin: trunk
early significant organ involvement

11

Environmental factors in SLE?

UV light
silica dust
viruses e.g. EBV

12

SLE - which type of hypersensitivity?

type 3

13

type of endocarditis assoc with SLE

Libman Sachs

14

Antibodies in SLE

anti ds DNA = specific
ANA - +ve but not specific
anti sm - specific but low sensitivity

15

high or low c3/c4 in active SLE?

low

16

SLE
treatment for skin disease & arthralgia
treatment in severe organ disease
treatment in unresponsive disease

skin disease & arthralgia: hydroxychloroquine, topical steroids, NSAIDs
severe organ disease: cyclophosphamide + IV steroids
unresponsive: Iv immunoglobulin + rituximab

17

Antibodies in anti phospholipid syndrome?

anti cardiolipin
anti beta 2 glycoprotein

18

features of anti phospholipid syndrome

i.e. skin appearance? condition of veins? etc

foetal loss
recurrent thrombosis
superficial thrombophlebitis
migranes
livedo reticular

19

mainstay treatment of APS?

anti coagulation
LMWH during pregnancy! warfarin = teratogenic

20

Sjogrens
symptoms?
increased risk of what?
antibodies?
test?
treatment?

dry mouth, dry eyes
(also: arthralgia, vaginal dryness, fatigue, parotid gland swelling, ILD, neuropathy)
increased risk of lymphoma
anti RO and LA
schrimmers test
tx = eye drops, saliva replacement (pilocarpine), regular dental care because ^ risk of caries, hydroxychloroquine for arthralgia and fatigue

21

Side effect of pilocarpine?

flushing

22

Symptoms of IPEX syndrome

v early onset DM
severe malabsorption syndrome
severe infections
eczema
autoimmune thyroid disease, haemolytic anaemia

23

mutation that causes IPEX syndrome?

FOXP3

24

is being male or being female a poor prognosic indicator for RA?

male

25

Lung problems associated with RA

bronchiectasis
pulmonary fibrosis
pleural effusions
pulmonary nodules

26

Specific antibody for RA?

ANTI CCP

27

treatment of RA?

DMARD within 3 months of symptom onset and steroid to cover lag phase
biologics e.g. anti tnf (infliximab, adalimumab) if unresponsive

28

Antibody associated with mixed connective tissue disease?

Anti RNP

29

Signs of dermatomyositis

Gottrons sign - red + scaly over MCP and PIP
heliotrope rash - red over eyelids
shawl sign - red over back of neck and in v down front of chest

30

antibodies associated with polymyositis?

anti jo
anti srp

31

how does polymyositis affect the muscles?

symmetrical proximal muscle weakness

32

treatment of polymyositis?

prednisolone
immunosuppression (MTX)

33

what is there risk of in poly and demo - myositis?

malignancy! (9% in poly; 15% in dermato)

34

Pattern of muscle weakness in inclusion body myositis?

distal muscle weakness

35

inclusion body myositis - more common in males or females?

males

36

Relationship between PMR and GCA?

50% of people with GCA have PMR
15% of people with PMR develop GCA

37

Characteristics of PMR?

early morning stiffness + pain
usually symmetrical
shoulder girdle and hip
muscle power NORMAL
seen almost exclusively in over 50s

38

what does PRM respond dramatically to?

low dose steroids

39

what 2 inflammatory conditions is fibromyalgia associated with?

seen in 50% of SLE and 25% of RA

40

Enteropathic arthritis
- what is it associated with
- how is it treated?

associated with IBD
DONT GIVE NSAIDS - may exacerbate IBD
treat the IBD!
paracetamol, cododamol
steroids
DMARDs
Anti TNF

41

Reactive arthritis -- Reiter's
what is the classic triad?
what infections commonly predispose it?
treatment

classic triad
- urethritis, uveitis, arthritis
"can't see, can't pee, can't climb a tree"
infections: chlamydia, neisseria, salmonella, campylobacter
tx:
90% resolve spontaneously in 6 months
NSAIDs
corticosteroids
AB for underlying infection
DMARDs if resistant/chronic

42

what type of arthritis are psoriatic, enteropathic and reactive usually?

reactive = asymmetric MONOarthritis

psoriatic and enteropathic = asymmetric OLIGOarthritis

43

X-ray signs of psoriatic arthritis

marginal erosions and whispering
pencil in cup deformity
osteolysis

44

what is the hallmark of ank spond?

sacroiliitis

45

ank spond more common in M or F?

Men

46

Ank spond = the 'A' disease, what are the 'A's?

Axial arthritis
Aortic regurgitation
Anterior uveitis
Apical fibrosis
Amyloidosis
Achilles tendonitis
plAntar fasciitis

47

Which HLA is and spond assoc with

HLA B27

48

1st line treatment for ank spond
whats the tx if there is peripheral joint involvement?

NSAIDs
DMARDs only if peripheral joint involvement

49

what neuro condition is GPA associated with?

mononeuritis multiplex

50

GPA - which type of ANCA?

cANCA

51

EGPA and MPA - which type of ANCA?

pANCA

52

What is seen in 90% of patients with microscopic polyangitis (MPA)?

glomerulonephritis

53

main treatment of large vessel vasculitis?

corticosteroids

54

What immunoglobulin mediates Henoch-Schonlein Purpura?

IgA

55

what do over 75% of kids with Henoch-Schonlein Purport have beforehand?

URTI, pharyngeal infection or GI infection
GAS is most common

56

What is it essential to check in HSP?

urinalysis because there's renal involvement in 50%